Women's Health

Who is most at risk for colorectal cancer?



Jennifer Jones, the first black woman to become a member of the Radio City Rockettes, has always been the healthiest of her family.

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

Jones told himself that “these things happen” at his age. She also thought it might be a food allergy and decided to cut gluten from her diet. She had no worries about cancer at all when she went to the doctor for her first colonoscopy, which at the time was recommended for people aged 50 and over.

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

“I was embarrassed and ashamed when I found out I had stage 3 colorectal cancer,” Jones said. She hid her diagnosis from friends and family for a few weeks. “At the time, my two children were in college and I began to think that I would never see their lives fully blossom.”

Who is at risk for 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 in 26 women will be diagnosed with colorectal cancer in her lifetime.

Certain racial and ethnic groups are at a higher 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 this population. A family history of colorectal cancer can also increase the risk of developing the disease.

But research suggests that most cases of colorectal cancer aren’t genetic or hereditary. African Americans, who are 20% more likely to be diagnosed with colorectal cancer and 40% more likely to die from 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 inequalities in health, such as a 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 during her cancer journey. Between jobs and without health insurance, Jones took a job at a company that delayed her hiring for a month and gave her a lower salary than promised. She said she took the job anyway because she needed to see a doctor and needed to support her family.

After her diagnosis, Jones said she was unhappy with the level of care she received from her doctor, who happened to be a white male, and decided to seek a new provider.

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

For decades, colorectal cancer was considered a disease of the elderly. But cases are increasing among young people, regardless of ethnicity. In 2020, about 12% of colorectal cancer cases in the United States were in people younger than 50.

“This prompted many societies 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. “Having done colonoscopies for eight years, I’m still shocked at how many young people in their twenties I’m looking for for other reasons already have polyps.”

Jones was screened in 2018, the year the American Cancer Society lowered the recommended screening age for colorectal cancer from 50 to 45 for people not considered high risk. She wishes these guidelines had been in place when she turned 45 – her cancer might have been detected earlier. Because of her diagnosis, she knows her children will be screened at age 40, the recommended age for those with a family history of colorectal cancer.

Lewis said the abnormal cells in a colon polyp can take seven to 10 years to turn into cancer. This means that a polyp detected and removed at age 45 versus age 50 gives patients a much better chance of long-term survival.

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

Reduce the risk of colorectal cancer

In addition to starting screening at the appropriate age; maintaining a healthy weight; to exercise; and avoiding red meats, processed meats and sugary foods are among the recommendations to help reduce the risk of colorectal cancer. Smoking and excessive alcohol consumption are also linked to higher rates of colorectal cancer, as well as 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 overweight and obese people have increased. More and more Americans are also developing diabetes in addition to 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, to be diagnosed with diabetes, and to be deficient in vitamin D, which may contribute to higher rates of colorectal cancer.

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

“By taking that extra time to explain the process, even non-verbally, I not only sometimes help the patient in front of me, but he also encourages his friends and family members to get tested,” said Lewis. “They can say, ‘That wasn’t scary. No one treated me like I was an object. Nobody looked at my butt. The preparation wasn’t as bad as everyone said.

Ready to graduate

Jones has been cancer-free since 2019. She hopes that streak will continue until December 2023, which would mark five years since her diagnosis.

After beating her 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 worked as a spokesperson with the Colorectal Cancer Alliance to help raise awareness of the importance of cancer screening.

“There is not enough conversation about [colon cancer] in our communities,” Jones said. “It’s a tough subject to talk about, but tough conversations need to happen. Learn your family history and get screened at age 45 or younger if your family has a history of colorectal cancer. If you don’t have health, you don’t have much.

This resource was created with support from Merck.



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