colon cancer

Why colon cancer is a major killer in African Americans

As the month of Colon Cancer Awareness month continues I knew it was imperative to touch on its effect in the African American community.  Like many of the disorders I encounter on a daily basis Colon Cancer tends to disproportionately affect those in this community at a much more detrimental rate.
Yesterday I discussed some of the some of the reasons for the disparities including diet, perception and other factors including physicians just plan dropping the ball. So I wanted to get into it a bit more for my readers who don't have the time to listen to my Lunch and Learns and for those who are a bit more visual.

Starting the race late..

Since 1999 the incidence rate(how many diagnosed) of colon cancer has fallen. A lot of that has been because of the efforts to get people screened earlier. Colon Cancer is the 2nd leading cause of death among men and women so this is truly a public health concern. Efforts such as educating patients, getting patients screened earlier and even with the Affordable Care Act allowing you to get your colonoscopy for free have allowed for vast improvements as show below in figure 1.

Fig 1: Source CDC
Fig 2: Source CDC

Unfortunately, in the African American Community we started behind on the eight ball so our rates still far outpace the rates of every other group in which we can see that for both men and women that holds true. Now taking a look at the rates of deaths due to colon cancer the same trend holds true that even though are numbers are improving because of the disproportionate start African Americans still lag behind.

Fig 3 Source CDC
Fig 4 Source CDC

Excuses Galore

In my short time as an attending I think I have heard almost every reason why someone doesn't want to get the colonoscopy. Here are some of my best ones. “Nothing wrong when I use the bathroom so I don't have colon cancer.”

My usual counter is that a majority of presentations of colon cancer are silent & by the time we find out its too late. 

There is this perception about the colonoscopy that is something I haven't been able to break in some of my patients. When ever I have to mention about getting a colonoscopy I tend to have many of patients (in particularly men) who tell me “Im not going to let anything go up my butt”, which for the life of me is perplexing.

My usual counter is that would they rather poop out of a bag attached to their stomach??

Some patients hate the prep work that goes into it, which usually includes drinking this lemonade type solution a few days because it keeps them on the toilet throughout the weekend?

My usual counter to that is would they rather have to repeat the procedure a month later because they weren't clean enough?

As you can see excuses are something we don't have time for when dealing with Colon Cancer in our community because these are the facts :

  1. We are more likely be diagnosed with colon cancer
  2. We are more likely to die from colon cancer
  3. We are least likely to be screened for colon cancer
  4. When we are screened we are less likely to be receive surgical treatment
  5. When we do get screened for colon cancer we are more likely to be diagnosed at a later stage where treatment options are few
  6. 90% of colon cancer is preventable
  7. Diet has been shown to be a factor especially does high in fat & low in fiber
  8. There are genetic reasons that result in more colon cancer diagnoses in the community
  9. For these reasons recommended to start screening at 45 in African Americans rather than 50.

Reason #6 is why when I hear the news of someone dying from colon cancer it hurts a bit more because I just know that it most likely could have been avoided. If you're like some of my readers and just skipped this the bottom page please make sure to get your family members screened tomorrow if you have to. If you are in palm beach county and want some suggestions on who to go to just leave it in the comments or send me a message.

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