By declaring March as National Colorectal Cancer Awareness Month, the U.S. government called attention to the lifesaving importance of prevention, early detection, and prompt treatment of the second leading cause of cancer deaths in America.
Colorectal cancer is the third most common cancer diagnosed in the United States. According to the American Cancer Society, approximately one in 23 men and one in 24 women will develop this cancer at some point in their lives; in 2023, the United States will see an estimated 106,970 new cases of colon cancer and 46,050 new cases of rectal cancer.
Those most likely to develop colorectal cancer are people over 45, African Americans, people with a family history of colorectal cancer, and people who smoke, consume alcohol or are obese.
Diagnosing colorectal cancer
Because it often comes with few or no symptoms, colorectal cancer can be complex and challenging to diagnose. Many cases start small as polyps; most polyps cause no symptoms until they begin to grow.
Circumstances that warrant a conversation with your primary care provider include:
Even with no symptoms, average-risk adults should start regular colorectal screenings at age 45. Screenings can detect pre-cancerous polyps (small growths on the inner lining of the colon or rectum) and early-stage colorectal cancer.
The gold standard for colorectal screening is colonoscopy, an exam allowing the doctor to view the entire colon with a video camera. A colonoscopy requires planning and preparation to clear the colon. Patients must take time off work on the day of the procedure and have a second person accompany them to and from the appointment.
Other screening options include simple tests that can be done at home, although their results might call for a follow-up colonoscopy. Studies show that regular colorectal cancer screenings and polyp removal prevent as many as 90 percent of colorectal cancer cases.
Preventing colon cancer
Several factors place people at increased risk of colon cancer. Some risk factors cannot be modified, including age and family history. It is important to know your family history and to tell your health care provider if a relative – parent, brother, sister, or child – has had colorectal cancer or polyps.
Other risk factors are more within our control. Diet, alcohol consumption, smoking, and obesity are modifiable risk factors. Red meat, processed foods, and not eating enough fruit, vegetables, and fiber contribute to a higher risk of colorectal cancer.
Social determinants of health
Unfortunately, access to fresh food and regular health screenings is not equitably distributed in our society. A higher percentage of African Americans live in urban areas with fewer farmers’ markets and grocery stores. This likely contributes to the fact that, compared to most other groups, African Americans are approximately 20 percent more likely to be diagnosed with colorectal cancer and about 40 percent more likely to die after diagnosis. The data also show that cancer screening rates are lower among African American patients than among white patients. As a result, colon cancer in African Americans tends to go undiagnosed for long periods, leading to delayed treatment and possibly death.
This makes it even more urgent for our Rochester community to address issues of health care equity and social determinants of health. These include factors such as socioeconomic status, education, neighborhood, physical environment, employment, social support networks, access to health care, and access to healthful food.
One way our community supports access to care is through Federally Qualified Health Centers. These centers deliver comprehensive, culturally competent, high-quality primary health care services regardless of the patient’s ability to pay. They also often integrate access to pharmacy, mental health, substance use disorder, and oral health services in areas where economic, geographic, or cultural barriers limit access to affordable health care services. Through its partnership with Mosaic Health, Rochester Regional is our area’s largest provider of FQHC services.
National Colorectal Cancer Awareness Month creates an opportunity for all of us as individuals to take charge of our bodies with healthful lifestyle choices and regular cancer screenings. It also calls us to look at the health disparities in our community and renew our commitment to health care equity and access for all.
Patrick Okolo III, MD, is the Division Chief of Gastroenterology at Rochester Regional Health.s