Nov. 6, 2023 – Colorectal cancer disproportionately affects Black Americans, and access to care for the highly preventable disease is thought to be behind why this group is 20% more likely to receive a colorectal cancer diagnosis than any other racial or ethnic group.
Black Americans are about 40% more likely to die from the disease than most other groups of patients. A recent study also found that 26% of Black Americans are diagnosed with CRC that has already metastasized, meaning the cancer has spread to other places in the body.
“The impact of social determinants of health on CRC diagnosis and treatment is clear to me as a practicing [cancer doctor] and person of color,” said Jason Willis, MD, PhD, a clinical investigator in the departments of Gastrointestinal Medical Oncology and Genomic Medicine at the University of Texas MD Anderson Cancer Center in Houston. “At a systemic level, we know that inequalities in health care access disproportionately impact many racial and ethnic minority groups. This is especially important when it comes to accessing preventative care and routine screening for common cancers, like CRC.”
The problem often exists throughout entire neighborhoods or cities.
“It may reflect a lack of access to primary care, inadequate referrals for screening, cultural barriers, and/or community-level factors,” Willis said. “Evidence has also suggested that some of the differences in CRC risk observed among various racial/ethnic communities may also be driven by differences in the prevalence of its underlying risk factors such as tobacco use and type 2 diabetes.”
Black patients can also face information roadblocks when it comes to early CRC evaluation, said Christina M. Annunziata, MD, PhD, senior vice president of extramural discovery science at the American Cancer Society.
Other barriers may include a fear of the invasiveness of a colonoscopy, a lack of understanding of the benefits of screening, and lack of understanding of how family history with the disease plays a role, Annunziata said. “These apply across the U.S. population, and are amplified with Black patients."
Then there are disparities in treatment, which may come from a lack of health care access, including insurance coverage, transportation challenges, and the time required for treatment such as surgery, radiation, and chemotherapy, she said. "In addition, Black patients diagnosed with advanced-stage cancers require more intensive, expensive, and time-consuming treatment regimens that can be unattainable due to social and economic barriers," she said.
Are There Biological Reasons Black People Are More at Risk for Colorectal Cancer?
Most likely, no. When Black patients received high-quality colonoscopies, there was no difference in the number of precancerous CRC polyps, or CRC tumors, when compared to white patients tested with the same equipment, according to data from Memorial Sloan Kettering Cancer Center. This further shows the importance of Black patients receiving early, and effective, screening for the disease.
But genetics may be one reason why CRC in Black patients can be difficult to treat. Additional research from Memorial Sloan Kettering found that colon cancer patients of African ancestry may have tumors that don’t respond well to immunotherapy and targeted cancer therapy.
The researchers found that these patients’ tumors were less likely to have the molecular profiles needed for these treatments to work.
But more research is needed. For now, researchers have very few clues as to why, when, and how these molecular and biological differences of CRC exist among various racial/ethnic and ancestral backgrounds, he said.
Black patients are also more likely to be diagnosed under the age of 50 as well. Researchers don’t know why this is exactly yet, but they think that poor diet, unhealthy bacteria in the gut, and inflammation may contribute to the cause. (Healthy eating and more exercise may lower a person’s risk.)
What Are the Symptoms of Colorectal Cancer?
Colorectal polyps, which are growths that can turn into colon cancer, and colon cancer itself can come without symptoms. If a person does have symptoms, they can include:
- Changes in bowel habits
- Blood in bowel movements
- Diarrhea
- Constipation
- The sensation that bowel movements aren’t complete
- Persistent stomachache, stomach pain, or cramps
- Weight loss without any explanation
Any or all of these symptoms warrant a trip to the doctor. These symptoms are the same for all racial and ethnic groups. Because CRC symptoms aren’t always obvious, this makes screening all the more important.
What Can Black Patients Do to Lower Their Risk of Getting Colorectal Cancer?
There are a number of solutions patients can pursue themselves.
Learn about CRC online
The untimely death of Oscar-nominated actor Chadwick Boseman from colon cancer at age 43 significantly boosted awareness of the disease, particularly for Black Americans. A study from the University of British Columbia and Simon Fraser University’s Beedie School of Business found there was an increase in internet searches about colon cancer in the months after Boseman’s August 2020 passing, particularly in areas where many Black Americans live. The study authors emphasized the importance of public health leaders discussing Boseman’s diagnosis with their Black patient population, so that they will not only be inspired by his brave battle against the disease, but will be proactive about getting tested for colon cancer themselves.
Reading about Boseman’s journey is an important start to patient education. It’s also key to learn about the disease itself, plus how colon cancer screening works specifically. Then, writing down questions to bring to the doctor before screening is an excellent way to feel empowered, and to understand what specific test results will mean.
Be proactive
Find out about family history.
“It’s challenging to determine the best age for screening if the patient doesn’t know their family history,” said Annunziata. Asking older members of the family whether CRC has affected previous generations is a helpful step.
If there is a strong family history, a patient will likely need earlier screening.
“[Doctors] should explain the benefits of colon cancer screening with colonoscopy starting at age 45 in the general population, or earlier if the person has a family history of colon cancer,” Annunziata said. If a patient’s doctor doesn’t offer this information upfront, it’s definitely the right move to ask for the testing directly.
If a Black patient gets diagnosed with CRC, they should educate themselves about critical follow-up care after a diagnosis. Doctors should also be more proactive about enrolling patients in key clinical trials. According to additional data from the American Cancer Society, only 7% of patients enrolled in the FDA's clinical cancer drug trials are Black. Doctors should also be more proactive about enrolling patients in these and other key clinical trials; it’s completely appropriate for a patient to search out trials on their own, and bring them to their doctor’s attention, too.
And attending all appointments and completing chemo or radiation treatment is vital.
“For patients undergoing treatment, physicians can ensure that the patients understand the importance of receiving the full recommended course of treatment, and receive the support to tolerate the anticipated side effects,” Annunziata said.
Reach out for reassurance
Patients who are diagnosed with colorectal cancer have many resources for emotional support. The American Cancer Society offers support for all physical and emotional aspects of cancer 24 hours a day. The Colorectal Cancer Alliance offers comprehensive resource guides as well.
Support groups, through local hospitals or communities, can also be extremely helpful.
Reading the stories of Black patients who are surviving and thriving despite a colorectal cancer diagnosis can be incredibly inspiring as well.
It’s also very important for Black patients to let their doctors know if they don’t have the support they need. A doctor can help by navigating extra help within a patient’s community – an approach that is truly breaking down barriers to CRC care.
“What’s very encouraging is that meaningful improvements in CRC screening rates and early detection among Black communities have been seen through purposeful interventions and outreach,” Willis said. “In this way, all doctors can play a significant role at a broad and systemic level by advocating for and implementing interventions in their communities.”
