MEMORANDUM FOR: Science Writers and Editors on the Journal Press List

African-Americans With Colon Cancer Fare Better in Clinical Trials Than in the General Population

November 10, 1999 (EMBARGOED FOR RELEASE 4 P.M. EDT November 16)

Julianne Chappell, Executive Editor, Dan Eckstein, (301) 986-1891, ext. 112

African-Americans with colon cancer in the general population have poorer outcomes than Caucasians, but in clinical trials, where stage of entry and treatment are the same, their outcomes are generally similar to those of white participants.

These results suggest that earlier detection and adequate treatment could appreciably improve the colon cancer prognosis of African-Americans. James Dignam, Ph.D., University of Pittsburgh, and colleagues, present these findings in the November 17 issue of the Journal of the National Cancer Institute.

The authors combined and analyzed data from five separate randomized clinical trials that are part of the National Surgical Adjuvant Breast and Bowel Project. Each trial involved a different chemotherapy treatment after surgery for colon cancer. Entry into these studies was restricted to patients with similar stages of disease, and all participants in each trial received the same treatment and follow-up. A total of 663 African-Americans and 5969 Caucasian patients entered the trials from 1977 through 1994 and are still being followed except for the first trial, where follow-up was terminated after 10 years.

A number of study "end points" were established—recurrence-free survival (defined as time from surgery until reappearance of colon cancer), disease-free survival (time from surgery until recurrence of colon cancer, occurrence of a new primary cancer, or death), and survival time (time from surgery until death from any cause).

Combining data from the five trials showed that 5-year recurrence-free survival was 70% for whites and 68% for blacks, and 5-year disease-free survival was 62% for whites and 60% for blacks, differences that do not indicate materially poorer outcomes for blacks. However, a greater disparity was seen in survival time, with 72% of whites surviving 5 years, compared with 68% of blacks. Over all available follow-up time, blacks had a statistically significant 21% greater risk of death.

The authors speculate that, because the rates of colon cancer recurrence in the study were quite similar between the races, the higher overall mortality seen among black patients might well be due to mortality from other chronic diseases. They also note that blacks with colon cancer in the population at large are generally diagnosed with more advanced colon cancer than whites, decreasing their chances of survival. This situation, which is linked to socioeconomic disparities, could be improved by increased and targeted screening for the disease.

Editorial writers Otis Brawley, M.D., National Institutes of Health, and Harold Freeman, M.D., The North General Hospital, New York, note that equal treatment provides equal outcome regardless of race. However, they point out that there are studies of colon and other cancers that show there is not equal treatment: For example, in one case-control study, 68% of blacks with colon cancer underwent surgical resection, compared with 78% of whites; furthermore, the 1996 U.S. death rate for colorectal cancer was 16.4 per 100,000 for whites and 22.5 for blacks. The authors speculate that the cause of this disparity is that medical research has found effective treatments that are not used equally throughout the population. They conclude that "deep ethical and moral questions" are raised about how relevant communities will move to remedy this "unacceptable reality."

Contact: Lori Garvey, (412)330-4621; fax (412)330-4661. Editorial: NCI Press Office, (301) 496-6641. (Note: The media contact for the editorial is the NCI Press Office because the first author is on the NCI staff.)

Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.



             
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