Black Men and Women Are at Higher Risk of Colorectal Cancer: What You Should Know

One of the cruel realities of cancer is that Black men and women are more likely to get colorectal cancer than any other racial or ethnic group in the country — and even worse, are more likely to die of the disease.

In May 2021, the nation’s top panel for guidance on preventing cancer took a major step against colorectal cancer. The US Preventive Services Task Force lowered the recommended age to begin screening for colorectal cancer from 50 years of age to 45 — a step that some experts had already urged for Black patients.

To find out how to protect yourself against colorectal cancer, and how the new screening age guidelines may help, we sat down with MSK’s Robin Mendelsohn. She is a gastroenterologist and co-director of MSK’s Center for Young Onset Colorectal and Gastrointestinal Cancer, the world’s first facility devoted to the specific needs of people with colorectal and gastrointestinal cancers who are younger than 50.

Why are Black people more likely to get colorectal cancer and die of it?

The reasons are complex. But research suggests the most important factors in this disparity are access to high-quality screening and cancer care — not biological issues.

For example, several of my MSK colleagues and I were involved in research involving colonoscopies, which are considered the gold standard of colorectal screening. They use a camera at the end of a long tube to look inside the colon and rectum for polyps, which are growths that can turn into cancer. A colonoscopy can also remove these polyps.

In our research, Black and white patients had equal access to high-quality colonoscopies. We found there were no differences between Black and white people in the number of polyps or cancers that were found. Other research has reached the same conclusion: The disparity is linked to a difference in how much access people have to high-quality screening and care.  

What are the barriers to high-quality screening and care that Black adults may face?

There can be many. Sometimes doctors and other healthcare providers don’t take the opportunity to urge people to get colorectal screening when they are seen for another reason, like a sore throat or more serious ailment. That encouragement from nurses and doctors is really important — often times for women it comes from their gynecologists.

Some people believe they don’t need screening because they don’t have symptoms, like rectal bleeding. But often there are no symptoms until the cancer is advanced, when it’s harder to treat. When colon cancer is found early, it has a high cure rate.

Of course, some people are worried about the preparation that’s needed for a colonoscopy or are squeamish about — let’s face it — poop. However, research shows that people who do colorectal screening once are much more likely to do it again.

There can also be concerns related to expense, particularly for people who don’t have health insurance. Colorectal screening is very cost-effective, but the best kind of screening — the colonoscopy — is the most expensive test. That can intimidate people. But people should know the cost is usually covered by insurance, including Medicare or Medicaid.

Why was the recommended age to begin colorectal screening lowered from 50 to 45?

For the last several years, there has been a disturbing rise in the number of younger adults who develop colorectal cancer — people in their 20s, 30s, and 40s. The new, younger screening age is intended to help.

Most of this rise has been among younger white adults, particularly those with rectal cancer. Colorectal cancer rates among younger Black adults, by contrast, have been pretty flat.

But Black people of all ages — including younger adults — are more likely to get colorectal cancer and to die of it than other groups. So even though the numbers aren’t rising for younger Black adults, they are already suffering more from colon cancer than any other group.

Does the lower age of screening help?

I think it will.

The new recommendation means that if you are 45 and insured, your insurance will cover all or most of the screening method you use. That helps more people get appropriate screening.

Also, the lower screening age means the conversation between patients and healthcare providers can begin earlier. More awareness helps.

The tragic death of Chadwick Boseman from colon cancer at just 43 highlighted two crucial issues about colorectal cancer: the greater burden borne by Black people and how vulnerable younger adults are to a disease that’s often thought of as “an old person’s cancer.”

What steps do you recommend people take?

First, it’s important to understand that colorectal screening saves lives. If you are 45 or older and haven’t been screened, advocate for yourself. Talk to your primary care physician or healthcare provider.

Equally important is to talk to your family. Is there a history of colorectal cancer in the family or of advanced polyps, which could grow into cancer? If so, you should talk to your doctor about screening no matter what age you are. Higher risk could run in the family and you may be eligible for screening at an earlier age.

You are also at higher risk if you have been diagnosed with polyps yourself, or if you have a history of inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, or a history of radiation to the abdomen or pelvis.  

Finally, don’t ignore possible symptoms. If you have rectal bleeding, stomach pain, change in bowel habits, or unexplained weight loss that lasts a couple of weeks, you should talk to a healthcare provider.

What should people know about the different kinds of colorectal screening tests?

Broadly, there are two kinds: imaging, like colonoscopy, and stool-based tests. Stool-based kits need to be done every year or every three years, depending on the test. If they are positive for cancer, they still need to be followed up with a colonoscopy. 

Stool-based tests are good at detecting cancer. But they are not as good at detecting polyps that can become cancer.

Colonoscopies can detect polyps and also remove them. So, a colonoscopy can not only find cancer, but actually prevent it in the first place. A colonoscopy only needs to be done every 10 years if no polyps are found.

However, the best screening test is the one you’ll actually get, whether it’s an imaging test or a stool test.

How is MSK helping to solve this cancer disparity?

MSK does outreach to many different communities to highlight the importance of colorectal screening and health through patient information sessions, health fairs, and other efforts.  

Physicians at MSK have been involved in an initiative in New York City called C5 — Citywide Colorectal Cancer Control Coalition — from the beginning. Since 2003, this group has been part of the NYC Department of Health outreach efforts to increase colorectal screening. Over the past two decades, C5 has helped increase colorectal screening rates by 64% in New York City — and the rates of screening among Black adults are among the highest of any group in the city.

New research from a team that includes my MSK colleagues Ann Zauber and Sidney Winawer finds that fewer Black people in New York City are developing colorectal cancer and fewer are dying from it thanks to increased screening. However, Black New Yorkers are still suffering a higher burden from colorectal cancer than other groups. People need to be aware of this disparity and we need to make sure that healthcare is equitable for everyone.