Who is most at risk of colorectal cancer?

Who is most at risk of colorectal cancer?

Jennifer Jones, the first black woman to become a member of the Radio City Rockettes, she had always been the healthy one in her family.

On the eve of her 50th birthday, she was an avid runner and dancer and had been a vegetarian for more than 25 years. She said she felt great when the big day arrived, but she became concerned when she started experiencing bloating, trapped gas and abdominal discomfort a few months later.

Jones told herself “these things happen” at her age. She also thought it might be a food allergy and decided to remove gluten from her diet. She wasn’t worried about cancer at all when she went to the doctor for her first colonoscopy, which, at the time, was recommended for people 50 and older.

After undergoing the procedure, she was stunned when the results came in. She had colorectal cancer and her doctor told her she had about five years to live. Lei Jones was amazed: She had no family history of colorectal cancer and no other known risk factors for her disease.

“I was embarrassed and ashamed when I found out I had stage 3 colorectal cancer,” Jones said. He kept his diagnosis from his friends and family for a few weeks. “At the time, both of my kids were in college and I started to think I’d never see their lives fully blossom.”

Who is at risk of colon cancer?

Colon cancer, or colorectal cancer, is cancer of the large intestine or rectum. It is the third most common cancer in the United States and up to 1 out of 26 women will be diagnosed with colorectal cancer in their lifetime.

Certain racial and ethnic groups are at an increased risk of developing colorectal cancer. A genetic mutation found primarily in people of Ashkenazi Jewish descent, APC I1307K, is thought to contribute to higher rates of colorectal cancer in that population. A family history of colorectal cancer can also increase your risk of developing the disease.

But research suggests that most cases of colorectal cancer aren’t genetic or hereditary. African Americans, that they are 20% more likely to be diagnosed with colorectal cancer and 40 percent more likely to die of the disease than other groups, develop cancer at a younger age and are diagnosed at a later stage, which reduces survival rates. These differences in diagnosis and survival rates have been linked to racial and socioeconomic health inequalities, such as lack of access to quality medical care due to finances or geography, and a lack of trust in health care providers.

Jones has faced inequality herself throughout her cancer journey. In between jobs and with no health insurance, Jones took a position at a company that delayed hiring her by a month and gave her a lower salary than promised. She said she still took the job because she needed to see a doctor and she had to support her family.

Following her diagnosis, Jones said she was dissatisfied with the level of care she was receiving from her doctor, who was a white male, and decided to look for a new provider.

“I finally sat my family down and told them about my illness and decided I was going to go to Memorial Sloan Kettering,” Jones said. “My surgeon…and my oncologist…and an almost exclusively female-led team welcomed me as a person, not a number. That’s when my treatment and my path to fighting cancer began.

For decades, colorectal cancer has been viewed as a disease of older people. But cases are rising among young people, regardless of ethnic origin. In 2020, approximately 12% of colorectal cancer cases in the United States were in people under the age of 50.

“It prompted many companies to change their guidelines to lower the age for colorectal cancer screening from 50, which it had always been, to 45,” said Ayanna Lewis, MD, gastroenterologist at Mount Sinai South. Nassau in Merrick, New York and a member of the Healthy Women’s Health Advisory Council. “After having colonoscopies for eight years, I’m still shocked at the number of young 20-year-olds I seek out for other reasons who already have polyps.”

Jones was screened in 2018, the year the American Cancer Society lowered the recommended colorectal cancer screening age from 50 to 45 for those not considered to be at high risk. He wishes those guidelines were in place when he turned 45: His cancer may have been caught earlier. Because of his diagnosis, he knows his children will be screened by age 40, the recommended age for those with a family history of colorectal cancer.

Lewis said abnormal cells in a colon polyp it can take seven to ten years to turn into cancer. This means that a polyp found and removed at age 45 versus age 50 gives patients a better chance of long-term survival.

“It’s important to know that colorectal cancer is treatable,” Lewis said. “Even if it’s diagnosed later than we’d like, there are effective treatments.”

Reduced risk of colorectal cancer

As well as starting screening at the appropriate age; maintain a healthy weight; exercise; and avoiding red meats, processed meats, and sugary foods are among the recommendations to help reduce the risk of colorectal cancer. Smoking and heavy alcohol use are also linked to higher rates of colorectal cancer, along with lower blood levels of vitamin D.

Lewis said that as the American diet has changed over the past three to four decades to include more processed foods, the rates of people being overweight and those living with obesity have increased. More Americans are also developing diabetes along with being overweight and some studies have shown links between colorectal cancer/colorectal polyps and diabetes, overweight and obesity. African Americans are more likely to be overweight or obese, be diagnosed with diabetes, and be deficient in vitamin Dwhich could contribute to higher rates of colorectal cancer.

Healthcare workers also have an important role in reducing cancer diagnoses, Lewis said. Connecting with people through health fairs, churches and community organizations can encourage more people to see a provider for screening. Building relationships with existing patients can make them feel more comfortable discussing their symptoms and be more open to cancer screening.

“By taking that extra time to explain the process, even non-verbally, sometimes I’ll not only help that patient who’s in front of me, but they’ll encourage their friends and family to get screened,” Lewis said. “They can say, ‘It wasn’t scary. No one treated me like I was an object. No one stared at my butt. The preparation wasn’t as bad as everyone said.’”

Ready to graduate

Jones has been cancer-free since 2019. She hopes this streak continues through December 2023, which will mark five years since her diagnosis.

After overcoming cancer, she lives by the mantra “Don’t wait to live life, live your dreams out loud.” For her, that includes publishing a children’s book, a memoir, and even a “Dancing Jenn” doll.

She has also served as an advocate for the Colorectal Cancer Alliance to help spread the word about the importance of cancer screening.

“There’s not enough conversation about (colon cancer) in our communities,” Jones said. “It’s a difficult topic to talk about, but there must be difficult conversations. Find out your family history and get screened at age 45 or earlier if your family has a history of colorectal cancer. If you don’t have your health, you don’t have much.”

This resource was created with support from Merck.

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