Racial and Ethnic Disparities in Distant-Stage Presentation of Lung, Breast, and Colorectal Cancers, 2006-2021.

Abstract

BackgroundRacial and ethnic disparities in stage at cancer diagnosis remain a major contributor to cancer-related mortality in the United States. Whether the magnitude of these disparities differs across cancers with distinct screening paradigms remains unclear.MethodsWe conducted a retrospective cohort study using the National Cancer Database (2006-2021) to examine racial and ethnic differences in distant-stage presentation among adults diagnosed with lung, breast, or colorectal cancer. Multivariable logistic regression models with robust standard errors were used to estimate adjusted odds ratios (ORs) for distant-stage disease. Interaction terms between race/ethnicity and cancer type were included to assess whether disparities differed across cancers. To facilitate cross-cancer comparisons, we also estimated adjusted predicted probabilities and absolute risk differences.ResultsAmong 3,386,771 patients, racial and ethnic disparities in distant-stage presentation varied substantially across cancer types. In lung cancer, compared with Non-Hispanic White (NHW) patients, the odds of distant-stage disease were modestly higher among Non-Hispanic Black (NHB) (OR, 1.02; 95% CI, 1.00-1.03), Hispanic (OR, 1.12; 95% CI, 1.10-1.14), and Non-Hispanic Other (NHO) patients (OR, 1.19; 95% CI, 1.16-1.22), corresponding to absolute increases of 0.5, 2.8, and 4.3 percentage points, respectively. In breast cancer, NHB patients experienced substantially higher odds of distant-stage presentation (OR, 1.61; 95% CI, 1.58-1.64), representing the largest disparity observed across all cancers. In colorectal cancer, NHB patients also had higher odds of distant-stage disease (OR, 1.14; 95% CI, 1.12-1.16), whereas Hispanic and NHO patients had lower odds and absolute probabilities compared with NHW patients.ConclusionsRacial and ethnic disparities in distant-stage presentation vary markedly across cancers. The largest inequities occur among Non-Hispanic Black patients with breast cancer despite the presence of long-standing population screening programs, suggesting that mechanisms beyond screening access-such as delays in diagnostic follow-up, barriers to care navigation, and structural inequities-contribute to persistent disparities in early cancer detection.