Racial Disparities in Guideline-Concordant Care in Early-Onset Colorectal Cancer in the United States

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In a study reported in the Journal of Clinical Oncology, Nogueira et al found that among U.S. Black and White patients with early-onset colorectal cancer, Black patients were more likely to receive poorer and less timely care.

As stated by the investigators: “Young individuals racialized as Black are more likely to die after a colorectal cancer diagnosis than individuals racialized as White in the United States.”

Study Details

The study involved data from the National Cancer Database on patients aged 18 to 49 who self-identified as non-Hispanic Black or non-Hispanic White and who were newly diagnosed with colorectal cancer between 2004 and 2019. Patients who received recommended care—staging, surgery, lymph node evaluation, chemotherapy, and radiotherapy—were considered to have received guideline-concordant care.

Key Findings

Among 84,882 patients with colon cancer, 17,672 (20.8%) were Black. Among 62,573 patients with rectal cancer, 9,063 (14.5%) were Black.

Black patients were more likely not to receive guideline-concordant care for both colon cancer (36.6% vs 32.9%, adjusted odds ratio [OR] = 1.18, 95% confidence interval [CI] = 1.14–1.22) and rectal cancer (62.3% vs 56.5%, adjusted OR = 1.27, 95% CI = 1.21–1.33).

Health insurance coverage type was a major mediator of discrepancy. For example, private insurance was held by 77.0% of White patients and 59.2% of Black patients with colon cancer and 78.3% vs 58.7% of those with rectal cancer. If Black patients had the same overall distribution of health insurance coverage as White patients, racial disparities in receipt of guideline-concordant care could be reduced by 1.03 percentage points (28.2% of the disparity) for colon cancer  and by 1.25 percentage points (21.6% of the disparity) for rectal cancer.

Black patients experienced an increased time to adjuvant chemotherapy for colon cancer (hazard ratio [HR] = 1.28, 95% CI = 1.24–1.32), neoadjuvant chemoradiation therapy for rectal cancer (HR = 1.42, 95% CI = 1.37–1.47), and neoadjuvant chemotherapy (HR = 1.43, 95% CI = 1.38–1.49) and radiotherapy (HR = 1.23, 95% CI = 1.18–1.28) for rectal cancer. Among patients who started radiation therapy for rectal cancer, Black patients had a longer time to completion of radiotherapy (HR = 1.19, 95% CI = 1.13–1.25).

The investigators concluded: “Patients with early-onset [colorectal cancer] racialized as Black receive worse and less timely care than individuals racialized as White. Health insurance, a modifiable factor, was the largest contributor to racial disparities in receipt of guideline-concordant care in this study.”

Leticia M. Nogueira, PhD, MPH, of the American Cancer Society, Atlanta, is the corresponding author of the Journal of Clinical Oncology article.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.