The incidence rates of colorectal cancer in men and women in Connecticut (46.9 and 35.6 per 100,000, respectively) are comparable to the national rates. Colorectal cancer incidence rates in Connecticut have been falling in both males and females; comparable declines have been observed nationally. (5) However, as with other cancer sites, patterns differ by sex and race and ethnicity. Incidence rates in women are lower than those seen in men for each racial or ethnic group.
Differences in incidence rates may be due to difference in screening rates, differences in genetic factors, environmental or lifestyle factors and socioeconomic disparities.(17,18) Some studies have indicated that the specific sub-site location of the colorectal tumor also varies with race and ethnicity, with the proportion of cancers proximal to the sigmoid colon or splenic flexure (subsites accessible by colonoscopy but not always reached during sigmoidoscopy) higher in blacks than whites. It has been suggested that screening practices contribute to this disparity. (19, 20)
Colorectal cancer mortality rates in Connecticut men and women, 1975-2010.
The colorectal cancer mortality rates in Connecticut, 15.0 per 100,000 in men and 10.7 per 100,000 in women, are lower than the national rates. Racial disparities in colorectal cancer mortality are observed nationally and in Connecticut.
The reasons for the higher death rate in blacks are complex; variations in access to screening and quality treatment have been implicated. (21, 22) When barriers to these differences are removed, the disparities are much reduced. (23, 24) In addition, proximal tumors have been shown to have poorer outcomes (25) and these tumors are diagnosed in a higher proportion in blacks. (19, 20) A recent study confirms the effectiveness of colonoscopy, a screening modality of increasing popularity, in reducing colorectal cancer mortality. (26) Continuing efforts to further increase compliance with colorectal cancer screening will likely lead to a further decline in colorectal cancer incidence and mortality.
Colorectal cancer incidence rates in Connecticut men and women, 1975-2010.
As has been observed nationally, disparities in five-year relative survival from colorectal cancer were observed in men and women in Connecticut diagnosed in 2001 to 2007. The survival rates in black men and women were 61.3 percent and 61.2 percent, respectively, compared with 69.1 percent and 66.5 percent in white men and women. This survival disparity has been the subject of considerable research. Findings indicate that multiple factors contribute to this survival disparity, including differences in screening, access to care (screening and treatment), socioeconomic status, physiological factors (BMI, comorbidity) and tumor characteristics. A concerted effort is required to further delineate and address the causes of this inequity.
Colorectal cancer is the third most commonly diagnosed cancer in men and in women in Connecticut. In 2013, a projected 1,670 Connecticut residents will be diagnosed with colorectal cancer and 470 people are projected to die of the disease. (6)