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Montefiore in the News

March 29, 2021

The rate of colorectal cancer is higher in Blacks than any other racial or ethnic group in our country.

By Sanjay Goel, M.D., Contributor March 29, 2021, at 3:23 p.m.

Colorectal cancer originates in the large bowel and rectum. In 2021, it is estimated to be diagnosed in 149,500 Americans and lead to 52,980 deaths. This is far too many deaths, and when you look exclusively at the Black population, the statistics get worse.

The rate of colorectal cancer is higher in Blacks than any racial or ethnic group in our country. Black Americans are approximately 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups.

Most colorectal cancers start as a growth on the inner lining of the colon or rectum, known as polyps. Some polyps grow slowly, over many years, eventually changing into cancer. Most colorectal cancer cases are adenocarcinomas, meaning they start in the mucous glands inside the colon.

There are several risk factors for developing colorectal cancer, including aging, obesity, diet (high in red and processed meat, and low in fiber, fruits, vegetables and whole grains), a sedentary lifestyle, smoking, alcohol, inflammatory bowel disease and certain inherited syndromes.

People can also inherit certain changes (or mutations) in their genes leading to the development of colorectal cancer. The two most common inherited syndromes include "Lynch syndrome" (or hereditary non-polyposis colorectal cancer, or HNPCC, 3% to 4%) and familial adenomatous polyposis (FAP, 1%), a rare condition that is generally inherited by a parent and is caused by a gene defect.

Early Detection Is Key

Colorectal cancer is unique, as it's the only cancer that can be detected and sometimes treated by a procedure at the same time. This procedure is called a colonoscopy, which involves inserting a flexible tube into the anus, through the entire length of the rectum and colon.

As per the American Cancer Society, the recommended age to start screening is 45. Left undetected, cancer can spread via the blood and lymphatic system, to other organs. Colorectal cancer is staged as I through IV, and the outlook gets worse with more advanced stages.

Therapeutic options can include surgery, radiation therapy and medical therapy, which involves chemotherapy and biologic therapy. In terms of treatment, it's important to note that engaging a team of different specialists leads to the best possible outcome. However, the most effective option is early screening.

The overall survival rate for people with colorectal cancer has improved from 50% in the 1970s to 65% in this decade, largely as a result of early detection via screening and new therapies via clinical trials.

What is scary is that at Montefiore Health System and Albert Einstein College of Medicine, in New York, colorectal cancer among our patients who are younger than 50 years of age, otherwise known as early onset colorectal cancer, is sharply increasing. This reflects a national trend, where over the past many years, we have seen an increase of 2% early onset colorectal cancer diagnoses each year.

A National Problem

We looked nationally, at the National Cancer Institute's Division of Cancer Control and Population Sciences' data. Under the NCI's Surveillance, Epidemiology, and End Results (SEER) Program, we found that early onset of cancer isn't just a Bronx problem. Between 1973 and 2010, early onset colorectal cancer was identified in 9.9% of all patients.

Moreover, the frequency of early onset colorectal cancer was higher in Blacks, at 12.7%, and Hispanics, at 16.5%, and much lower in whites, at 8.7%.

Another important difference is that the origin of early onset colorectal cancer among Blacks is closer to the center of the body. This means the disease is harder to reach by an imaging test than it is for Caucasians.

Lastly, we worked with other groups to identify genetic differences between Black and White patients with colorectal cancer. What we found is that a certain type of colorectal cancer, known as mismatch repair deficient (dMMR), found commonly in patients with Lynch syndrome, tends to have a better outcome, and is found less commonly among Black patients, than White patients.

Blacks also have more mutations in their KRAS gene that preclude some patients with advanced cancer from receiving certain drugs, which tends to lead to worse outcomes. We continue to study the implications of these differences, but what the early onset of colorectal cancer data plus our genetic research tells us is that, we need to be much more diligent about screening – particularly if you are Black or Hispanic.