Colorectal cancer is now the number one cause of cancer death in adults under 50, according to a 2026 report from the American Cancer Society, and persists as one of the most commonly diagnosed cancers in the U.S.
In California, part of that surge may be due to a racial gap in diagnosis between Black individuals and other races, according to a viewpoint published Aug. 11 in Black Voice News in partnership with California Black Media.
From 2014 through 2018, the age-adjusted colorectal cancer incidence rate was 40.2 cases per 100,000 among Black Californians, compared with 35.8 among white Californians, wrote Gracie Ann Dinkins, MD, a clinical assistant professor of surgery and surgery clerkship director at Charles R. Drew University College of Medicine’s department of surgery in Los Angeles, and Sydney Brown. The authors referenced a study published in Advances in Cancer Research in 2021. The mortality gap was steeper: 25.3 deaths per 100,000 among Black Californians versus 17.7 among white Californians, a 43% difference. A later state analysis found the incidence gap persisted into 2021, at 39 cases per 100,000 among Black Californians compared with 35 among white Californians.
Dr. Dinkins and Ms. Brown argue those figures reflect breakdowns across the cancer care continuum — prevention, screening, diagnostic follow-up, treatment and surveillance — rather than an inevitable biological difference. Nearly six in 10 colorectal cancers were diagnosed at a regional or distant stage among both Black and white patients from 2009 through 2018, and the racial difference in stage at diagnosis was not statistically significant. But the state’s cancer registry does not track who was offered a screening test, who completed it or who received a timely colonoscopy after an abnormal result, the authors noted, leaving a gap in what the data can show about missed opportunities.
A California Cancer Registry study of nearly 27,000 patients with stage I through III colorectal cancer found Black patients had 39% higher odds of receiving less than guideline-recommended treatment and 78% higher odds of waiting more than 60 days to start treatment. The authors wrote that some of that treatment gap was tied to broader inequities in where patients received care, not solely individual patient factors. Among patients diagnosed from 2009 through 2013, survival was lower for Black patients than white patients; once researchers adjusted for cancer stage, chronic illness and other factors, the survival difference was no longer statistically significant — a finding Dr. Dinkins and Ms. Brown said points to unequal access and timing rather than an unavoidable outcome.
The viewpoint’s central example is Kaiser Permanente Northern California, part of Oakland, Calif.-based Kaiser Permanente, which built an organized outreach program that identified eligible patients, mailed annual home stool tests to those overdue for screening, offered colonoscopy as an alternative and tracked abnormal results through follow-up. Screening rates among Black members climbed from about 40% in 2009 to 80% in 2019. Over the same period, the colorectal cancer death rate among the health system’s Black members fell from 54.2 to 20.9 per 100,000, which the authors said essentially eliminated the Black-white mortality gap within that system.
Dr. Dinkins and Ms. Brown frame that result as evidence that organized care, not chance encounters, is what closes disparities. They called for mailed screening outreach, patient navigation and guaranteed follow-up colonoscopy to become standard across Medi-Cal, county health systems and community clinics. They also recommended that health systems publicly report screening completion rates, time from a positive stool test to colonoscopy, time from diagnosis to treatment, receipt of guideline-concordant therapy and completion of post-treatment surveillance, each broken out by race, insurance status and neighborhood.
Transportation, paid time off, bowel-preparation costs, childcare and distrust of the health system are not peripheral concerns, the authors wrote. These factors may determine whether patients can complete screening and treatment at all. Dr. Dinkins and Ms. Brown recommended involving community organizations, churches, clinicians and public hospitals in designing outreach from the outset, rather than delivering messages developed elsewhere, and ensuring survivors leave treatment with a clear surveillance plan and ongoing navigation support.
“Closing California’s colorectal cancer gap is achievable,” Dr. Dinkins and Ms. Brown wrote. “The state has the tests, specialists, data systems and proof of concept. What it needs is the will to connect them.”
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