February is Black History Month and Cancer Prevention Month
Inova Schar Cancer Institute oncologist Timothy Cannon, MD, recently treated a middle-aged black man with aggressive colorectal cancer. The patient is a real-life representation of new national data pointing to substantially higher rates of this disease in African Americans.
Not only do African Americans have the shortest survival rate of any racial or ethnic group in the United States for most cancers, but they also have the highest incidence of colorectal cancer. Nearly 20,000 new cases of colorectal cancer were expected in the United States among African Americans in 2019, with incidence rates 24 percent higher in black men and 19 percent higher in black women compared to other races, according to the American Cancer Society. Black colorectal cancer patients are also 15 to 20 percent more likely to die from the disease than patients of any other race.
With February marking both Black History Month and Cancer Prevention Month, Dr. Cannon says colorectal cancer awareness among African Americans is especially crucial.
Symptoms may include a change in bowel habits such as diarrhea or constipation, rectal bleeding with bright red blood, blood in the stool making it look dark, cramps or abdominal pain, and feeling like the bowel isn’t emptying completely with a bowel movement.
“Black people have a higher incidence of colorectal cancer that also tends to be a more aggressive subtype. They also have worse outcomes,” explains Dr. Cannon, who has particular expertise in managing gastrointestinal cancers. “It’s important because it’s a fairly big problem, and it may be solvable.”
Occurring in the colon, rectum or both, colorectal cancer is the third-most common cancer in all adults in the United States, with the American Cancer Society predicting about 148,000 new cases in 2020. The black community’s heightened risk appears to be due to several contributing factors, according to Dr. Cannon. “Some biological factors may be at play,” he says, “but there are also socioeconomic factors that can make it more difficult for people to gain access to screening.”
Like his recent patient, African Americans with colorectal cancer are more likely to cope with an aggressive subtype fueled by a mutation in the KRAS gene, which drives cancer growth, Dr. Cannon says. This cancer in black people also occurs more often on the right side of the colon, another factor that can lead to poor prognoses, he adds.
Socioeconomic factors may also place some African Americans at a disadvantage by making it harder to seek timely screening or access high-fiber, minimally processed foods, which can lead to lower rates of colorectal cancer, Dr. Cannon says. “Their cancers tend to be harder to treat and grow more quickly, so the prognosis isn’t as good,” he adds.
In 2018, the American Cancer Society updated its colorectal cancer screening guidelines, lowering the recommended age of initial screening to 45, due to higher rates of the disease in younger people.
“But even before that, many expert bodies recommended African Americans get screenings at 45,” Dr. Cannon notes. “Unfortunately, fewer than half of African Americans are screened by 45.”
Dr. Cannon has considered formally assessing the severity of toxicities and tolerance of common colorectal cancer treatments in black Americans, as well as compliance. He says this is an important area of research.
While a colonoscopy is considered the gold standard colorectal cancer screening because cancer-causing polyps can be removed during the exam, Dr. Cannon emphasizes that any test is far better than skipping it altogether.
Other screening tests include:
- Fecal occult blood test, which can detect blood in a stool sample
- Cologuard, a stool DNA test you can take at home
- Virtual colonoscopy, which requires the same preparation as a colonoscopy, but no sedation, for those who are medically unable to undergo colonoscopy
Dr. Cannon’s recent patient, whose colorectal cancer has spread quickly, would have significantly benefited from screening, he says.