African Americans should be screened for colorectal cancer beginning at age 45 — five years earlier than other people, according to new guidelines issued by the American College of Gastroenterology.
The advice is in response to previous findings that African Americans have earlier onset of the disease and higher incidence and mortality rates than whites. Experts suspect that the increased mortality rates may be due, at least in part, to inadequate access to health care and lack of proper screening, which allows doctors to detect and remove polyps that could become cancerous.
'A clarion call'
The report containing the new guidelines, which appears in the March edition of the American Journal of Gastroenterology, says most African Americans should undergo a colonoscopy every 10 years beginning at age 45. A colonoscopy allows physicians to visually examine the entire colon and remove polyps that might turn cancerous. For those considered to be at higher risk because of family history or previous polyps, testing may be recommended even earlier or more frequently.
Cancer of the colon or rectum is the third most common type of cancer in African American men and the second most common type in African American women. African American men were 10 percent more likely to have been diagnosed with colorectal cancer than white men from 1997 to 2001, according to the American Cancer Society (ACS). African American women were 20 percent more likely than white women to have been diagnosed with the disease.
A committee issued the guidelines in response to a request by the American College of Gastroenterology to examine ways to decrease rates of colorectal cancer in African Americans.
"It's a clarion call . . . to bring everybody's attention to an issue that has already been known," said Stanley M. Knoll, a clinical professor of surgery at George Washington University Medical Center. What experts don't fully understand is why African Americans have lower rates of screening for colorectal cancer and higher rates of diagnoses than other groups.
An alternative test, a flexible sigmoidoscopy, is usually done every five years. Like the colonoscopy, it uses a camera-tipped tube to view the colon, but it examines only the lower third of that organ, the portion located on the left side of the body. Research shows that African Americans often develop cancer in the part of the colon that sits on the right side of the body, which a sigmoidoscopy would not detect.
"The concern is that we recommend screening [only] part of the colon," said Duane Smoot, chairman of the Department of Medicine at Howard University School of Medicine. "Many people feel that [sigmoidoscopy is] not adequate for anybody."
Recommendation comes at a cost
About 16,090 new cases of colorectal cancer will be diagnosed among African Americans this year, according to the ACS. Obesity and cigarette smoking increase the risk for the disease. Exercise, a healthy diet, hormone replacement therapy, anti-inflammatory drugs and screening with removal of polyps are thought to provide protection from colorectal cancer, the ACS says.
African Americans tend to be diagnosed with colorectal cancer at a younger age than whites. The study cited a 2001 study that found that 10.6 percent of African Americans with colorectal cancer were diagnosed before age 50, compared with 5.5 percent of whites.
Post-diagnosis survival rates are also lower for African Americans. From 1992 to 1999 African Americans with colorectal cancer had a 53 percent five-year survival rate, compared with a 63 percent survival rate in whites, according to the report.
Despite the new recommendations, experts say it is unlikely that insurers will soon pay for widespread earlier testing. It took many years and several cancer groups' recommendations before insurance companies and Medicare began to pay for colonoscopies.
The cost of a colonoscopy generally starts at about $650 but may be twice as high, said Douglas Rex, a professor of medicine at the Indiana University School of Medicine.
"Anytime a new recommendation is made, there's going to be an issue with insurance coverage," said Rex. People who want to go for testing before age 50 should verify coverage with their insurance companies first, he said. Rex and other experts agreed that the test is well worth the cost if patients can afford to pay out-of-pocket.
Radhika Srinivasan, a University of Pennsylvania School of Medicine professor who sat on the committee that produced these guidelines, said that while the group recommends colonoscopy over other screening methods, the most important thing is that people get some form of screening — even if they are uncomfortable getting a colonoscopy. "Something is better than nothing," said Srinivasan.
