numbers, particularly for distant-stage disease. Source: SEER Program, 2019. ©2020, American Cancer Society, Inc., Surveillance Research Figure 10. Colorectal Cancer Five-year Survival (%) by Age and Race/Ethnicity, 2009-2015 0-49 years 50-64 years 65+ years All ages Non-Hispanic white Non-Hispanic black Asian and Pacific Islander American Indian/Alaska 2020-2022 Race/ethnicity Outcomes among racial/ethnic minorities are described in terms of cause-specific survival because life expectancy data for minority groups are inadequate to calculate relative survival. The highest CRC survival rates are for APIs (68%) and the lowest are for blacks (60%; Figure 10), one-quarter of whom are diagnosed with distant-stage disease (Figure 11). As described earlier, disparities in CRC outcomes are largely driven by socioeconomic inequalities that result in differences in access to early detection and receipt of timely, high-quality treatment.61, 66 Access to care is directly related to stage at diagnosis, which plays the largest role in racial/ethnic survival disparities.67 Notably, when CRC is diagnosed at localized stage, 5-year survival is relatively similar (89%-92%) across racial/ethnic groups. A recent nationwide study found that more than onehalf of the black-white survival disparity is explained by differences in insurance status and one-quarter is due to differences in tumor characteristics (e.g., grade, location).3 There is also compelling evidence that black patients are less likely to receive prompt follow-up after an abnormal CRC screening test32 and appropriate surgery, adjuvant chemotherapy, and radiation treatments.3, 68-70 Although a recent study found no evidence of treatment delays in an equal-access health system,71 equal cancer treatment does not eliminate the racial survival disparity.72, 73 Thus, equity in care across the cancer continuum, from prevention to early detection to clinical-trial participation and individualized treatment, is necessary to eliminate these disparities.74 Changes over time The 5-year relative survival rate for CRC has increased moderately from 50% in the mid-1970s to 64% during 2009-2015.24 However, recent advances in the treatment of metastatic disease, including improved surgical methods and the development of targeted therapies,75-77 have rapidly extended survival for these patients. For example, the 2-year relative survival rate for distantstage disease increased from 21% for patients diagnosed during the mid-1990s to 37% for those diagnosed during 2009-2015, with a larger jump for rectal cancer (22% to 41%) than for colon cancer (21% to 36%). Although progress is evident across race and age,78 gains are most prominent among white and non-elderly patients.79 *Cause-specific survival rates are the probability of not dying from colorectal cancer within 5 years of diagnosis. Rates are based on cases diagnosed from 2009 to 2015, all followed through 2016. Rates for American Indians/Alaska Natives are based on small case numbers, particularly for distant-stage disease. Source: SEER Program, 2019. ©2020, American Cancer Society, Inc., Surveillance Research Figure 10. Colorectal Cancer Five-year Survival (%) by Age and Race/Ethnicity, 2009-2015 0-49 years 50-64 years 65+ years All ages Non-Hispanic white Non-Hispanic black Asian and Pacific Islander American Indian/Alaska Native Hispanic *Cause-specific survival rates are the probability of not dying from colorectal cancer within 5 years of diagnosis. Rates are based on cases diagnosed from 2009 to 2015, all followed through 2016. Rates for American Indians/Alaska Natives are based on small case numbers, particularly for distant-stage disease. Source: SEER Program, 2019. ©2020, American Cancer Society, Inc., Surveillance Research Figure 10. Colorectal Cancer Five-year Survival (%) by Age and Race/Ethnicity, 2009-2015 0-49 years 50-64 years 65+ years All ages Non-Hispanic white Non-Hispanic black Asian and Pacific Islander American Indian/Alaska Native Hispanic 0 10 20 30 40 50 60 70 80 90 100 All stages Local Regional Distant 0 Colorectal Cancer Facts & Figures 2020-2022 13 Colorectal Cancer Risk Factors In the United States, more than half (55%) of all CRCs are attributable to lifestyle