Although colorectal cancer is one of the most treatable forms of cancer, it disproportionately affects the Black community, where the rates are highest of any racial or ethnic group in the U.S., according to the American Cancer Society.

The reasons are complex, as there are multiple factors that contribute to the higher incidence of colorectal cancer in the community.

Here are Five Key Reasons:

#1: Lack of Adequate Health Care

Proper healthcare is instrumental in the fight against colorectal cancer. Screening tests can find precancerous polyps so they can be removed before they turn into cancer, according to the Centers for Disease Control and Prevention. They also can find colorectal cancer early when treatment is most effective.

The American Cancer Society now recommends that people at average risk of colorectal cancer begin regular screening at age 45. Blacks are less likely than Whites to get screened for colorectal cancer, and some of those concerns are related to expense, particularly for people who don’t have health insurance.

Although a colonoscopy is the most expensive screening method, there are other, more cost-effective options available. The cost might be a deterrent for some, although insurance, including Medicare or Medicaid, usually covers the cost of a colonoscopy. Please contact your doctor to discuss cost-effective screening options.

Even though Blacks have higher colorectal incidence than Whites, Blacks are less likely than Whites to receive a recommendation for colorectal screening, according to a National Institute of Health (NIH) study. Physicians, the study found, are less likely to recommend screening if they believe the patients won’t be able to pay for it.

For patients, trust in their doctor is an important factor in their decision to get screened for colorectal cancer, and Blacks have a history of mistrust in health providers, which can stem from negative experiences.

#2: Lack of Representation In Clinical Research

Clinical trials are carried out for all types and stages of colorectal cancer. Many patients may explore if a new treatment is safer and more effective than existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

Blacks have been historically underrepresented in clinical trials, accounting for just 5% of clinical trial participants in the United States, while White patients make up the vast majority of participants. Diverse representation in clinical trials is essential, as it allows researchers to learn how treatments work for and impact different populations.

The research community has been focusing its efforts on improving clinical trial diversity. It is important to study the genetic differences in patient populations regarding race and ethnicity. Studies that focus on colorectal cancer are ongoing and looking for patients. Learn more about one such study for patients with late-stage diagnosis, the OrigAMI-1 Colorectal Cancer Study.

#3: Not Knowing Family History

One risk factor for colorectal cancer is a family history of the disease, according to the American Cancer Society. This NIH study shows that Blacks may be less likely to know their family history of cancer than Whites, and family members are less likely to tell relatives about the finding of colonic polyps.

This lack of information could be a reason Blacks are less likely than Whites to get screened for colorectal cancer, leading to potentially higher incidences of diagnoses and fatalities related to the disease. Colorectal screening is critical, as many people with the disease do not have early warning symptoms.

Talking to people who know your family medical history can help you and your doctor determine if you are at an elevated risk for colorectal cancer. This knowledge can help ensure you get screened at the right time in the most appropriate way.

#4. Stigma about Getting a Colonoscopy

While the colonoscopy remains the gold standard for colorectal cancer screening, an exam used to look for changes — such as swollen, irritated tissues, polyps or cancer — in the large intestine (colon) and rectum, there’s a stigma associated with that part of the body, particularly for Black men.

This NIH study found that one particularly important barrier among Black men when it comes to colonoscopy is the view of the invasive procedure as a potential challenge to their masculinity. That, coupled with fear and embarrassment, may have contributed to low engagement in colorectal screening among this population, the study found.

It’s part of the reason efforts are underway to raise awareness of colorectal cancer among Black men, who have the highest incidence rates in the U.S., according to the American Cancer Society. For example, behavioral scientist Dr. Charles R. Rogers, who studies racial disparities in colorectal cancer, has targeted Black barber shops in his work to eliminate the stigma and increase screenings.

#5. Not Being Informed

While information about colorectal cancer may be available online, few within the Black community may truly know the elevated risks that they face in developing it.

At the very least, it’s important to know what symptoms to look out for that may be associated with colorectal cancer: a change in bowel habits that lasts more than a few days; a feeling you need to have a bowel movement that’s not relieved by having one; rectal bleeding; blood in the stool; abdominal cramping; feeling tired or weak; or losing weight without trying. You should contact your doctor if you are concerned about any of the symptoms you are experiencing.

Share this article with your loved ones and remind them of the importance of medical screening, doctor visits, and advocating for diverse patients to be represented in colorectal cancer research.