The Need for Colorectal Cancer Screening in the Hispanic Community
Mar 29, 2023 Victoria Pelham
Cancers of the colon and rectum are the second-most common types of cancer in Latinos—newly affecting about 16,500 people in 2021 and killing an estimated 4,700, according to American Cancer Society (ACS) estimates (PDF). Only lung and prostate cancers are responsible for more deaths.
While more people are living with the disease, risks remain for the Latino community, which faces a slew of barriers accessing U.S. healthcare, including language and cultural competency, income and a lack of health insurance. These obstacles set back providing preventive cancer approaches to all, says Jane Figueiredo, PhD, director of Community and Population Health Research at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute.
Latinos are the least likely to get screened for colorectal cancer—less than half (49%) of eligible Hispanic adults, compared with 58% of their non-Hispanic white counterparts, ACS figures show. As a result, tumors are found later, with just 33% diagnosed in a local stage.
"In many ways, your zip code is more important than your DNA."
"We’ve had huge setbacks in cancer because of the COVID-19 pandemic, so that number is particularly concerning because it was already low," says Dr. Figueiredo, who leads the largest U.S. study on colorectal cancer prevention and treatment among Latinos.
Screening is essential
Because colon cancer usually grows slowly, over 10 to 15 years, early detection saves lives.
The U.S. Preventive Services Task Force (USPSTF) recommends regular colorectal screening beginning at age 45, lowered in 2020 from the previous standard of 50. The aim is to catch the fourth-leading cause of cancer death early enough to improve survival.
When the cancer is still confined to the colon or rectum, most (90%) of Hispanic patients live. Five-year survival falls to 71% with nearby spread and 15% for advanced stages. Overall, 64% of Latinos reach five years after diagnosis.
Testing should continue until 75, then your doctor will reassess your need (based on health history) over the next decade.
Know your test options
Stool-based tests—such as fecal immunochemical (FIT) and FIT-DNA—detect blood, DNA and unusual cells from at-home stool samples and should be done annually. Abnormal findings require more invasive screening.
Doctors look for—and remove—tumors and precancerous polyps using:
- Flexible sigmoidoscopy (insertion of a thin tube and camera to view the rectum and lower third of the colon)
- Colonoscopy (throughout the entire rectum and colon)
- Virtual (or CT) colonoscopy, using X-rays and CT scans
Health officials suggest a full colonoscopy every 10 years or other screening every five years.
The ACS notes Hispanic adults undergo fewer colonoscopies than other ethnicities but use stool tests more often. In communities with health barriers, fecal tests are often easier, Dr. Figueiredo says, because they’re less costly and don’t require anesthesia or time off work.
“Any type of screening is the right screening,” Dr. Figueiredo encourages—whatever gets you in.
If you have insurance, preventive colonoscopies are covered—and free—under the Affordable Care Act.
Latinos are more likely to develop colorectal cancer younger
Across the board, colon cancer has skewed younger in recent years as more people are diagnosed before age 50.
Latinos are bearing the brunt of that shift, with earlier diagnosis in more advanced stages. One American Association for Cancer Research study found Latinos between 20 and 29 saw among the highest increases in distant-stage, early-onset colorectal cancer.
"It’s alarming," Dr. Figueiredo says, "because you don’t screen for colorectal cancer until much later."
That can cut lives short and also hurt quality of life, fertility and finances.
"These are some of the most productive periods in people's lives—where they’re maybe having or wanting to have children and developing their careers," she says.
Risks are genetic, behavioral and environmental
Researchers are investigating earlier onset, as well as the multilayered factors that make the Latino community vulnerable to colorectal cancer.
Higher risk factors include:
- History of colorectal polyps or colon, rectum or ovarian cancer
- Inflammatory bowel conditions (such as ulcerative colitis and Crohn’s disease)
- Obesity or Type 2 diabetes, both more prevalent among Latinos
- Over 50 years old and male
- Having a close relative who has had polyps or colorectal cancer
- Inherited conditions such as familial adenomatous polyposis or Lynch syndrome
Talk to your doctor about genetic testing for Lynch syndrome and earlier screening if you have a family history.
Dr. Figueiredo says her research is working on defining the genetic landscape of cancers in Latinos, who are racially diverse after 500 years of blending European, African American and indigenous American ancestory.
"Colorectal cancer studies are largely based on non-Hispanic white populations, and we don’t entirely understand the genetic patterns of tumors across diverse populations," she says.
Some risks such as inactivity and smoking are driven by—and can be managed with—lifestyle changes. Add fruits and vegetables, and limit alcohol and red and processed meats, Dr. Figueiredo encourages. Vitamin D and calcium can also be preventive.
Others are structural, such as higher stress, racism, neighborhood disinvestment and the lack of parks to be active in many Latino communities.
"In many ways, your ZIP code is more important than your DNA," she says.
Don’t ignore unusual bleeding
Watch for rectal bleeding (especially bright red or dark blood in your stool), the most frequent rectal cancer symptom. Changes in bowel movements (diarrhea or constipation) and abdominal pain or cramps lasting more than a few days are also warning signs, as well as severe fatigue and unexplained weight loss.
It might be tempting to think symptoms will resolve on their own or can be explained away by common, less serious conditions such as hemorrhoids, which also cause rectal bleeding.
But it’s crucial to visit your primary care provider to make sure, even if you’re young.
"Always take symptoms seriously," Dr. Figueiredo cautions.
Many colorectal cancers caught early enough are treatable with just surgery and radiation.