August 11, 2025
2 min read
Key takeaways:
- Black individuals face higher CRC risk and mortality rates compared with white individuals.
- Improving screening and care access could help eliminate these disparities.
Black communities often experience systemic barriers to care, leading to disparities in colorectal cancer outcomes, according to a review published in Nature Reviews Gastroenterology & Hepatology.
“Our review looked at why we continue to have persistent Black-white disparities in colorectal cancer in the U.S., despite overall declines in incidence and mortality,” Folasade P. May, MD, PhD, MPhil, associate professor at David Geffen School of Medicine and associate director of UCLA Kaiser Permanente Center for Health Equity, told Healio.
May and colleagues examined data from the Surveillance, Epidemiology and End Results program and National Cancer Institute to determine cancer incidence and morbidity rates. These rates were age-adjusted and analyzed for differences in race and state.
CRC incidence was approximately 20% higher in Black individuals compared with white individuals, while CRC survival was about 30% lower.
The review also highlighted obesity prevalen among 49.6% of Black individuals compared with 41.1% of white individuals, and type 2 diabetes among 9.6% vs. 7.3%, respectively.
More than half (60.4%) of Black individuals experience vitamin D deficiency vs. 14.7% of white individuals.
Historically, CRC cancer screening rates were lower among Black individuals, with only 12% to 15% of reporting receiving screening in 1987, compared with 24% to 26% of white individuals. While targeted programs have helped narrow that gap, Black individuals are more likely to utilize less-sensitive screening tools such as fecal immunochemical tests, rather than colonoscopy.
“Black-white differences are not biologic — they are due to differences in social determinants of health and access to care, and unequal access to screening, timely diagnosis, high-quality treatment and follow-up care,” May said.
Barriers to screening are often multifaceted and range from patient- and provider-related factors to health-system and policy-related ones, the authors noted.
First, lower awareness of personal risk has been observed with misinformation, lower health literacy and more medical mistrust often being prevalent in Black communities.
Second, systemic barriers such as lack of insurance, inability to take time from work, and lack of transportation and childcare also contribute to lower screening rates in underserved communities.
“There are proven interventions that reduce these disparities — things like patient navigation programs, community-based outreach and removing cost or logistical barriers to screening,” May told Healio. “The problem is that these approaches haven’t been implemented at scale or sustained equitably across health care systems or regions in the U.S.”
May and colleagues reiterate the need to prioritize access to care, infrastructure and accountability to increase screening rates, leading to prevention and earlier CRC detection.
“Ultimately, reducing CRC disparities isn’t just about recommending a colonoscopy or stool-based screening test — it’s about making sure patients can realistically complete that screening and access follow-up care if needed,” May added.
For more information:
Folasade P. May, MD, PhD, MPhil, can be reached at fmay@mednet.ucla.edu.
Sources/Disclosures
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Disclosures:
May reports consulting/advisory roles with Exact Sciences, Freenome, Geneoscopy, Guardant Health, InterVenn, Medtronic and Natera. Please see the study for all other author’s relevant financial disclosures.
