By Alex Williams, MD
Colorectal cancer is the second-leading cause of death from cancer in both men and women in the U.S. And while it is promising to note that overall colorectal cancer rates have been falling, largely due to increased screening, racial disparities vastly impact the incidence and outcomes for patients in this country.
These disparities exist across many diseases and affect many groups, but the data for colon cancer is compelling. Compared to whites, African Americans have a 20% higher incidence of colorectal cancer. They are more likely to develop the disease at younger ages, to be diagnosed further along in their illness, and to die of their disease. In fact, African Americans have the lowest five-year survival rate for colorectal cancer of any racial group in the country.
There is hope. Colorectal cancer is very preventable with early detection. Unlike other cancers found at varying stages, colorectal cancer begins as a polyp in the colon before it actually becomes cancer. Successful management of the disease requires access to screening.
The gold standard for colorectal screening is a colonoscopy. But that is not the only option. Alternatively, there are tests that can check for blood in the stool. While not immediately conclusive, they can provide a level of screening for patients who may otherwise not have access to or a comfort level with getting a colonoscopy. Any test is better than no test.
The fecal immunochemical test (FIT) checks for hidden blood in the stool from the lower intestines. Ideally, this test is done every two to three years. FIT testing should only be used for average-risk patients, not those with a personal or family history of polyps or colon cancer, or patients with inflammatory bowel disease.
Stool tests can be done yearly, often during an annual physical by a primary care provider. A positive test demands further investigation. False positive results from simple things like hemorrhoids make this a less than ideal test, but follow-up colonoscopy from positive tests have been shown to save lives.
Even an x-ray can serve as a screening exam if there are no other options. Polyps will appear darker on an x-ray and may offer clinical information that a physician can use to convince a patient to investigate further.
In 2018, the American Cancer Society modified its guidelines to recommend beginning screening at age 45 for individuals of all races. These newer guidelines are expected to have an impact in reducing early-onset colorectal cancer incidence.
In partnership with colleagues from many health care organizations, I have worked for decades to encourage colorectal screening – especially among minority communities. We know patients will be receptive to messages coming from trusted sources. To that end, we’ve visited churches, worked with local colleges and hosted events to share information about gastrointestinal tract health. Even with the challenges of hosting these events in more recent times, our overarching messages remains unchanged: get tested and make sure to follow up if it is indicated.
Most major health systems in our area have free clinics and resources to help socioeconomically disadvantaged patients get access to screening. For those with insurance, preventative care is often fully covered.
Dr. Williams is with Gastrointestinal & Liver Specialists of Tidewater, PLLC, providing liver and gastroenterology care. He specializes in Colorectal cancer, occult GI bleeding, M2A capsule, hepatology and ERCP. glstva.com
