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By Gracie Ann E. Dinkins, MD, FACS and Sydney Y. K. Brown, MA, Special to California Black Media Partners

Every breakthrough in cancer care carries a promise: earlier detection, better treatment and longer life. California has helped deliver that promise through world-class cancer centers, a statewide cancer registry and major public-health investments. Yet colorectal cancer still exposes a painful divide: Black Californians are more likely to develop the disease and far more likely to die from it than their White neighbors.

The numbers are stark. From 2014 through 2018, the age-adjusted colorectal cancer incidence rate was 40.2 cases per 100,000 Black Californians, compared with 35.8 among non-Hispanic White Californians. The mortality rate was 25.3 deaths per 100,000 among Black Californians and 17.7 among White Californians—a 43% difference. 

A later state analysis showed that the incidence gap remained in 2021, at 39.0 versus 35.0 cases per 100,000.

These differences should not be treated as an inevitable consequence of biology. The more revealing explanation lies in what happens—or fails to happen—across the cancer-care continuum: prevention, screening, diagnostic follow-up, treatment and surveillance after treatment.

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Colorectal cancer is one of the few cancers that screening can sometimes prevent. Colonoscopy can find and remove precancerous polyps, while stool-based tests can identify people who need further evaluation. The U.S. Preventive Services Task Force recommends screening for average-risk adults from ages 45 through 75, with several acceptable options. But a screening test saves no one if it is never offered, never completed or not followed by a timely colonoscopy after an abnormal result.

California’s cancer-burden report shows both the urgency of the problem and a troubling data gap. Nearly six in 10 colorectal cancers were diagnosed at a regional or distant stage among both Black and White patients from 2009 through 2018. The racial difference in stage was not statistically significant. Yet, the registry report did not include screening information, so it could not show who was offered a test, who completed it or who received the necessary colonoscopy afterward. It also did not assess whether survivors completed recommended follow-up. California can count cancers and deaths, but it cannot yet see every missed opportunity that produced them.

The disparities become clearer after diagnosis. A California Cancer Registry study of nearly 27,000 people with stage I through III colorectal cancer found that Black patients had 39% higher odds of receiving less than guideline-recommended treatment and 78% higher odds of waiting more than 60 days for treatment than White patients. Neighborhood socioeconomic disadvantage explained part of the substandard treatment, but racial differences persisted even after researchers accounted for where patients lived.

Survival reflects the accumulation of these missed opportunities. Among Californians diagnosed from 2009 through 2013, five-year relative survival was 58.8% for Black patients and 65.1% for White patients. After researchers adjusted for age, insurance, neighborhood income, stage, chronic illness and other factors, the survival difference was no longer statistically significant. That does not make the gap less serious. It identifies much of it as potentially preventable: when access, timing and health conditions are unequal, survival will be unequal too.

California already has proof that a better system can work. Kaiser Permanente Northern California built an organized program that identified eligible patients, mailed annual home stool tests to those overdue, offered colonoscopy as an alternative, and tracked abnormal results through follow-up. Screening among Black members rose from about 40% in 2009 to 80% in 2019. Over the same period, their colorectal cancer death rate fell from 54.2 to 20.9 per 100,000, essentially eliminating the Black-White mortality gap within that health system.

The lesson is not that every Californian must join one health plan. It is that equity requires organized care rather than reliance on chance encounters. Mailed screening outreach, patient navigation and guaranteed follow-up colonoscopy should become standard across Medi-Cal, county health systems and community clinics. Health systems should publicly report screening completion; time from a positive stool test to colonoscopy; time from diagnosis to treatment; receipt of guideline-concordant therapy; and completion of post-treatment surveillance—each stratified by race, insurance, and neighborhood.

Transportation, paid time off, bowel-preparation costs, childcare and distrust are not side issues; they determine whether patients can complete care. Community organizations, churches, clinicians and public hospitals should help design outreach from the beginning, not merely deliver messages created elsewhere. Survivors should leave treatment with a clear surveillance plan, navigation support and reminders that do not disappear when active therapy ends.

Closing California’s colorectal cancer gap is achievable. The state has the tests, specialists, data systems and proof of concept. What it needs is the will to connect them. Success should be measured not only by how many cancers we treat, but by how many we prevent, how quickly we act and whether every Californian has an equal opportunity to survive.

About the Authors 

Gracie Ann E. Dinkins, MD, FACS, is a Clinical Assistant Professor of Surgery and Surgery Clerkship Director at the Charles R. Drew University College of Medicine, Department of Surgery. Her mission is to help realize the CDU vision: Excellent health and wellness for all in a world without health disparities.

Sydney Y. K. Brown, MA, is a medical student at the Charles R. Drew University College of Medicine whose work focuses on clinical research, community engagement, and health equity. She is committed to advancing equitable access to high-quality care and improving health outcomes in underserved communities.

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This summer, Misty Copeland will step into a different kind of spotlight. Instead of taking center stage as a dancer, she will help determine what audiences see onstage as curator of the 2026 Joyce Ballet Festival. Taking place August 4 through August 16 at The Joyce Theater in New York City, the two-week celebration will bring together dancers, choreographers and companies representing a broad spectrum of ballet. The festival gives Copeland an opportunity to share not only her appreciation for ballet’s traditions, but also her vision for its future.

Copeland understands better than most how powerful a ballet stage can be. Her historic career with American Ballet Theatre changed the conversation about representation in one of the world’s most traditional performing arts. When she became the company’s first Black woman to reach the rank of principal dancer, her achievement carried significance far beyond a personal milestone. It gave young dancers of color a new image of what was possible and challenged the industry to reconsider who belonged at the center of ballet.

That history informs the perspective she brings to the festival. Copeland has spent much of her career moving between performance, mentorship, advocacy and storytelling. Her curatorial role allows her to bring those interests together by creating a program that does not treat ballet as a museum piece. Instead, the festival presents dance as an evolving language capable of carrying classical traditions into new cultural and artistic territory.

Audiences will encounter a mixture of established works and contemporary creations during the festival. Classical ballet vocabulary will share space with choreography that pushes dancers toward different physical, emotional and theatrical possibilities. The result is intended to give audiences a broader understanding of the art form while demonstrating that tradition and innovation do not have to be competing forces.

The lineup also provides an opportunity to see dancers from different artistic environments. Performers connected to organizations including American Ballet Theatre, New York City Ballet, Paris Opera Ballet, Houston Ballet, Dance Theatre of Harlem and Complexions Contemporary Ballet are among those represented in the festival. Each company carries its own history and artistic identity, making their participation part of a larger conversation about the many ways ballet can be performed and interpreted.

The presence of Dance Theatre of Harlem is particularly meaningful within the larger story of Copeland’s career and the evolution of Black representation in ballet. Founded during a period when opportunities for Black dancers were severely limited, the company helped demonstrate that excellence and classical training could flourish in a Black cultural environment. Its legacy continues to influence dancers and audiences, making its connection to a festival curated by Copeland especially resonant.

The program also reaches beyond a single definition of contemporary ballet. Choreographers with different backgrounds and artistic philosophies contribute to an evening that can move from recognizable classical structures to works shaped by modern dance, theater, popular culture and new approaches to movement. That diversity reflects a generation of artists who increasingly see ballet not as a rigid vocabulary but as a foundation from which they can explore.

For New York audiences, the festival offers something that is increasingly valuable: the opportunity to experience outstanding dancers in an intimate setting. The Joyce is known for presenting dance in a theater where audiences can see movement and artistry up close. That environment can make a familiar ballet work feel newly personal while allowing experimental pieces to communicate with unusual immediacy.

Copeland’s role as curator also sends a message about the importance of artistic leadership. The people who select performers and choreography help determine which stories receive attention and which artists receive opportunities. By bringing a range of voices into the festival, Copeland is using that responsibility to broaden the conversation around ballet. Her choices can introduce audiences to artists they may not otherwise encounter while encouraging longtime ballet followers to look at the form from a different perspective.

The 2026 Joyce Ballet Festival ultimately arrives at an important moment for the art form. Ballet is carrying centuries of tradition into an era defined by changing audiences, broader representation and increasingly adventurous choreography. Copeland’s festival reflects that transition. For two weeks in August, The Joyce will become a meeting place for the familiar and the unexpected—a celebration of where ballet came from and a preview of where it may be going. And with Misty Copeland helping shape the conversation, the future of ballet promises to be as expansive as the dancers who are defining it.

Based on reporting by The Positive Community.

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