Despite advances in medicine, colorectal cancer remains a significant threat, particularly among minority communities. Shockingly Black Americans face the second-highest mortality and incidence rates in the U.S., being 35 percent more likely to die from colorectal cancer and 15 percent more likely to develop it than non-Hispanic whites, according to the Colorectal Cancer Alliance (CRC).
Tragically, colorectal cancer has become the second leading cause of cancer death in Black Americans, and the disease is increasingly affecting younger generations, becoming the deadliest cancer among men under 50. Researchers predict it will soon become the leading cause of cancer death in men and women ages 20-49. Black Americans are also 30 percent more likely to develop young-onset colorectal cancer.
Moreover, one in four Black Americans is diagnosed with colorectal cancer at later stages, when treatment becomes challenging. Colorectal cancer can develop silently, without symptoms, until it reaches advanced stages, which makes a proactive approach crucial. BlackDoctor.org spoke with Dr. Cedrek McFadden, a colorectal cancer surgeon and member of the Colorectal Cancer Alliance Medical Scientific Advisory Committee, to discuss these disparities, the prevention and treatment strategies available, and how individuals can take charge of their prostate health.
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Can you start by discussing the key factors contributing to minorities’ higher rates of death from colon cancer?
Dr. McFadden: Family history plays a role, but most patients with colorectal cancer don’t have a family history. Diet is also crucial; diets high in red and processed meats can increase risk. Additionally, obesity and social determinants of health, like access to healthcare and effective communication with doctors, play significant roles. This collective of factors, rather than a single cause, contributes to higher cancer rates in African Americans.
How can healthcare providers and communities work together to improve the outcomes for minority patients?
Dr. McFadden: Number one, see your doctor. Take the advice of the doctor for the improvement of your health and the maintenance of your health. Also, feel comfortable and speak up during those visits about things that you may be facing about your health.
It’s important that the doctors appropriately recommend screening tests at the right time and with the right frequency, that we have the right screening test for the right patients, and that we advocate for appropriate care for cancers that are diagnosed, whether it be surgery, whether it be potential radiation or chemotherapy, and in the inclusion of clinical trials. There’s a lot of responsibility that we have as doctors, but also patients have responsibility as well. It’s a partnership together that both parties have to recognize.
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As a surgeon, can you talk about how your background in treating disorders that affect the large intestine informs your approach to colorectal cancer prevention and treatment?
Dr. McFadden: Having inflammatory bowel disease, that’s a risk factor for colon cancer, and we form partnerships with our patients, especially those that have Crohn’s disease and ulcerative colitis, so they know that we’re going to be looking more frequently for colorectal cancer. That means more frequent colonoscopies. There may be biopsies that are obtained during those procedures because if your large intestine, is chronically inflamed, it may allow for the development of colorectal cancer. So we want to be very proactive about our screening and surveillance in these patients.
And there are occasions where patients who have ulcerative colitis, where their advanced disease or precancerous lesions may encourage conversations about definitive surgeries that may remove the large intestine [and] the colon, to help prevent further propagation or further advances of colorectal cancer. We’re very proactive about looking at their risk and ensuring that [the] surgeon, gastroenterologist, [and] patient, [are] all united in our goals of prevention and care [to] reduce their risk of colorectal cancer and [ensure] that their cancer is adequately and appropriately treated.
You mentioned screening, which is an important prevention method to catch the disease early. Can you talk about how patients can overcome barriers to getting screened?
Dr. McFadden: I think you have to identify where they are as we talk about how we overcome some of the barriers to screening. So that’s the cost of the test, that’s the ability to have the doctor recommend and actually administer or deliver the test, but then there’s also some of the barriers about the fears about getting the test, the fears of what might be found and how that could impact your life.
In some ways, it requires us to potentially face our own mortality. It’s the fear of the unknown. And so I think it’s always an important time to identify what those fears are and to speak to the fears with the patients to help them understand the importance of the test and maybe how those fears can be dealt with.
The financial cost, prohibits many patients. Fortunately, we have a lot of support. The Colorectal Cancer Alliance is one of those that provides options for patients to get screenings. And so it’s important that patients not only reach out to the Colorectal Cancer Alliance, but to their individual healthcare providers to see if there’s assistance available for them to get the appropriate screenings.
As you mentioned, many people may be fearful of getting colonoscopies. Do you have any advice for them?
Dr. McFadden: I would say that it’s important to acknowledge that fear, to understand where it comes from. But then it’s also important to understand the potential consequences of not having a colonoscopy. What are the benefits of having a colonoscopy? We know that a colonoscopy is not just a diagnostic test, it’s also a treatment for colorectal cancer. So if there is a potential polyp that is found, we can remove that polyp before it becomes cancer. And so I think understanding what the colonoscopy is and what the benefits are can often help remove some of those fears.
But there are also other tests that are available besides colonoscopies, and those are things that can be done at home. The Cologuard test is a test that you can do at home. It’s also important to understand that just because you do the Cologuard test and it’s abnormal, doesn’t mean that you have cancer, but it does mean that you need further testing and that further testing may need to be a colonoscopy. So there are options that are available for people who are fearful of colonoscopies, but those options should be discussed with a healthcare provider to see if those are appropriate for that individual.
How often should individuals get screened for colorectal cancer?
Dr. McFadden: The recommendation is that we start screening for colorectal cancer at age 45 for the average-risk individual. And then how frequently depends on the individual patient, their risk factors, their family history, [and] the type of screening test they had. So the gold standard, of course, is the colonoscopy, and if you have a colonoscopy and there are no findings, then that’s typically every 10 years. But there are other tests available that can be done more frequently. That’s the Cologuard test, a test that can be done at home. That’s a test that has to be done every three years. But again, it depends on the individual patient, depends on their risk factors, depends on their family history, so it’s important to have that conversation with your healthcare provider to see what’s the right test at the right time for that patient.
The Colorectal Cancer Alliance provides valuable resources. Can you talk about the work that they do?
Dr. McFadden: The Colorectal Cancer Alliance, provides a lot of support, a lot of information, [and] a lot of resources for patients and their families who are facing colorectal cancer. So that can range from educational materials about what is colorectal cancer, the treatments available, [and] the screening tests available.
They also provide a lot of support for patients who are undergoing treatment for colorectal cancer. That could be support groups, that could be financial assistance, that could be assistance with getting screenings [and] the appropriate care that they need. The Colorectal Cancer Alliance provides a wide range of resources for patients and their families who are facing colorectal cancer.
Is there anything else you’d like to share about colorectal cancer treatment and prevention?
Dr. McFadden: Yeah, I think that it’s important to recognize that your health is your wealth and that it’s important to advocate for yourself. It’s important to seek second opinions if you feel that’s necessary. It’s important to ask questions of your healthcare team because that’s the only way that you’re going to understand what’s happening with your health and be able to advocate for yourself. So I think it’s important that patients feel empowered to ask questions and seek help when they need it.
For more information, about colon cancer symptoms and risk factors, visit the Colorectal Cancer Alliance.
