about cancer prevention and by wider use of established screening tests. Although recommendations are for adults aged 50 and older to be screened for colorectal cancer, only 39 percent of people aged 50 or older in the United States have had a fecal occult blood test within the past year or endoscopy (i.e., either sigmoidoscopy or colonoscopy) within the past 5 years. Screening rates are lower among those without health insurance, recent immigrants, people with lower educational attainment, and Hispanics/Latinos (ACS, 2005c). Individuals at higher risk for colorectal cancer include those with a family history of colorectal cancer, those with a history of inflammatory bowel disease, and those with certain lifestyle risk factors (e.g., obesity, cigarette smoking, high alcohol use, physical inactivity).

Mortality rates from colorectal cancer continued to decline in both men and women from 1984 to 2001, at an average of 1.8 and 1.4 percent per year, respectively (Jemal et al., 2004). This decline reflects the decreasing incidence rates since the mid-1980s and improvements in survival. The decreases in incidence may reflect detection and removal of precancerous polyps during endoscopic screening. They may also reflect the increased use of hormone replacement therapy in women and anti-inflammatory drugs, both of which appear to reduce the risk of colorectal cancer.

Colorectal cancer incidence and mortality rates are highest in African-American men and women (Table 2-4). African Americans and American Indians and Alaskan Natives are more likely than whites to be diagnosed after the disease has spread beyond the bowel wall (Figure 2-27). The higher incidence rates, later stages at diagnosis, and higher mortality rates among certain racial and ethnic group members results in their

TABLE 2-4 Age-Standardized Incidence and Death Ratesa for Colorectal Cancer by Race and Ethnicity, U.S., 1997 to 2001

Race/Ethnicity

Incidence

Mortality

Males

Females

Males

Females

White

63.1

45.9

24.8

17.1

African American

72.9

56.5

34.3

24.5

Asian/Pacific Islander

56.3

38.6

15.8

10.8

American Indian/Alaskan Native

38.3

32.7

17.1

11.7

Hispanic/Latinob

49.6

32.5

18.0

11.6

aRates are per 100,000 and age-adjusted to the 2000 U.S. standard population.

bHispanics/Latinos are not mutually exclusive from whites and other groups shown.

SOURCE: ACS (2005c).



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