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Colon cancer: Another ‘silent killer’ within African-American community


Early testing can help save lives

For years, African-Americans have been about 20% more likely to be diagnosed with colon cancer and about 40% more likely to die from it than most other ethnic and racial groups. The disease has tragically taken the lives of Black celebrities, including actor Chadwick Boseman, soccer legend Pelé, and singer Eartha Kitt.

The American Cancer Society (ACS) reported that this year, about 153,020 people will be diagnosed with colon cancer and 52,550 will die from it, including 19,550 cases and 3,750 deaths in individuals younger than 55. In New York City, colorectal cancer is the second-leading cause of cancer death.

Black hospital leadership, elected officials, and church groups are launching innovative new ways to screen for colon cancer, as well as promoting local and national awareness about the risks. Often, colon and colorectal cancer does not show signs or symptoms of growth until it spreads. More importantly, when colon cancer is detected early, it has an almost 90% survival rate.

“The risks of not getting [screening] done are death and dying from a terrible disease,” said NYC Health + Hospitals Chief of Gastroenterology Dr. Joan Culpepper-Morgan. “I hope that this demystifies and takes away some of the fear that people have, especially that Black men may have.

Most insurance plans, including Medicaid and Medicare, cover colon cancer screenings starting at age 45. There are two common ways to test and screen regularly for colon cancer: a colonoscopy or an at-home fecal immunochemical (FIT) test, which is less invasive and samples can be sent in by mail. A colonoscopy is a simple procedure where a doctor checks a patient’s rectum with a finger-sized camera for signs of cancer.

Generally speaking, symptoms of colon cancer can include blood in the stool or rectum, nausea and vomiting, sudden weight loss, and diarrhea or constipation that doesn’t go away. Culpepper-Morgan stressed that these are often late presentations of the cancer and may indicate a serious progression.

“The bowel is large and it can stretch—it takes a lot to cause a blockage. By the time there is a blockage, it has spread already beyond the walls of the bowel to other organs,” she said. “We definitely don’t want anyone to get to that point.”

The journey to lowering the risk of getting colon cancer starts with a conversation about awareness with a trusted doctor, which is understandably difficult for many in Black and brown communities that have been subject to the whims of a systemically racist healthcare system, said Culpepper-Morgan.

She added that Black and brown people are prone to environmental factors, like food deserts and redlining, that contribute to poor diets and poor health outcomes. Processed meats, such as hot dogs and deli meats, fast foods, and sugary foods overly available in food deserts can lead to unhealthy weight gain and potentially to colorectal cancer, according to research.

“High-fructose corn syrup has, of course, been linked to diabetes, obesity—a tremendous uptick—but now we’re coming into a generation that has been weaned, if you will, on high-fructose corn syrup their entire life,” said Culpepper-Morgan. “We’ve seen in animal models that this substance increases the rate of growth of colorectal cells.”

Dr. W. Franklyn Richardson, chair of the Conference of National Black Churches (CNBC), concurred that it’s often not easy for people to trust doctors. In communities of color, “trusted voices” tend to be a pastor or church when it comes to health matters, which was evident during the COVID-19 pandemic. He said that the culture of health neglect and fear, sexual connotations about getting a colonoscopy, and mental health must be addressed in the church and in the community.

The CNBC represents more than 25 million people and 31,000 Black ecclesiastical congregations. The network has been dedicated to improving access to health and beating back comorbidities, and launched a series of efforts in March for Colorectal Cancer Awareness Month, since many congregants missed doctors’ appointments and skipped screenings and follow-up during the pandemic.

“There’s a stigma attached to any kind of health challenge in the African-American community, [including] prostate cancer among men,” said Richardson. “Men have a tendency to avoid the health experience, and it’s the lack of trust in the health experience. It doesn’t matter what illness is going on, the Black community has hesitancy and it’s borne out of a history of neglect and barriers to healthcare.”

People are also more likely to have a higher risk of developing colon cancer if they are older, have a history of polyps or cancer in their family, have inflammatory bowel disease, exercise irregularly, are obese, drink alcohol, or smoke.