Communities of color, particularly Black Americans, have long faced health disparities and a disproportionate burden of cancer. Colorectal cancer is no exception.
Colorectal cancer occurs at a higher rate in Black Americans than any other racial or ethnic group in the U.S., according to the American Cancer Society. African Americans are more than 20% more likely to get the disease and 40% more likely to die from it than most other groups. These disparities were highlighted in a recent editorial co-authored by Christopher Manz, MD, MSHP, and Deborah Schrag, MD, MPH, members of the Division of Population Sciences and gastrointestinal oncologists at Dana-Farber/Brigham and Women’s Cancer Center.
Studies have shown that colorectal cancer in Blacks is more likely to occur on the right side of the colon, where it can be more difficult to detect with standard screening techniques. This may result in its not being diagnosed at an early stage, when it is easiest to treat.
It is important for everyone to be aware of these disparities, screening recommendations, and other critical information regarding colorectal cancer to make informed decisions about their healthcare.
What is colorectal cancer?
Colorectal cancer is a form of cancer that originates in either the colon (the largest part of the large intestine) or rectum (the final portion of the large intestine that connects the colon to the anus). An oncologist may refer to the disease as either “colon” or “rectal” cancer depending on where the cancer originates. Often, the two are collectively referred to as “colorectal cancer,” as they share many similarities.
Colorectal cancer typically occurs in patients age 50 and older, but recently, incidence rates are on the rise in young people (under the age of 50) while decreasing in older adults (50+). While the reasons for this are unknown, researchers believe it may have to do with changing lifestyle habits, new environmental exposures, or other factors.
What are the risk factors for colorectal cancer?
It’s important to be aware of the risk factors for colorectal cancer, including:
- Increasing age: Most people who develop colorectal cancer are 50 or older.
- A family history of cancer of the colon or rectum.
- Certain hereditary conditions, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer, also called Lynch syndrome.
- A history of inflammatory bowel disease, such as ulcerative colitis and Crohn’s disease.
- A personal history of cancer of the colon, rectum, ovary, endometrium, or breast.
- A personal or family history of adenomas (polyps) in the colon or rectum. These growths can be pre-cancerous. Most adenomas will not turn into cancer. However, regular screening to remove them reduces the risk of developing colorectal cancer.
Factors related to environment and lifestyle factors include:
- Lack of exercise: According to the American Institute for Cancer Research (AICR), studies show that regular physical activity — at least 30 minutes per day — supports your immune system, reduces inflammation, and helps your body maintain healthy levels of insulin and estrogen, all of which may lower your risk of cancer. Exercise may be especially potent for lowering your risk of colorectal, breast, and endometrial cancer. Exercise is also an important part of any weight management plan.
- Obesity: According to AICR, a strong link exists between excess body fat and the risk of 12 different kinds of cancer. We now understand that body fat secretes substances that may make it easier for cancer cells to develop and grow. Any steps taken to reduce weight — or limit weight gain over time — are helpful for managing cancer risk. Strategies that can help with weight management include eating more fruits, vegetables, and whole grains, along with protein from healthy sources like seafood, poultry, beans and soy foods. It’s also important to limit sugary beverages, alcohol, and processed foods, and be physically active most days of the week.
- Smoking: Smoking is the leading cause of cancer worldwide, causing almost 6 million deaths each year according to the AICR. There are no good forms of smoking, including vaping which still contains harmful chemicals. For help quitting smoking, you can call the national Smokers’ Helpline (1-800-QUIT-NOW) for programs in your state or talk with a medical professional to learn more. The number for the Massachusetts Smokers’ Helpline is 1-800-TRY-TO-STOP (1-800-879-8678). See Quitting Smoking for additional resources.
- Alcohol consumption: Strong evidence points to alcohol consumption raising your risk of several types of cancer, including colorectal, regardless of whether you’re drinking beer, wine or liquor. The AICR recommends women consume no more than one drink per day, and men no more than two. One drink is a 12-ounce beer, 5-ounces of wine or 1.5-ounces of liquor. Less is even better. Measure your pour at home so you know whether your serving is larger than recommended.
- A diet high in red and processed meat: Research suggests that eating more than 12-18 ounces of cooked red meat per week increases the risk of colorectal cancer. Red meat includes beef, pork, and lamb. A 3-ounce serving is about the size of a deck of cards, so aim for no more than four to six “decks of cards” of cooked red meat weekly. The AICR especially recommends staying away from processed meats like ham, hot dogs, bologna, salami, bacon, and sausages (including those made from chicken and turkey). Limit these to only occasional use.
Colorectal cancer screening
Regular screenings are the best way to prevent colorectal cancer, and there are a number of ways to screen for the disease, with colonoscopy being the gold standard. The American Cancer Society and U.S. Preventive Services Task Force (in draft form) recommend that people at average risk begin colorectal cancer screening at age 45.
Most colorectal cancers originate as precancerous polyps (growths) on the inner lining of the colon or rectum. The only effective way to detect these growths and remove them before they turn cancerous, is with a colonoscopy.
Before beginning regular screenings, be sure to speak with a medical professional. They’ll be able to review your risk factors and determine which age, and type of screening, is right for you.
Addressing colorectal cancer disparities in the Black community
Factors contributing to the disproportionately high rate of colorectal cancer in Black Americans include:
- Less access to cancer screening services
- Structural racism
- Social determinants of health (the environments in which people are born, work, play, worship)
- A shortage of African American physicians in some areas and lack of familiarity with Black economic and social conditions
- Comorbid conditions (more than one illness or disease occurring at the same time)
- Severity of disease presentation (staging at diagnosis)
- Inequitable access to cancer treatment
A specific example: Colorectal cancer screenings, which are a proven way to spot early stages of colorectal cancer, typically take place at a health care facility. This requires access to health insurance, an established relationship with a trusted physician or clinic, reliable transportation, and time off from work. For those unable to step away from their jobs, have unstable housing, or pressing responsibilities (elder-care or childcare, for example), it may be difficult to take the time to undergo screening tests.
“Disentangling the relative contributions of each of these potential barriers to care is critically important because it prioritizes strategies for eliminating disparities,” explains Schrag, one of many Dana-Farber researchers conducting studies into the causes of cancer disparities and approaches to alleviating them. “We must build trust, especially in communities where it has historically been in short supply.”
Dana-Farber is committed to offering quality cancer care to all patients regardless of their race or socioeconomic status. The Institute has a dedicated team of resource specialists working to connect income-eligible patients with available resources, both at Dana-Farber and in the greater Boston community.
Dana-Farber also offers patient financial assistance to eligible patients who do not have the ability to pay for their healthcare. To learn more about financial assistance, and to connect with a financial counselor, call 617-582-9820.
Finally, investigators have worked in the lab, clinic, and the community to improve access to quality cancer care, heighten awareness of cancer risk and prevention, and improve treatment outcomes for Black, Latinx, and other people of color or underserved groups.
- A Dana-Farber/Harvard Cancer Center (DF/HCC) effort to increase underserved communities’ access to clinical trials of new cancer therapies
- A prostate cancer screening initiative by Dana-Farber, DF/HCC, and the Harvard T.H. Chan School of Public Health that seeks to improve outcomes for patients and reduce disparities in cancer mortality.
- Dana-Farber and DF/HCC projects to expand early detection of liver cancer and melanoma skin cancer and improve access to treatment of these diseases.
- The launch by the Dana-Farber Young-Onset Colorectal Cancer Center of the Colorectal Cancer Count Me In Project, which will partner with patients in collecting biospecimens and information on diet and lifestyle for research into the risk factors and causes of the disease in younger patients. A main goal of the project is to include patients from underrepresented groups.
As colorectal cancer continues to rise in young adults, Dana-Farber is also working to address the unique situations and issues facing these patients. Recently, the Institute’s Young-Onset Colorectal Cancer Center held its second annual Patient and Family forum featuring Ibram X. Kendi, PhD, one of America’s foremost historians and leading antiracist scholars. He is also a stage IV young-onset colon cancer survivor.
During his speech, Kendi discusses his cancer experience and how we can make cancer care and research equitable for all. You can watch the full event here.