Preventive screenings can help take 'emergency' out of colorectal cancer

Almost one in every three patients with colorectal cancer is diagnosed in an emergency setting, with African-Americans and those living in high-poverty areas the most likely, according to new data presented in late October.

Dr. Sandi L. Pruitt, a clinical sciences specialist in medical outcomes and health services delivery research, and her UT Southwestern Medical Center colleagues evaluated national disparities in emergency colorectal cancer presentation using Medicare statistics from 1992 to 2005 of U.S. adults older than 65 with invasive colorectal cancer.

“Overall, we found that there are high rates of emergency presentation of colorectal cancer in the United States,” says Dr. Pruitt, a member of the Harold C. Simmons Comprehensive Cancer Center faculty. “These high rates of emergencies indicate that there are multiple missed opportunities for screening. Many patients aren’t diagnosed until they have an emergency, such as an obstruction or perforation of the bowel, which leads to more complications and a higher risk for death.”

Colorectal-cancer screenings – recommended for all healthy adults starting at age 50 – include colonoscopies or home-based stool blood tests.

In their study, Dr. Pruitt and her colleagues identified 88,859 patients with colorectal cancer, 29 percent presenting as emergencies. Of these, 81.3 percent had an emergency admission, 31.6 percent had obstructions, and 4.2 percent had perforations. After accounting for multiple factors, including cancer stage, patient health status, and sociodemographic differences, African-Americans were 29 percent more likely to be diagnosed with emergency cases, and those living in census tracts with the highest poverty rate were 10 percent more likely to present with emergency colorectal cancer.

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