What Are My Colon Cancer Screen Options?

Written By: Melissa M. Murphy, MD,  Executive Chief of Surgery, Care New England Health System; Chief of Surgery, Kent Hospital on March 9, 2022

Are you turning 45 this year?  If so, there is an important health screening you should know about. While it’s something most would rather not think about, the American Cancer Society’s colonoscopy screening guidelines recommend starting colon cancer screening at age 45. In this blog, I will talk about your screening options and why it’s so important – specifically for Black Americans.  

By the Numbers
In 2019, an estimated 20,000 Black Americans were diagnosed with colorectal cancer with more than 7,000 deaths. People of color have the highest rates of colorectal cancer amongst any ethnic group in the United States.
  • The American Cancer Society reports Black Americans are 20% more likely to develop colorectal cancer and 40% more likely to die from it.
  • Colorectal cancer is the 3rd most common cause of death for Black Americans in the United States
  • Black Americans get colorectal cancer at an earlier age, present at later stages, and have a lower survival rate than White Americans.
Increasing Cancer Risk in Young Black Americans
In people under the age of 50, colorectal cancer has risen by 1.5% annually since 1992 for reasons not fully understood.
  • Among Black Americans, the rate of young-onset colorectal cancer is nearly twice as common among their white counterparts.
  • Black Americans have a 5-year survival at every stage that is worse than Hispanics or White Americans at the same stage.
Colon Cancer is Preventable
Approximately 90% of all colorectal cancer cases and deaths are preventable by removing polyps and treating colon cancer when detected early. However, screening among Black Americans is lower than for other ethnic groups – for several reasons:
  • Access to healthcare providers and testing 
  • Medical Mistrust
  • There are studies examining why Black Americans are less likely to proceed with colorectal cancer screening with some contributory reasons listed below.
    • General mistrust of doctors and the US healthcare system
    • Skepticism of provider motives
    • Fear of experimentation based on historical events
    • Invasiveness of procedure and “perceived” sexual connotation.

It is important for physicians to build relationships with their patients and provide them with the data to help the patients make an informed decision about colorectal cancer screening.

Diet, Genetics, & Lifestyle
Black Americans make up a disproportionate number of those with lower socioeconomic status which can directly impact access to healthcare, food, and resources.  

Here are some examples of what contributes to a high risk of colon cancer in the Black Community: 

  • Diets with more animal fat and less fiber are risk factors for colon cancer.
  • Lifestyle factors including tobacco use, obesity, alcohol use, decreased physical activity, and lower intake of Vitamin C and E are related to increased colon cancer risk.
  • Black Americans are more likely to develop polyps and colon cancer on the “right” side of the colon which can be harder to diagnose early.
  • Preliminary data that colorectal tumors in Black Americans are more likely to have molecular characteristics associated with worse outcomes including mutations in the KRAS gene (this can affect the ability of the body to repair errors made during DNA replication)
  • Black Americans males are more likely to decline a colonoscopy than other groups
Know the Symptoms of Colorectal Cancer
Speak with your primary care doctor if you notice any of the following.
  • Any change in your bowel habits (constipation, diarrhea, narrow stool)
  • Rectal bleeding/blood in your stool
  • Abdominal pain
  • Unexplained weight loss
  • Weakness and fatigue
  • The sense that you are not completing your bowel movement

Advocate for your health if you have any of these symptoms. But remember, not everyone with colorectal cancer has symptoms which is why screening is SO important.

The American Cancer Society recommends screening begin at age 45 or earlier if you have other risk factors including: 
  • Family/personal history of colorectal cancer
  • Genetic syndromes (Familial Adenomatous Polyposis Syndrome or Lynch Syndrome)
  • History of Inflammatory Bowel Disease (Ulcerative Colitis or Crohn’s Disease)
  • History of radiation to your abdomen/pelvis

There are different types of tests to screen someone for colorectal cancer.

  1. Visual tests

A. Colonoscopy

  • When a surgeon/gastroenterologist places a small flexible tube with a camera in your colon while you are receiving anesthesia. 
  • They can identify polyps (and remove them) or find concerning areas like cancer (take biopsies).
  • How often should you get a colonoscopy? It’s recommended you repeat this screening every 3-10 years - depending on the findings.

B. Virtual Colonoscopy

  • This is an advanced type of CT scan of the colon and rectum that creates a 3D image which can show abnormal areas like polyps or cancers. 
  • If there is something concerning on this test a routine colonoscopy needs to be performed.
2. Stool based tests

A. Cologuard

  • Stool DNA test used to identify any abnormal sections of DNA from cancer or polyp cells or look for blood.
  • These should be done every 3 years.
  • This can be done at home
  • If positive the patient will need a routine colonoscopy

B. Fecal Immunochemical Test (FIT)

  • Looks for hidden blood (occult) in the stool
  • Must be done every year
  • If positive the patient will need a routine colonoscopy
What Should I Do If I Think I Need to be Screened for Colorectal Cancer?
If you are over age 45, have family history of colorectal cancer, or any of the symptoms of colorectal cancer please consult with your primary care provider. 

If you are over age 45, have family history of colorectal cancer, or any of the symptoms of colorectal cancer please consult with your primary care provider. 

At Care New England we are committed to a culture of diversity, equity, and inclusion. We care about your colon health and want to make sure we provide care to you in a safe, comfortable, and respectful environment. 

Help us beat COLON CANCER. Get screened today!

Schedule A Colonoscopy

Disclaimer: While I am a doctor, I am not your doctor. The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis. If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.  

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