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In Reply: Dr Barr highlights the challenges involved in understanding the relationship between race and colorectal carcinogenesis. We concur with his comments regarding the importance of socioeconomic factors. Indeed, several studies have shown that the lower rate of colorectal cancer screening among black individuals may be largely attributed to socioeconomic factors.¹ On the other hand, the issue of racial disparities appears to be more complicated, as suggested by the National Cancer Institute Black/White Cancer Survival Study Group report, which noted that a large component of the excess colorectal cancer mortality among black patients could not be explained by socioeconomic status, education level, tobacco/alcohol exposure, or access to care.²

We agree that the evidence regarding genetics and race is fairly modest, which may have been a reason that Agrawal et al³ were quite circumspect when they stated that "genetic susceptibilities . . . may be part of the explanation for the earlier mean age of . . . [Full Text of this Article]

Hemant K. Roy, MD
h-roy@northwestern.edu

Laura K. Bianchi, MD
Department of Internal Medicine
NorthShore University HealthSystem
Evanston, Illinois

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