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Lack of Screening Led to Higher Colon Cancer Rates for Black Veterans

A Black doctor putting her arm on a Black male patient

Jose Luis Pelaez Inc / Getty Images

Key Takeaways

  • A recent study found that Black veterans are less likely to get a colonoscopy compared to White veterans.
  • Early screenings can help people at risk for colorectal cancer be treated before cancer develops.
  • But accessing that screening and care due to a lack of health insurance or other issues can be difficult.

Black people are at a higher risk of developing colorectal cancer, but not due to genetics. New research continues to point to early screening access as the factor that makes all the difference.

A new study from the Regenstrief Institute looked into whether race, age, and sex played a role in which people were more likely to get screened and more likely to get diagnosed with colorectal cancer.

They found that while Black people are diagnosed with colorectal cancer at higher rates than White people, they also were less likely to be screened for the condition.

The researchers used data from more than 90,000 military veterans between the ages of 40 and 80 screened at fourteen Veterans Affairs medical centers in the United States. The study was published ahead of print in the Journal of Clinical Gastroenterology.

Early Screening Is Crucial

Researchers found that Black veterans were diagnosed with colorectal cancer and advanced neoplasia at higher rates in comparison to White and Hispanic veterans.

But, when examining a subgroup of people who received routine screenings, the risk was equal for Black patients and White patients. This suggests that the differences in risk aren't biological.

"What this study does is it specifically looks at a fairly homogenous group of people since they're all veterans, so they're part of the VA hospital system," Anton Bilchik, MD, PhD, surgical oncologist and chief of medicine at Saint John’s Cancer Institute at Providence Saint John’s Health Center, who was not involved in the study, tells Verywell. "These veterans have access to health care and they have access to screening colonoscopy."

Before being diagnosed with colorectal cancer, many develop early-stage precancerous polyps. Regular and early screenings such as colonoscopies can help doctors detect and treat these polyps before they develop into cancer.

“If we as Black people get our colonoscopy done...then there shouldn't really be much difference between Black and White people,” Adeyinka O. Laiyemo, MD, MPH, gastroenterologist and associate professor of medicine at Howard University College of Medicine, tells Verywell.

Recent research also shows that colorectal cancer is affecting people at a younger age. A May report from the U.S. Preventive Services Task Force now recommends that people start screenings at the age of 45.

"It's an important study, among many many studies that just stress the fact that colon cancer is affecting younger people, particularly people of color, and that screening should be performed before age 50," Bilchik says.

Beyond starting those screenings early, people should pay attention to changes in their body like abdominal pain and rectal bleeding. "That's really important because sometimes those are the early signs of colon cancer, and we know that colon cancer is picked up early, it's treatable and beatable," Seth A. Gross, MD, a gastroenterologist and advanced endoscopist, tells Verywell.

Colorectal Cancer Disparities

Black people are 20% more likely to develop colorectal cancer and 40% more likely to die from this form of cancer than people of other races, according to the American Cancer Society.

But for many people, getting an early screening isn't a simple task.

There are various societal and environmental factors that contribute to these disparities. According to the Dana Farber Cancer Institute some of these include:

  • Less access to cancer screenings. Some people may not have access to adequate health insurance to cover screenings.
  • Structural racism, which could also continue to impact the care that a Black person receives after a colorectal cancer diagnosis.
  • A shortage of Black physicians in some areas and a lack of familiarity with Black economic and social conditions.
  • Comorbid conditions, or having one or more conditions simultaneously.

Having a Conversation With Your Family

As someone who works predominately with Black patients, Laiyemo says that one of the most important steps that Black people can take is to talk to their family members about any family history of colon cancer. When possible, you should encourage others to get a colonoscopy or an alternative screening.

"So when we are in a situation where, in our families as Black people, we are not discussing colon cancer, then you may not realize it's supposed to be screened for," he says.

Laiyemo adds that doctors and family members can help alleviate concerns about getting colonoscopies.

"Family members and healthcare providers should also bring the issues up with their patients, and slowly but surely we will get everybody," he says.

What This Means For You

There are also additional factors that could increase your chance of developing colorectal cancer. People who live with Crohn’s disease, ulcerative colitis, familial adenomatous polyposis, and hereditary non-polyposis colorectal cancer (Lynch syndrome) are at a higher risk of developing this type of cancer. To reduce your risk you should consider regularly exercising and getting your servings of daily fruits and vegetables. You can also limit your alcohol consumption and stop smoking tobacco.

Alternatives to Colonoscopies

One barrier to early screening for some people can be discomfort with colonoscopies, an examination typically used to check for colorectal cancer. If you or someone you know is uncomfortable with getting a colonoscopy, there are alternatives.

"There's no one-size-fits-all. [The] best test is the one that's a person's willing to get done," Gross says. "There are some radiology tests like such as CT—or CAT scan—colonography."

The Centers for Disease Control and Prevention (CDC) recommends that people speak to their doctors about which of the following tests may be right for them:

  • Stool tests, where stool is collected and sent to a lab. These include a guaiac-based fecal occult blood test, fecal immunochemical test, and FIT-DNA test.
  • A flexible sigmoidoscopy, where a doctor puts a short, thin, flexible, lighted tube into a patient's rectum. A doctor would check for polyps or cancer inside the rectum and lower third of the colon.
  • Computed tomography (CT) colonography, where X-rays and computers are used to produce images of the entire colon for a doctor to view.
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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Imperiale TF, Daggy JK, Imler TD, et al. Prevalence of advanced colorectal neoplasia in veterans: effects of age, sex, and race/ethnicityJ Clin Gastroenterol. Published online May 28, 2021. doi:10.1097/mcg.0000000000001402

  2. Simon K. Colorectal cancer development and advances in screening. Clin Interv Aging. 2016;11:967-976. doi:10.2147/cia.s109285

  3. U.S. Preventive Services Task Force. Colorectal cancer: screening. Updated May 18, 2021.

  4. American Cancer Society. Colorectal cancer rates higher in African Americans, rising in younger people. Published September 3, 2020.

  5. Dana Farber Cancer Institute. Colorectal cancer in the Black community: information to know. Updated May 10, 2021.

  6. Centers for Disease Control and Prevention. What are the risk factors for colorectal cancer? Updated February 8, 2021.

  7. Centers for Disease Control and Prevention. Colorectal cancer screening tests. Updated February 8, 2021.