Addressing disparities in colorectal cancer burden: how far could equal health care access bring us?
Addressing disparities in colorectal cancer burden: how far could equal health care access bring us?
复制标题
解决结直肠癌负担的差异：平等的医疗保健服务能让我们走多远？
DOI：
10.1158/1055-9965.epi-12-0287
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Pignone,MichaelP
中科院分区：
文献类型：
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作者：
Reuland,DanielS;Pignone,MichaelP
人们对结直肠癌(CRC)预防、早期发现和治疗方面的科学进步的热情仍然受到清醒认识的影响，即美国在CRC筛查、发病率和死亡率方面存在种族和民族差异。根据NCI的监测、流行病学和最终结果(SEER)计划2004-2008年的数据，黑人的结直肠癌发病率大约比白人高24%，黑人的结直肠癌死亡率比白人高49%(1)。导致种族和民族之间癌症负担不平等的原因网络很复杂，包括社会经济、环境、行为和遗传因素(2)。然而，确定造成差异的可补救因素的研究可以指出可行的解决方案，并阐明需要更多研究的领域。对观察到的儿童权利差距进行划分，以澄清疾病负担的差异可能在多大程度上有助于改善保健服务，这有助于我们了解促进弱势群体获得系统筛查和及时适当治疗的政策干预措施如何能够减少儿童权利委员会的差异，减轻儿童权利委员会的整体负担。Lansdorp-Vogelaar及其同事在本期《癌症流行病学、生物标记物和预防》上的这项研究试图估计反映医疗保健可获得性的因素，而不是没有直接受到癌症筛查和治疗影响的因素(例如，肥胖、缺乏运动、肉类消费、吸烟、遗传因素)在多大程度上可以解释CRC负担的种族差异(3)。研究人员使用经过充分验证的MISCAN-Colon模型来解决以下具体问题：(I)如果以相同的比率对黑人和白人进行筛查(即，如果1975年至2007年期间对黑人和白人的筛查模式相同)，2007年结直肠癌发病率和死亡率中的黑人和白人差距将减少多少？(Ii)如果黑人和白人接受同样有效的癌症治疗(使用特定阶段的生存率)，2007年结直肠癌死亡率的黑人和白人差距将减少多少
Enthusiasm over scientific progress in prevention, early detection, and treatment of colorectal cancer (CRC) remains tempered by the sobering recognition that racial and ethnic disparities in CRC screening, incidence, and mortality exist in the United States. According to 2004–2008 data from the NCI’s Surveillance, Epidemiology and End Results (SEER) Program, the incidence of CRC is approximately 24% higher in blacks than in whites and mortality from CRC is 49% higher in blacks than whites (1).The causal web leading to unequal cancer burden across racial and ethnic groups is complex and includes socioeconomic, environmental, behavioral, and genetic factors (2). Nevertheless, research that identifies remediable factors responsible for disparities can point to actionable solutions and illuminate areas in need of more research. Partitioning the observed CRC disparities in a way that clarifies the extent to which differences in disease burden may be amenable to improvement in health care access is useful in that it allows us to understand how policy interventions promoting access to systematic screening and timely and appropriate treatment in vulnerable populations could reduce disparities in CRC and lessen the burden of CRC overall. The study by Lansdorp-Vogelaar and colleagues in this issue of Cancer Epidemiology, Biomarkers & Prevention seeks to estimate the degree to which factors that reflect health care access, as opposed to factors that are not directly affected by having access to cancer screening and treatment (eg, obesity, physical inactivity, meat consumption, smoking, genetic factors), can explain racial disparities in CRC burden (3). The investigators use the well-validated MISCAN-Colon model to address the following specific questions:(i) How much would the 2007 black-white disparity in CRC incidence and mortality be reduced if blacks and whites had been screened at the same rates (ie, if the screening pattern for blacks was the same as for whites during the years 1975–2007)?(ii) How much would the 2007 black-white disparity in CRC mortality be reduced if blacks and whites had received equally effective cancer treatment (using stage-specific survival as a