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Environmental influences on the high mortality from colorectal cancer in African Americans
  1. Sumit Sharma1,
  2. Stephen J D O’Keefe2
  1. 1Department of Medicine, Rosalind Franklin University of Health and Sciences, Chicago Medical School, Chicago, Illinois, USA
  2. 2Division of Gastroenterology, University of Pittsburgh, Pennsylvania, USA
  1. Correspondence to:
 Dr Stephen J D O’Keefe
 Division of Gastroenterology, University of Pittsburgh Medical School, 200 Lothrop Street, Pittsburgh, PA 15213, USA; OkeefeS{at}


Colon cancer is the second leading cause of cancer related death in American adults. The incidence and mortality are highest in African Americans (AAs) (incidence: 52 per 100 000) and lowest in American Hispanics (37 per 100 000). Comparative studies with Native Africans (<5 per 100 000) suggest that genetic susceptibility is an unlikely explanation and that environmental influences are to blame. Studies have suggested that risk is high because of excessive intakes of animal meat and fat products and differences in colonic bacterial metabolism, and that preventative and therapeutic management of colon cancer is compromised by the development of greater tumour virulence possibly resulting from disparities in educational and insurance status, screening behaviour, treatment patterns, social support, and access to and use of health care facilities. It should be possible to reduce the unacceptably higher rates of morbidity and mortality from colon cancer in AAs by dietary and lifestyle changes aimed at suppressing excessive intakes of animal meat and fat products, increasing the consumption of fresh fruit and vegetables, controlling energy balance, and by developing strategies to improve the availability, use and accessibility to health care resources.

  • AAs, African Americans
  • CAs, caucasian Americans
  • CI, confidence interval
  • HCA, heterocyclic amines
  • NIH, National Institutes of Health
  • NSAID, non-steroidal anti-inflammatory drug
  • OR, odds ratio

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  • Competing interests: None declared.