Blacks have a significantly higher risk than Whites for developing colorectal cancer. Increasing their participation in clinical trials is critical to exploring the disease’s impact on the Black community.
Colorectal cancer starts in the colon or the rectum. These cancers can also be called colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common.
Colorectal cancer is the third most common cancer diagnosed in the United States. The American Cancer Society estimates 106,180 new cases of colon cancer and 44,850 new cases of rectal cancer in the U.S. for 2022.
The rate of people being diagnosed with colon or rectal cancer each year has dropped overall since the mid-1980s, mainly because more people are getting screened and changing their lifestyle-related risk factors, according to the American Cancer Society. From 2013 to 2017, incidence rates dropped by about 1% each year.
But colorectal cancer disproportionately affects the Black community, where the rates are the highest of any racial/ethnic group in the U.S., according to the American Cancer Society. African Americans are about 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups.
The reasons for the differences are complex, but they largely reflect differences in risk factors and in health care access, both of which are related to socioeconomic status. Blacks in the U.S. often experience greater obstacles to cancer prevention, detection, treatment, and survival, including systemic racial disparities that are complex and go beyond the obvious connection to cancer.
“Colorectal cancer is the second deadliest cancer in the country,” said Durado Brooks, M.D., who has spent much of his career working to enhance the role of prevention in primary care and to improve care for medically underserved populations. “This disease is ravaging the Black community, and it is as important as ever that everyone has access to and is receiving the recommended screenings.”
According to NYU Langone’s Perlmutter Cancer Center, most experts recommend Black men and women start routine colorectal cancer screenings at age 45 because they’re more likely to get and die from the disease. Many experts recommend all adults with average risk, regardless of race, start getting screened at age 45. Colon cancer is usually slow growing and, in most cases, highly treatable in its early stages.
But medical professionals say a lot more research is needed to explore the disparities. In people younger than age 50, colorectal cancer incidence has risen by 1.5% annually since 1992 for reasons that are not fully understood, according to the National Institute of Health’s National Cancer Institute. Among African Americans specifically, young-onset colorectal cancer is nearly twice as common as it is among whites.
A study published in Journal of Clinical Oncology found that young African Americans fared significantly worse in terms of 5-year survival at every stage of disease compared with White and Hispanic patients. That differs from previous studies, which showed the most pronounced racial disparities in survival were among those with advanced-stage disease.
“Could it be due to differences in tumor biology, to differences in standard of medical care treatments that were offered, or to some sort of interactive response between tumor and treatment?” asked Elena Stoffel, M.D., of the University of Michigan Comprehensive Cancer Center. “In the end, we’re left with a lot of questions that only more research can answer.”
There’s also evidence that the right side of the colon ages faster in African American patients while the left side of the colon ages faster in White patients, according to this study published in the Journal of the National Cancer Institute. While this aging is normal, it does impact cancer risk and right-sided aging may present a more serious risk than left-sided.
Patients with right-sided colorectal cancer tend to have bigger, more advanced tumors than patients with left-sided colorectal cancer, found the study. More research is needed to explore these findings further, but the incidence of right-sided colorectal cancer in patients of color may help explain why the rate of cancer diagnosis is so high and often occurs in later stages among this group.
Clinical trials are used for all types and stages of colorectal cancer. Many focus on new investigational treatments to learn if a new potential treatment is safe, effective, and possibly better than the existing standard of care treatments. These types of studies evaluate new study drugs, different combinations of investigational treatments, new different approaches to radiation therapy or surgery, and methods of treatment.
Learn more about colorectal cancer clinical trials here.
This article is sponsored by Bristol Myers Squibb. If you’re interested in seeing if you qualify for an active colorectal cancer study, visit bmsstudyconnect.com.
