Abstract
BACKGROUND
Death rates for most cancers continue to be higher for African Americans, particularly those in inner cities. Harlem Hospital serves a poor, predominantly AfricanβAmerican community in New York City.
METHODS
Tumor registry records for 615 patients treated for colorectal carcinoma at Harlem Hospital between 1973 and 1992 were reviewed.
RESULTS
Of the patients, 45.2% were male and 54.8% female, 97.2% were black, and 82% resided in Harlem. All patients were symptomatic at the time of diagnosis;15.3% were first diagnosed intraoperatively; 8.4% were in American Joint Committee on Cancer Stage I, 20.8% Stage II, 22.8% Stage III, 39.0% Stage IV, and 8.0% could not be staged. Colon resection with intention of cure was performed on 50.6%, 21.5% had palliative resection, and 11.6% had colostomy or other palliative surgery. Adjuvant chemotherapy or radiotherapy was given to 6.2%; 16.9% had no surgical treatment because of advanced stage, poor condition, or refusal of surgery; 12.7% presented with perforation or intestinal obstruction. Operative mortality was 15.3% overall and 10.6% for 311 patients who had surgery with intention of cure. Twentyβfive patients had local recurrence, 86 had subsequent distant metastases, and 33 patients had both local and distant recurrence. Fortyβnine patients (8%) were lost to followβup. The 5βyear crude survival rate for 615 patients was 18.7%. The relative survival rate was 19.7%, substantially lower than the national average for the same years.
CONCLUSIONS
Although colorectal carcinoma mortality continues to decline nationally, in this population of poor blacks the mortality rate remained high and unchanged. The most important cause of this is late presentation at an incurable stage, resulting from the combined effects of poverty, lack of education, and lack of access to primary care. Culturally sensitive educational programs and accessible health care systems for the poor are needed. Cancer 2002;94:2327β32. Β© 2002 American Cancer Society.
DOI 10.1002/cncr.10486