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Black and African American People Are at Greater Risk for Colon Cancer

Although colorectal cancer is one of the most commonly diagnosed and most preventable cancers, it does not affect all people equally. While there’s been progress in reducing cases and deaths in older adults, a concerning trend shows that Black people still face a higher risk. 

According to the American Cancer Society, African American people in the U.S. are 20% more likely to get colorectal cancer and 40% more likely to die from it. Black people (including African Americans) have the highest death rate and shortest survival of any ethnic group for most cancers.

The passing of actor Chadwick Boseman from colorectal cancer at age 43 in August 2020 came as a surprise and shock to many. Still, it has brought to light the rising cases of colorectal cancer in young adults – especially among Black men and women.

Read on to understand more about what colorectal cancer is, why it affects Black people more and what you can do to protect yourself. 

What is colorectal cancer?

Colorectal cancer is a disease of the colon or rectum, which is part of the large intestine. A medical oncologist may refer to the disease as either colon cancer or rectal cancer, but the two are often grouped as colorectal cancer.

“It typically starts as a polyp – an abnormal tissue growth – inside the colon or rectum,” said Madappa Kundranda, MD, a gastrointestinal medical oncologist with Banner MD Anderson Cancer Center at Banner Gateway Medical Center. “Some polyps can become cancer over time, but not all polyps become cancer.”

Why are Black people at greater risk for colorectal cancer?

The reasons Black people are at greater risk are complex. Still, research shows factors like awareness and access to health care and high-quality screenings are some of the contributing factors to this inequality.

Colorectal cancer in Black men and women also occurs more often on the right side of the colon, another factor leading to poor outcomes. Research shows that cancer in the right side of the colon is more aggressive, while cancer in the left side of the colon – more common in European Americans – is easier to diagnose and treat.

“Right-sided colorectal cancers are more difficult to diagnose, perhaps leading to less detection in early stages of the disease,” Dr. Kundranda said. “Because colorectal cancers in Black people tend to be right-sided, they can also be more aggressive and more advanced at diagnosis, so the outlook isn’t as good as those found on the left side.”

Early detection and access are key 

When it comes to diagnosing and treating colorectal cancer, education, early diagnosis and improved access to health care are important. When communities provide better access to colorectal screening, racial and ethnic disparities in colorectal cancers are dramatically reduced.

“It is so important that everyone has access to and is receiving their recommended screenings, particularly those at a higher risk,” Dr. Kundranda said. 

Screening tests for colorectal cancers include:

  • Colonoscopy: In this test, the rectum and entire colon are looked at using a colonoscope, a flexible, lighted tube with a camera for viewing and a tool to remove tissue for testing. This remains the gold standard for colorectal cancer screenings.
  • Virtual colonoscopy: In this test, a CT scan produces a series of 3D pictures of the colon and rectum from outside the body.
  • Stool-based test for blood or DNA: Both polyps and colorectal cancers can bleed, and a stool-based test can check for tiny amounts of blood or cancer DNA in the stool that can’t be seen visually. If you choose a stool-based test, Banner MD Anderson recommends one of the following:
    • Stool DNA test: This test combines testing for changes in stool DNA with a fecal immunochemical test (FIT). These are the most accurate of the stool-based tests. 
    • Fecal immunochemical test (FIT): This test looks for proteins found in blood. This can help identify blood in your stool, which can be a sign of colon cancer. 

Medicaid and Medicare typically cover colorectal cancer screenings as part of their preventive care screenings. Many private insurance plans also cover screening in full. Check with your plan and health care provider to understand coverage details and potential out-of-pocket costs. 

You may also qualify for a free or reduced-cost colonoscopy or screening. You can locate some of these programs through Stop Colon Cancer Now.

What steps can I take to lower my risk for colorectal cancer?

If you are Black, don’t wait to know your risk. Talk to your health care provider about potential risk factors, family history and when you should start getting screened for colorectal cancer. 

“People at average risk of colorectal cancer should begin regular screening at age 45,” Dr. Kundranda said. “If you have an immediate relative who was diagnosed with colon cancer before age 45, such as a parent or sibling, you should get your first screening colonoscopy 10 years before you reach that age.”

Here are some additional steps you can take to reduce your risk:

  • Eat a healthy diet: Eat plenty of fruits, vegetables, whole grains and lean meats. Limit red meat and avoid processed meats like bacon and sausage, which may contribute to the development of cancer.
  • Get regular exercise: Aim for at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week.
  • Maintain a healthy weight: Having a high body weight can increase your risk, so focus on a balanced diet and exercise.
  • Limit alcohol: No alcohol is best for cancer prevention. If you drink alcohol, do so in moderation. For example, up to one drink per day for women and up to two for men.
  • Quit smoking: If you smoke, the single best thing you can do for your health is to quit.  

Bottom line

While strides are being made in the treatment of colorectal cancer, it is important to address the disparities that persist, particularly in Black communities. By understanding these unique challenges and taking proactive steps, we can collectively work toward a future where colorectal cancer affects everyone less.

Talk to your health care provider or a Banner Health specialist to learn more about your colorectal cancer risk. 

For more colon cancer-related articles, check out:

Women's Health Men's Health Gastroenterology Cancer Colorectal Cancer