Colorectal cancer and race: What Black men and women need to know

Last updated Oct. 4, 2021

Despite an overall decline in colorectal cancer cases and deaths over the past several decades, Black men and women are still more likely to get the disease and more likely to die from it than people in any other racial group.

What’s behind this difference in colorectal cancer rates?

“The relationship between race and colorectal cancer is complex,” says George Chang, M.D. “But we do know that the differences in incidence and survival are mostly due to disparities in access to health care and the age of diagnosis.”

Because of these factors, colorectal cancer in Black men and women is less likely to be prevented or detected early by screening, when it’s most treatable.

Why is colorectal cancer screening important?

Screening colonoscopy exams detect cancer early when treatment is most effective. They also can prevent colorectal cancer. During a colonoscopy, a doctor can remove precancerous adenomas and polyps before they turn into cancer. 

“The single most important thing you can do to reduce your risk for colorectal cancer is to get screened,” says Chang. 

Why are colorectal cancer screening rates lower among Black men and women?

Unfortunately, Black men and women get screened for cancer at lower rates than other groups. It can be difficult for researchers to separate all the different factors that affect screening rates, says Chang.

“It’s hard to know why screening rates are lower among Black men and women. How do you unpack individual and community attitudes toward screening and health institutions, lack of awareness about the benefits of screening, and limited access to quality care for those who are underinsured or uninsured?” says Chang.

Chang notes that when the state of Delaware removed these barriers to screening and care, they eliminated the difference in colorectal cancer rates between the Black community and groups in other races.

The state paid for screening for low-income patients, assigned patients a nurse navigator to help them manage their care, and worked with churches to raise awareness about the benefits of screening. The state also covered the cost of treatment for uninsured patients with colorectal cancer.

“In a span of eight years, disparities in screening were eliminated, incidence rates were equalized, and mortality differences were nearly eliminated,” says Chang.

Low-cost colorectal cancer screening options are available

Colonoscopy is the gold standard for colorectal cancer screening. But if cost or discomfort are stopping you from getting a colonoscopy, there are alternatives.

Stool-based tests can detect markers – or clues – that might indicate cancer. There are several types of stool-based tests. The most accurate is the stool DNA test, which can find changes in DNA that happen as colorectal cancer develops. A doctor must prescribe these tests.

Keep in mind that if a stool-based test shows signs of cancer, your doctor will likely recommend you get a colonoscopy. This colonoscopy will be considered a diagnostic test, not a screening test, and that could affect the cost.

No matter which test you choose, you should begin regular colorectal cancer screening at age 45. If you are at the recommended age for colonoscopy and you are insured, your insurance will cover all or most of the cost of the test.

Younger age means later stage

Colorectal cancer is on the rise in people under 35. This is especially true in the Black population.

Young people often aren’t thinking about cancer, so they may be more likely to ignore symptoms, and they are years away from regular screening exams that might catch the disease.

“We know that being younger at diagnosis means the cancer will be at a later stage,” says Chang. “That makes the cancer harder to treat.”

For younger people, a family history of cancer can be a valuable clue that they should be concerned about their colorectal cancer risk and may need to be screened earlier.

To determine if you have a family history of colorectal cancer, trace out three generations of your family cancer history, if possible. Find out who had cancer, how you are related, what type or types of cancer they had, and what age each person was diagnosed. Focus on first- and second-degree relatives. First-degree relatives are parents, siblings, and children. Second-degree relatives are aunts, uncles, nephews, nieces, and grandparents.

Pay attention to colorectal cancer symptoms

No matter your age, be familiar with your body and your bowel habits, and see a doctor if colorectal cancer symptoms appear. Talk to your doctor if symptoms last more than two weeks.

Symptoms of colorectal cancer include blood in the stool, changes in stool frequency, narrow stools, frequent abdominal pain that doesn’t go away, unintentional weight loss or unexplained loss of appetite. 

“A lot of people think these symptoms are nothing, or because it’s related to their bowels, they just don’t want to think about it at all,” says Chang. “It’s normal to have bowel movements. Bowel function is normal. If you have a change in your bowel habits, don’t ignore it.”

Healthy choices can reduce colorectal cancer risk

In addition to getting screened and learning your family history, there are healthy choices that can help reduce your risk for colorectal and other chronic diseases. These include:

• Don’t smoke or use tobacco products
• Maintain a healthy weight
• Eat a plant-based diet
• Be physically active
• Limit red meat
• Avoid processed meat
• Limit alcohol

“Research shows that diets that are heavy in processed foods and low in fresh fruits and vegetables increase cancer risk,” says Chang. “We know that fresh fruits and vegetables are good. We know that too much red meat is not good.”

While colorectal cancer is more common among Black men and women, knowing your family history, making healthy choices, and getting screened can all help you take control of and reduce your risk.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.