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Cancer disparities: Colorectal cancer in African Americans

https://www.facingourrisk.org/XRAY/cancer-disparities-colorectal-cancer-African-Americans
Full article: https://cancerprogressreport.aacr.org/disparities/

The American Association for Cancer Research (AACR) released a 2020 report about cancer disparities among racial and ethnic groups in the United States. In this XRAY review, we highlight data from the report about the burden of colorectal cancer in African Americans, who have the highest rates of diagnosis and death related to the disease among all racial and ethnic groups. (Posted 4/27/21)

Expert Guidelines

The U.S. government and many professional and health organizations have evidence-based recommendations for colorectal cancer screening and other preventative measures, such as lifestyle changes and daily aspirin use, to prevent colorectal cancer. Here, we highlight the most recent recommendations from the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN) and the U.S. Preventive Services Task Force (USPSTF).

 

Screening Recommendations

 

ACS

NCCN

USPSTF

Recommended age to begin routine colorectal cancer screening for people at average risk for the disease

Age 45

Age 45

Age 45

Recommended age to discontinue routine screening for those at average risk

Age 75

Age 75

Age 75

Recommends that screening for adults ages 76 to 85 be based on patient preferences, health status, and prior screening history.

yes

yes

yes

Advises against colorectal cancer screening beyond 85 years of age

yes

-

-

Recommended age to begin routine colorectal cancer screening for people at high risk* for the disease

Before age 45: specific age depends on risk factor

Before age 45: specific age depends on risk factor

-


*People are considered to be at high risk if they have the following: 1) personal history of colorectal cancer or certain types of polyps, 2) family history of colorectal cancer, 3) personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease) and 4) a confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC).

 

Insurance coverage of colorectal cancer screening

Colorectal cancer screenings such as stool-based tests (see descriptions below) are considered grade “A” services by the U.S. Preventive Services Task Force (USPSTF). This means that these services have shown substantial effectiveness in detecting or preventing the disease. 

The Patient Protection and Affordable Care Act (ACA) requires that most group health plans, as well as policies sold in the Health Insurance Marketplace and in small group and individual markets, cover 100 percent of one colorectal cancer screening at its recommended frequency (see Colorectal cancer screening tests table below) with no out-of-pocket costs to patients who are age 50 and older—no matter their risk. (The USPSTF is currently updating its position. The new guidelines, which are under review, propose lowering the recommended starting age to 45.) 

Medicare beneficiaries—no matter their age—are allowed one colonoscopy covered at 100 percent every six years for those at average risk and one colonoscopy per 24 months for those at high risk.

Medicaid coverage of colorectal cancer screening varies by state. Individuals who qualify based on their state’s decision to expand Medicaid under the ACA are entitled to the same screening and preventive services as those who are covered by private insurance.

For individuals at increased risk, certain states require insurance coverage of colonoscopy beyond that required under the ACA. Check with your state insurance commission to determine if you live in one of these states.

 

Colorectal cancer screening tests

Stool‐based tests are tests performed on a stool (feces) sample to help diagnose conditions affecting the digestive tract, including colorectal cancer. Like most screening diagnostics, the frequency of stool tests varies. Stool tests include:

Stool Test

Recommended frequency

Fecal protein test (FIT)

Once per year

Fecal blood test (gFOBT)

Once per year

Fecal DNA test (FIT-DNA)

Once every 1 or 3 years

 

Structural examinations

Recommended frequency

Colonoscopy

Once per 10 years

CT colonography

Once per 5 years

Flexible sigmoidoscopy

Once per 5 years

Flexible sigmoidoscopy with FIT

Flexible Sigmoidoscopy every 10 years plus FIT every year

 

Structural (visual) examinations look inside the colon and rectum for areas that might be cancerous or have polyps. These examinations include the following:

 

Lifestyle Factors

A risk factor is anything that raises your chance of getting a disease. Some risk factors for colorectal cancer, like your age or family history, cannot be changed. Others, like smoking and diet, can be changed (modifiable risk factors). According to the ACS and NCCN, you might be able to lower your risk of colorectal cancer by doing the following:

 

Aspirin as a Preventative Measure

The USPSTF and NCCN support the use of daily low-dose aspirin as a preventative measure against colorectal cancer. Research has shown aspirin to be protective against colorectal cancer when it is taken daily at a low dose for at least five to 10 years. The USPSTF and NCCN recommend the following:

Questions To Ask Your Health Care Provider

Open Clinical Trials

About FORCE

FORCE is a national nonprofit organization, established in 1999. Our mission is to improve the lives of individuals and families affected by adult hereditary cancers.