Many of us are still mourning the loss of actor Chadwick Boseman, who lost his battle with colon cancer in August 2020, at age 43. His untimely death has reignited discussions about the rising cases of colorectal cancer in young adults, particularly among the Black and African American community.
“Black and African American men and women have the highest incidence rates among any other ethnic group in the U.S.,” said Tomislav Dragovich, MD, a gastrointestinal medical oncologist with Banner MD Anderson Cancer Center in Arizona. “In addition, when diagnosed with colorectal cancer, they also have the highest risk of dying from cancer.”
Although colorectal cancer is one of the most commonly diagnosed and most preventable cancers, it does not affect all people equally. Age and race seem to play into this disparity. While we continue to see an overall decrease in colorectal cancer cases and deaths in the past two decades, the rate has surprisingly increased in younger Americans (those under the age of 50). Blacks and African Americans still have the highest incidence of colorectal cancer – with nearly 20,000 cases in 2019 and are 15 to 20 percent more likely to die from the disease than patients of any other race.
“We do not fully understand what drives this trend, but it is probably a combination of hereditary and environmental factors,” Dr. Dragovich said. “Thankfully, there is ongoing research looking into this.”
This greater awareness and understanding led to the recent change by the American Cancer Society to recommend starting screening for all average risk adults at the age of 45. The hope is that this will aid detection in those at risk for early onset colon cancer.
Why Are Blacks and African Americans at Greater Risk?
The reasons Blacks and African Americans are at greater risk are complex, but socioeconomic status, awareness and access to care are some of the contributing factors to this inequality. Colorectal cancer in Blacks and African Americans also occurs more often on the right side of the colon, another factor leading to poor prognosis.
“Their colon cancers tend to be located more frequently on the right side of the colon, which are more difficult to detect, perhaps leading to less effective detection at an early stage,” Dr. Dragovich said. “Colorectal cancers in Blacks and African Americans also tend to be more aggressive and more advanced at diagnosis, so prognosis isn’t as good.”
Improving Access to Diagnosis and Treatment
While we don’t know the contributing factors behind Chadwick’s diagnosis at age 39, his death creates an opportunity to call for better research, screening and outcomes for this type of cancer.
When it comes to diagnosing and treating colorectal cancer in populations at risk, early diagnosis and improved access are key. When communities provide better access to colorectal cancer screening, racial and ethnic disparities in colon cancer are significantly reduced.
Types of Colorectal Screenings
In addition to colonoscopies, which remain a gold standard for colorectal cancer screening, Dr. Dragovich said there are other tests that can be considered for individuals who are unable to have a full colonoscopy.
Screening tests for colon cancer include:
- Colonoscopy: In this test, the rectum and entire colon are examined using a colonoscope, a flexible lighted tube with a lens for viewing and a tool for removing tissue.
- Virtual Colonoscopy: In this test, a CT scan produces a series of pictures of the colon and rectum from outside of the body.
- Stool Test for Blood or DNA: Both polyps and colorectal cancers can bleed, and stool tests can check for tiny amounts of blood or cancer DNA in the stool that can’t be seen visually.
“It’s so important that everyone has access to and are receiving their recommended screenings, particularly those who are at a higher risk,” Dr. Dragovich. “If you have a first-degree relative in the family who was diagnosed with colon cancer at an earlier age, the rule of thumb is that you should get a first screening colonoscopy 10 years before you reach that age even if it is before the age of 45 for Blacks and African Americans, or 50 for other races. Talk to your doctor to discuss these options."
If you’re Black/African American, don’t wait to know your risk. Talk to your doctor about potential risk factors, family history and when you should start getting screened for colorectal cancer.
For more information, schedule an appointment with your doctor or locate a Banner MD Anderson specialist. Our team of colorectal cancer experts are here to help you with your diagnosis. We take time to understand your needs and focus on providing you with effective, personalized treatment.
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.
Updated: Screening guidelines updated on November 3, 2021.