The impact of preventive screening resource distribution on geographic and population based disparities in colorectal cancer in Mississippi

October 10, 2021, Crawford and O brein

Based on worldwide GLOBOCAN estimates ,there were an estimated 1.4 million diagnosed cases of colorectal cancer (CRC) and 693,900 CRC-attributable deaths in 2012. However, there are significant disparities in both incidence and mortality rates throughout the world. The increasing incidence in some Eastern European and Asian nations is believed to reflect changes in preventable CRC risk factors whereas decreasing mortality rates are generally occurring in high-resource nations which offer preventive screening and advanced treatment to their population. In anticipation of future global trends where colorectal cancer incidence is expected to rise coincidently with increasing prevalence of obesity and tobacco smoking, this manuscript will explore a microcosm of preventive screening resource distribution effects on geographic and population-based disparities set in the context of a relatively lower-resource state in a very high-resource nation. These insights may prove useful to the design and implementation of colorectal cancer screening programs .

CRC is the third-leading cause of cancer death in men and in women in the United States and the second-leading overall cause of cancer deaths in all Americans . In addition to its human toll, CRC imposes a tremendous economic burden; costs of CRC care are estimated at $14.14 billion for the year 2010, second only to breast cancer care . As a disease affecting a significant proportion of the working population, the cumulative lost economic productivity associated with readily-avoidable CRC deaths will amount to as much as $33.9 billion by the year 2020.

Colorectal cancer is highly preventable, as demonstrated by the landmark National Polyp Study which established that colonoscopic polypectomy reduces the incidence of colorectal cancer. A follow-up study indicated that colonoscopy-guided removal of adenomatous polyps reduces death from colorectal cancer by 53 %. Between 1990 and 2007, CRC mortality rates significantly decreased in all states except Mississippi Colonoscopy, and the state-by-state decline in CRC mortality rates correlates with CRC screening compliance .Based on data from the National Program of Cancer Registries (NPCR) for the year 2011, the US Centers for Disease Control and Prevention (CDC) listed Mississippi as the state with the highest CRC mortality rate for men and women of all races.The majority of gastrointestinal cancers have higher incidence rates in counties within the Mississippi Delta, one of the poorest and unhealthiest regions within the United States, than in non-Delta counties of Mississippi.

It has been projected that CRC mortality in the USA could be reduced by 50 % with currently available interventions , and deliberate public health action is being implemented in selected states to accomplish this goal. If the benefits of this national effort are to extend into Mississippi, one must first assess the CRC situation of this state. Approximately 37 % of Mississippians are of African ancestry, and regardless of the data source, numerous studies confirm worse CRC mortality rates prevail in African-Americans than in European-Americans .Mississippi is a predominantly rural state with relatively low population densities, and studies in Utah, a state with even lower population densities, show that rural residents are less likely to be compliant with CRC screening than their urban counterparts ,However, the CDC lists Utah as the state with the lowest CRC incidence and mortality rates, so any obstacles imposed by a state’s rural nature are clearly surmountable. As of 2010,


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