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Colon cancer survival in the US Department of Veterans Affairs by race and stage: 2001 through 2009

We would like to thank White et al for their examination of the racial discrepancies in colon cancer (CC) survival in the CONCORD-2 study between 2001 and 2009. They have inspired us to investigate the differences with regard to black and white survival in the US Department of Veterans Affairs (VA) Cancer Cube Database during the same time period. Of the 30,196 patients with CC seen between 2001 and 2009, approximately 66.12% (19,967 patients) identified as white and 16.32% (4929 patients) identified as black. The distribution of disease stage in black individuals was as follows: 10.49% (517 patients) with stage 0, 25.10% (1237 patients) with stage I, 18.58% (916 patients) with stage II, 17.73% (874 patients) with stage III, and 17.91% (883 patients) with stage IV. By comparison, cases of CC in white individuals presented as stage 0 in 8.92% (1781 patients), stage I in 26.62% (5316 patients), stage II in 22.29% (4450 patients), stage III in 18.75% (3744 patients), and stage IV in 13.71% (2738 patients) (P for the chi-square trend test5.021). Approximately 8.87% and 8.77% of cases, respectively, in black and white patients were of unknown stage. It is interesting to note that, in contrast to the results reported by White et al, the overall 5-year survival rates for all stages of CC in black and white patients were similar (black patients: 57.90% [2854 patients] and white patients: 59.58% [11,897 patients]; P 5 .2750). The same holds true for the 5-year survival rate for patients with stage 0 (black patients: 81.82% [423 patients] and white patients: 78.10% [1391 patients]; P 5 .5338), stage I (black patients: 75.34% [932 patients] and white patients: 74.74% [3973 patients]; P5.8667), stage II (black patients: 66.05% [605 patients] and white patients: 65.78% [2927 patients]; P 5 .9427), stage III (black patients: 58.24% [509 patients] and white patients: 57.10% [2138 patients]; P5.7513), and stage IV (black patients: 11.44% [101 patients] and white patients: 13.29% [364 patients]; P 5 .2058) disease. The racial disparity in survival highlighted in CONCORD-2 (9%10% lower 5-year survival rate for black patients) could not be replicated in the VA system. This difference most likely is due to the uniformity of the VA in providing screening and treatment services and in leveling the playing field in terms of access to care. We believe these results should be taken into consideration in the current discussion of the shape of the health care system that should be adopted by the United States.