Screening for colorectal cancer has been proven to reduce colorectal cancer (CRC) mortality. However, men, in particularly Black men and Black Americans in general, have a higher mortality rate when it comes to colorectal cancer, and an apparent aversion towards care seeking. While there are diverse explanations as to why this occurs, a major reason behind all statistics for many people still revolves around access and affordability.
According to an article by the Commonwealth Fund, titled “Are Financial Barriers Affecting the Health Care Habits Of American Men?”, “whether it’s stubbornness, an aversion to appearing weak or vulnerable, or other reasons, men go to the doctor far less than women do.”
“While behavioral and cultural norms may have a lot to do with the care-seeking habits of American men, the fact remains that the United States is the only high-income country that does not ensure all its residents have access to affordable health care. Roughly 16 million men are without health insurance and affordability is the reason that people most often cite for why they do not enroll in a health plan,” the article states.
Factual as that may be, Black men continue to languish in the high percentile of those negatively affected by poor health care habits and inequities within the health care system.
African American men are particularly cumbersome by CRC disparities. They rank last among all racial/ethnic groups of both genders for age-adjusted CRC mortality and 5-year survival rates, according to the American Cancer Society. Compared with their White counterparts, African American men have incidence and mortality rates 25% and 50% higher, respectively.
Although there are limited colorectal cancer studies that include only Black men as subjects, many health organizations have issued specific recommendations for Black men, including lowering the screening age to 45 years, the use of patient navigators, improved reporting and monitoring of colorectal cancer screening rates and increasing access to health care and addressing and healing medical mistrust in an effort to reduce the existing disparities.
Jodi Olson, manager of Public Health of Seattle-King County’s Breast and Cervical Health Program, says that the numbers on a local level are in line with the national statistics and believes that proper screening can help lower the mortality rates of Blacks.
“Nationally in the U.S., Black men and Black Americans have the highest incidence rate of colorectal cancer and highest mortality rate, compared to White, Asian/Pacific Islander, and American Indian/Alaskan Native Americans,” says Olson. “In King County, among adults ages 50-75 years of age, 28% of Black residents had not met colorectal cancer screening recommendations. This is similar to rates for King County overall, but less than White residents. We don’t have King County-specific data for colon cancer rates, but at the state level we know that Black residents in Washington had a higher rate of colorectal cancer compared to White, Asian, and Hispanic residents.”
Early detection through testing is simple and relatively inexpensive. The tests, called a Fecal Immunochemical Test or “FIT test”, can detect blood in the stool, which can be an indication of a patient having colon polyps, which if left untreated can morph into colon cancer. If these polyps are detected early enough, they can be easily removed with a colonoscopy, reducing the risk of the patient developing colon cancer.
According to Olson, the tests are widely available. However, fewer Black residents in King County get this annual screening compared to White residents.
“Because of legislations like ACA, many more people now have access to affordable health care, including free or very low-cost annual colon cancer screening tests,” says Olson. “However, due to a historic lack of affordable healthcare, and systemic racism in the medical system, many Black men and Black Americans may not be accessing the healthcare that they have a right to, given fears that they will be overcharged or lack of awareness of these screening guidelines and the availability of low-cost screening tests.”
According to Daphne Pie, who leads King County Public Health’s Community Health Access Program, colon cancer is referred to as a “silent cancer” because people don’t typically experience any symptoms until it’s too late, and she believes that everyone ages 50-64 should be screened annually for colon cancer.
“Education about these screening tests are very important,” says Pie. “When individuals are not being offered these tests, it’s important that they advocate for themselves with their health care providers, and speak out when they are denied these simple but very effective test.”
If you don’t have a doctor, there are a number of local health organizations that provide free or sliding-scale colon cancer screening and other preventative care, including many Public Health clinics and other non-profit community clinics, such as the NeighborCare network, Carolyn Downs, and Health Point Network.
If you don’t have a regular healthcare provider or health insurance, you can call Public Health’s CHAP line at 1-800- 756-5437 and they can help get you enrolled in a health insurance program.
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