Black Americans are 20% more likely to be diagnosed with colorectal cancer and are more likely to develop it at a younger age than whites. When they get it, studies show, they are also up to 35% more likely to die from it.
This disparity has been going on for years, according to Dr. Douglas Rex, distinguished professor emeritus at Indiana University School of Medicine and director of Endoscopy at Indiana University Health.
He says it is important to remember colon cancer is regarded as preventable — but only with timely screening.
“So when we do screening we have two goals in mind. One is to identify cancers that have not spread and therefore are curable and so we can prevent death by finding an early cancer,” he said.
Screening with a colonoscopy can also identify polyps, where the cancer started. “So, when we remove those, we actually prevent the cancers from ever developing,” Rex said.
The effectiveness of screening for colorectal cancer has sparked calls for lowering the recommended age for Black Americans to start.
The new draft of federal guidelines recommends that everyone start screening at age 45 — down from 50. Still, some, such as the American College of Physicians, say African Americans should start at 40.
Although screening is highly effective in reducing mortality, only 60% of those who need it actually get it. That’s lower than screening rates for breast and cervical cancers. And Black Americans are the least likely to complete screening.
Health care access inequity
Like many health disparities, the reasons behind the colorectal cancer disparity are complex and at times interrelated, Rex said.
“Because of the lack of screening and access to care, African Americans get more cancers, and these cancers have progressed to a later stage,” he said. “They’re more likely to have [the cancer] spread by the time that they’re diagnosed.”
He believes the biggest problem is health care access inequities. Improving access could help lessen the disproportionate burden of cancer on Black patients, he said.
Rex points to the Veteran Affairs health system, where patients, regardless of racial or financial background, have more equal access to services at no cost.
“There are really no racial barriers to care — or if there are, they are less than in the private system,” he said. “And so within that system, the mortality of African Americans from colorectal cancer is very similar to whites. So, equal access to care is associated with comparable mortality.”
Related issues
Generally, Black Americans suffer from higher rates of chronic diseases. Many are related to socioeconomic factors such as access to healthy food, time for exercise, environmental pollution and daily stress levels.
“There are a variety of medical issues that are more common in African Americans and some of these are also associated with [higher] colon cancer risk and so those include factors like obesity and diabetes mellitus,” he said. “And so those factors may also be contributors to racial differences in the risk of colon cancer.”
Researchers are also investigating how such factors can influence the operation of genes — and lead to the disparity in cancer rates.
Research suggests the invasive nature of screening — which involves a long tube called a colonoscope inserted into the rectum — might cause reticence among some at-risk individuals.
In one study, the reticence seemed equal among Black and white American men due to “cultural concepts [of] masculinity and homophobia,” the authors wrote.
In another large survey, over half of the Black Americans said they perceive or experience racism in the health care system. Those who reported racism were less likely to have completed a colorectal cancer screening.
Rex recognizes these challenges and says health care systems need extensive outreach and education programs to increase access to screening.
“It’s critical to consider yourself at risk, if you hit the right age” he said. “Or if you haven’t hit the right age, but you have a family history of colon cancer … [ask] your doctor to provide a screening test for you.”
This story was reported as part of a partnership between WFYI, Side Effects Public Media and the Indianapolis Recorder. Contact Farah Yousry at fyousry@wfyi.org or 857-285-0449. Follow her on Twitter @Farah_Yoursrym.
