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Thursday, August 21, 2014
Colorectal cancer is the second overall cause of cancer death in the United States. According to the American Cancer Society, an estimated 102,480 new cases of colon cancer and 40,340 new cases of rectal cancer will be diagnosed in 2013.1 Colorectal cancers are expected to cause about 50,380 deaths in 2013. Both men and women can develop cancer of the colon and rectum, and their risk increases over the age of 50. African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the United States. The reasons for this are not yet understood.2
The number of new cases of colorectal cancer diagnosed each year in African Americans has not decreased. Of equal concern, is that:
These differences may be due to:
Screening can in most cases prevent the development of colon cancer by removal of precancerous polyps before they progress to cancer. Also, if colorectal cancer is diagnosed at an early stage, the chance of a surgical cure is good, and 5 year survival is 90%.
For average-risk individuals (patients without symptoms and without a family history of colon cancer), there are several recommended screening options. Colonoscopy is gaining acceptance as the preferred screening method since it has a therapeutic potential to identify and remove polyps throughout the entire colon. Other screening options include flexible sigmoidoscopy every 5 years, annual fecal occult blood testing (FOBT), and double contract barium enema every 5 years. Each screening test has advantages and limitations that should be discussed with patients to maximize their compliance.
Emerging research also suggests that African Americans are more likely than Whites to have precancerous polyps and colon cancer in the proximal colon, which could potentially be missed if screening was done by flexible sigmoidoscopy alone.
In response to the higher incidence and mortality of colorectal cancer among African Americans, the American College of Gastroenterology advocates modifying current screening guidelines in this population and recommends screening at the age of 45 rather than age 50.3
Current research data also suggests colonoscopy may be the preferred screening procedure rather than flexible sigmoidoscopy because of the greater prevalence of proximal polyps and proximal cancers in African Americans.
Patients commonly have questions, misconceptions, and fears about the need for colon cancer screening. Talk to your primary care physician about screening which is one of the most powerful weapons in preventing colon cancer.
1What are the key statistics about colorectal cancer? American Cancer Society, 1/17/2013.
2What are the risk factors for colorectal cancer? American Cancer Society, 1/17/2013.
3Colorectal Cancer Screening, American Journal of Gastroenterology 2009;104:739–750.
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Last Reviewed: Feb 27, 2013
Gregory S Cooper, MD
Professor of Medicine
School of Medicine
Case Western Reserve University