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Effect of Race on Colon Cancer Treatment and Outcomes in the Department of Defense Healthcare System

Hofmann, Luke J. D.O.; Lee, Sukhyung M.D.; Waddell, Brad M.D.; Davis, Kurt G. M.D.

Diseases of the Colon & Rectum: January 2010 - Volume 53 - Issue 1 - p 9-15
doi: 10.1007/DCR.0b013e3181bdcdb2
Original Contribution

PURPOSE: The increase in mortality noted in African Americans with colon cancer is attributed to advanced stage at presentation and disparities in treatment received. The aim of this study was to assess the influence of race on the treatments and survival of colon cancer patients in an equal-access healthcare system.

METHODS: This retrospective cohort study included African American and white patients with colon cancer treated at Department of Defense facilities. Disease stage, surgery performed, chemotherapy used, and overall survival were evaluated.

RESULTS: Of the 6958 colon cancer patients identified, 1115 were African American. African Americans presented more frequently with stage IV disease, 23% vs 17% for whites (P < .001). There was no difference in surgical resection rates for African American or whites (85.8% vs 85.5%, respectively; χ2, P > .05). There was no difference in the use of systemic chemotherapy for stage III colon cancer (73.5% for African Americans vs 72.2% for whites; χ2, P > .05) or stage IV colon cancer (56.3% for African Americans vs 54.4% for whites; χ2, P > .05). The overall 5-year survival rate was similar for African American and white patients (56.1% vs 58.5%, respectively; log-rank, P > .05). After adjusting for gender, age, tumor grade, and stage, African American race was not a risk factor for survival in Cox proportional hazard analysis (hazard ratio, 0.981; 95% confidence interval, 0.888–1.084).

CONCLUSIONS: In an equal-access healthcare system, African American race is not associated with an increase in mortality. African American patients undergo surgery and chemotherapy is administered at rates equal to whites for all stages of colon cancer.

Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas

The views expressed in this manuscript are those of the author(s) and do not reflect the official policy of William Beaumont Army Medical Center, the Department of the Army, the Department of Defense, or the U.S. Government.

Presented at the meeting of The American Society of Colon and Rectal Surgeons, Hollywood, Florida, May 2 to 6, 2009.

Correspondence: Luke J. Hofmann, D.O., Department of Surgery, William Beaumont Army Medical Center, 5005 N. Piedras St, El Paso, TX 79920. E-mail:

© The ASCRS 2010