Colorectal Cancer Screening, Research Paper Example

Comparison of Colorectal Cancer Screening Among Adult Black Men Versus White Men in the United States

Introduction

Cancer is becoming increasingly prevalent as time continues. Colon cancer is defined as cancer of the large intestine, the lower part of your digestive system. Rectal cancer is cancer of the last several inches of the colon. Together, they’re often referred to as colorectal cancers. Colorectal cancer (CRC) is the second leading cause of cancer related deaths in the United States (Henschke et al., 1973). There are major differences in CRC incidence and mortality by race with the highest number occurring among blacks. To ensure that the mortality rate of this disease can be decreased, it is necessary to determine how to increase the likelihood that individuals will receive effective screening to detect the development of cancer before it causes complications.

Detecting cancer in general is problematic because patients do not typically visit their physician’s for screening until symptoms have developed. At this point in time, there is significant tumor growth and possible metastasis. It is important for medical professionals to find new ways to treat cancer before it reaches the metastatic stage because tumor spread is associated with increased mortality.

There are several different screening method that could be utilized to detect colorectal cancer in patients of any age. Broadly, these tests are divided into two categories: tests that can detect both colorectal polyps and cancer, and those that primarily detect cancer. Screening is necessary to help patients who are experiencing no disease symptoms to determine if cancer is forming (Carcaise-Edinboro et al., 2008). Such screening is recommended for elderly patients over the age of 65 in addition to those that have family history of the disease. However, it is important to consider that while some populations are at increased risk for the disease, colorectal cancer is a concern for all people (United States Preventive Services Task Force, 2008). Therefore, some doctors recommend that colorectal cancer screening be included in regularly scheduled general health check-ups.

Screening tests that are designed to determine the existence of both colorectal polyps and cancer are designed to examine the structure of the colon itself to determine if any abnormalities are present (Doubeni et al., 2012). Typically, this is done through a specialized x-ray examination that involved insertion of the x-ray device into the rectum. This is a valuable way of determining whether pre-cancer is present. If polyps are detected, they can be removed before they cause cancer. This is the preferred screening method by many physicians, although it is important to consider that patient discomfort will be caused from this procedure. Thus, many patients prefer to avoid this screening method altogether.

Tests that screen primarily for cancer are less invasive, but are unable to detect the presence of polyps, just fully developed cancer. These methods involve testing feces for signs of cancer, such as blood in the stool and a change in bowel movements. Thus, while this is the preferred screening method for many patients because it is minimally invasive, it is also necessary to note that this method compromises the ability of physicians to detect the existence of cancer prior to its development.

Typically, the risk for developing colorectal cancer occurs after 50 years of age. As of 2015, there were 93,090 new reported causes of colon cancer and 93,090 new cases of colon cancer. Studies have shown that black people are most likely to become affected by the disease, followed by white individuals. According to the National Institute of health, there are many symptoms that are commonly associated with colorectal cancer, including diarrhea and constipation, a sense that the bowels do not empty completely following bowel movements, blood in the stool, stools that are narrower than usual, frequent gas cramps or pains, a sense of bloating, weight loss for no known reason, fatigue, and nausea and vomiting. These symptoms occur primarily because there is an extent of blockage towards the end of the gastrointestinal system. Polyps can cause the blockage of bowel movements, which contributes to the development of the abnormal shape of feces. In addition, individuals have a sense that their bowels do not completely empty due to the presence of these polyps. Ultimately, if any changes are noticed in an individual’s excretory system, it is recommended that they seek medical attention and be screened for colorectal cancer and similar disorders.

Since cancer is caused by the abnormal growth of cells in the body, it is important to consider that colorectal cancer begins for this same reason. However, the causes of colorectal cancer are distinct. There are many risk cancers for the disease, not only including age, but lifestyle choices such as tendency to exercise and eat a well-balanced diet in addition to having a genetic predisposition for the disorder (Colorectal Cancer: Screening. 2015). Even though colorectal cancer is not thoroughly understood, scientists have found that individuals that are more likely to get this cancer have certain genetic anomalies (Colon Cancer, 2015). Other lifestyle or environmental factors that can contribute to the development of this illness include tendency to smoke or be near smoke, consume alcohol, exposure to radiation, and to have other diseases such as diabetes and obesity (USDA, 2000). Interestingly, race is said to be a risk factor for the disease, which is due to the differential genetic and environmental influences that people of different races have (Doubeni et al., 2010). Since the prevalence of colorectal cancer is higher in black individuals, it is reasonable to hypothesize that this because these individuals have a higher degree of disease genes within their gene pool. Thus, these genetic maladies are perpetuated into future generations. In addition, certain cultural factors can play a role. Black individuals living in the United States, for example, are less likely to be physically active and eat healthier diets compared to black individuals living in other nations (Tehranifar et al., 2009). The same is generally held true of other races living in the United States as well. Thus, simply living in this country predisposes individuals to unhealthy activities, such as having a sedentary lifestyle and eating foods that are high in fat, which contribute more significantly to the disease.

Individuals that are at high risk for colorectal cancer are expected to receive regular screenings for this disorder. Screening is recommended between the ages of 50 and 75. Furthermore, these individuals will be provided with non-steroidal ant-inflammatory drugs, such as aspirin, to reduce their risk. This treatment is also valuable to be provided to individuals that have been formally diagnosed with colorectal cancer to help reduce the severity of its symptoms. In particular, the body attempts to fight off cancer cells by having an immune response, which requires the recruitment of white blood cells to the active site. This body function typically also triggers inflammation, which makes it more problematic for individuals with colorectal cancer to use the bathroom. Thus, use of these additional drugs can help reduce discomfort and provide aid to the afflicted individual until surgical or chemotherapeutic options can be provided.

The type of treatment used for colorectal cancer will depend on the severity of the cancer. Local colorectal cancer can typically be treated by using surgery, while cancer that has spread is more challenging to treat. In both cases, individuals with colorectal cancer are asked to make changes to their lifestyle with regards to their diet and exercise to provide their body with more strength to help fight this cancer. Furthermore, surgery, radiation therapy, chemotherapy, and targeted therapy are also used as treatments. Unfortunately, cancer that has spread to other parts of the body are not highly curable, because some of these treatment methods are not effective in certain parts of the body, such as the lungs. In spite of this, it is expected that 65% of individuals diagnosed with colorectal cancer will survive for the first five years of their diagnosis, although there are many factors that could influence this statistic, including what stage of the cancer was detected at the time of diagnosis and whether it can be treated using the aforementioned methods.

It is imperative to take action to learn more about this disease because colorectal cancer is now the third most common type of cancer. There are more than one million cases diagnosed each year in developed countries that implement the use of screening methods. However, we cannot truly be certain of the world impact of the disease because it is likely underreported in countries without the same screening standards. Cases in the United States have shown a significant discrepancy of affliction on the basis of race. It is more likely for a black male to be diagnosed with colorectal cancer than a white male. It is therefore beneficial to assess the causes for colorectal cancer and determine why this disparity is present in the population. As suggested, it is hypothesized that differential genetics and lifestyles are a component of the problem. However, it is also important to consider social differences between these two groups in the United States. Since black individuals are considered to have minority status, they are more likely to live in low income areas with compromised health systems, preventing them from being able to have access to effective care. Furthermore, they are less likely to be able to afford the expensive medical treatments for this reason, which means that the death rate of these individuals are likely to increase because even if the disease is detected, treatment is more challenging. Last, it is important to evaluate the frequency with which members of different races receive screenings for colorectal cancer. It is hypothesized that white men are more likely to receive screening for this cancer due to suggestions provided by their doctors, while this same care will not be provided to members of the black population due to the existing discrepancy in health care. The aim of this study is to make awareness of the disparity of colorectal cancer screening among African American adult males versus Caucasian adult males in the United States.

Materials and Methods

To assess the relationship between race and the status of colorectal cancer, a variety of search engines will be utilized. These search engines will include Google Scholar, the World Journal of Gastroenterology, the National Institute of Health information database (nih.gov), the American Cancer Society website (cancer.org), the Centers for Disease Control (cdc.gov), the informational website of the United States preventative task force (uspreventivetaskforce.org), Web MD (webmed.com), and Mayo Clinic (mayoclinic.com). Additional medical journals and medical literature will be utilized, such as information retrieved from the PubMed database. At least 30 sources of peer-reviewed, governmental, and medical sources will be compiled to contribute to a precise understanding of the relationship between colorectal cancer and race and the associated causes of disparity between African American males and Caucasian males in the United States.

The U.S. Preventive Services Task Force (USPSTF or Task Force) recommended that any patient between 50-75 years has average risk CRC evaluated by using one of the following methods:  fecal occult blood testing (FOBT) every year, sigmoidoscopy every 5 years (with high-sensitivity FOBT every 3 years), or colonoscopy every 10 years. The literature review will be utilized to determine why there is a discrepancy between the frequency of screening between African American and Caucasian men in the United States. To conduct the literature review, the following search terms will be used “colorectal cancer”, “diagnosis”, “screening”, “FOBT”, “sigmoidoscopy”, “African American”, “Caucasian”, “black”, and “white”. A combination of these search terms will also be searched using the “AND” command in relevant databases. For websites that do not host peer-reviewed journals and therefore do not use this search style, relevant terms will be inserted into the search bar on top of their websites.

A majority of sources utilized will be from the past five years, but this will be primarily a requirement for peer-reviewed journals. Since charitable cancer organizations are constantly publishing new statistics and updating their websites to contribute to cancer awareness, these websites will be considered recent and the information will be utilized in this manner. Finally, government websites will also be considered to be timely sources in light of the Affordable Care Act and dissemination of information related to additional health legislation. Where possible, databases will be filtered to include only articles that have been published after 2010, to ensure that they reflect a recent understanding of colorectal cancer. However, statistics will not be used if they reflect information published in the year 2015 because doing so will create an incomplete understanding of the incidence and prevalence of the disease during this year. It will take time for government scientists to compile the information regarding colorectal diagnoses made in this year.

The literature review will focus on the health differences of white and black individuals, in addition to genetic makeups associated with their predisposition for colorectal cancer, lifestyle choices, and access to effective health care. This analysis will be qualitative in nature, primarily drawing from the data gathered in the databases in a manner that will create a summary and draw inferences from the retrieved information. This information will be utilized to create awareness of this disparity and provide other researchers with the tools needed to raise awareness more directly in their communities and create actionable change to ensure that the access that people have to health care will become more equal.

Results

While there has been a decrease in the disparity of colorectal cancer between white and black males over time, it is apparent that this is still problematic. The difference between the two groups have decreased by 4% over the last three years (CDC, n.d.). Therefore, it is important to consider that even though disparity still exists, social effects are helping this difference minimized. According to the World Journal of Gastroenterology, the incidence of CRC among black males is 65.1 per 100,000 population but 52.8 per 100,000 among white males (Siegel et al., 2013). However, a more recent study showed that the incidence of cancer is in fact highest in blacks and lowest in Asians/Pacific Islanders, although the rate in black was 29.4 per 100,000 population were more than double those in Asians/Pacific Islanders (13.1) and 50% higher than those in non-Hispanic whites (19.2) (Mayberry et al., 1995). However, it is important to consider that these values demonstrate that the incidence of colorectal cancer is lowering overall. It is possible that as these numbers continue to decrease, the disparity seen between people of different races will continue to decrease as well (Schroy et al., 2008).

Reasons for the prevalence among this one race have been explained in part due to the molecular biology of the polyp (Soneji et al., 2010). Because there are genetic factors that contribute to the disease, the African American gene pool has a greater extent of oncogenes that will contribute to the development of more resistant colorectal cancer (Huxley et al., 2009). Thus, when individuals with these genes have children, they are passing them down to the future generations. If a male inflicted or genetically predisposed for colorectal cancer has a child with a woman that is also a carrier for the illness, there is an enhanced likelihood that their male offspring will have the illness as well.

Additional reasons for the disparity between African American and Caucasian men with regards to the incidence of colorectal cancer has been explained by the lifestyle factors that they engage in. Because the cultures of these two groups are different, they consume many different foods and engage in varying degrees of physical activities (Ford et al., 1999). Some members of the black community, especially those from a Caribbean background are likely to eat foods that are high in fat due to the cooking methods used. Many foods are fried and this is a cultural tradition that is continued by many different American Caribbean’s (Bolen et al., 1997). The use of high fat content in diets contributes to an increased rate of obesity in the population (O’Keefe et al., 2007). Therefore, the increased incidence of high fat diet and diseases such as obesity and diabetes that predispose people for colorectal cancer is higher among members of these communities, contributing to a greater likelihood for disease to occur.

Additional reasons for the difference between the colorectal cancer rate in these two groups is the difference in access to health care that these individuals have. Individuals living in low-income communities typically live in more highly populated areas that have less funding for hospitals (Qaseem et al. 2012). Because of this, there is a shortage of physicians available to help these patients, contributing to emergency room overcrowding and the lack of ability of each physician to spend adequate time with each patient. It is important to consider that because of this, screening methods are not used frequently for these individuals because they are often receiving only urgent care. Thus, there is not much thought about providing these screening services because emergency departments must prioritize medical events that are of immediate concern.

Discussion

The primary factor contributing to reduce screening among members of the African American and Caribbean American communities is the fact that their neighborhood health clinics do not have the support necessary to provide them with preventative screening (Rex et al., 2009). Until recently, many individuals in these communities were uninsured, meaning that costs for yearly preventative visits were not within the realm of possibility for these individuals due to expense. Therefore, many black individuals did not recognize that they had cancerous polyps or cancer until they experienced many of the symptoms warning them of this diagnosis. On the other hand, individuals living in white communities are more likely to have access to hospitals with more resources, allowing physicians to spend more time with them and offer them preventative screening if relevant (Murff et al., 2010). Furthermore, members of this demographic are more likely to have consistent access to health insurance that will allow them to pay for a screening visit with as little as $15 to $40.

An aspect of this research that was not considered but should be included in future research is the understanding that differential education may exist between members of the black and white community. Black individuals may be less likely to get screening because they are less aware of the programs available, both for free and at a charge. Having an understanding of colorectal cancer is an important part of an individual’s ability to take action against if. If colorectal cancer isn’t discussed as much in black communities, then people will be unable to take the steps they need in order to ensure they get relevant screening (Grubbs et al., 2010). On the other hand, it is plausible that white families, especially those with family members who are medical professionals, warn their relatives to get screening for this cancer if they are over age 50 or if there is any family history. Simply knowing that screening is important is significant in changing the incidence of this disease and its potential severity among members of different races.

It is therefore valuable to put education programs in place to help members of this population. Because access to health care is a problem that is frequently experienced by members of this community, it would be beneficial to provide them with increased access (Inadomi et al., 2012). A simple way of doing so would be to host free screenings in community centers in these communities or to have a mobile van to achieve this same purpose. Such initiatives are currently being used to help individuals decrease the risk of a variety of other illnesses, such as HIV (Benarroch-Gampel et al., 2012). Thus, this initiative could be extended to help members of this population as well.

Conclusion

It has been determined that cancer is the third leading cause of death and that this problem is significantly more problematic than African American males compared to members of different demographics. Screening is a major problem because individuals living in low-income communities are less likely to have access to adequate medical care. Furthermore, environmental and genetic factors predispose these individuals to this disease. Last, education appears to be different between white and black individuals. Cancer risk is more openly discussed in the white community, which allows these individuals to understand the benefits of screening. A reasonable resolution would therefore be to enhance education and screening options for black individuals in low income communities. Doing so will help them have more equal access to health care, thereby reducing the disparity seen between white and black men with regards to this cancer.

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