Colorectal Cancer Screening

What it is

Colorectal cancer screening looks for cancer, or for growths that could become cancer, in people who have no symptoms. It is done either by examining the bowel directly with a colonoscopy or by testing a stool sample for hidden blood [2].

Why this guide is written for Black patients

The US Preventive Services Task Force states that Black adults have the highest incidence of and mortality from colorectal cancer compared with other races and ethnicities [1]. From 2019 to 2023, incidence among Black men ran at 50.1 per 100,000 against 42.7 for the total population [3].

The National Cancer Institute adds the sentence that explains what to do about it: new cases and deaths from colorectal cancer remain higher among Black people than other racial groups, and studies show that Black people are not more likely than others to have precancerous growths [2].

Read that carefully. If the growths are not more common, the difference is in what happens around them. That is a story about who gets screened, who gets a colonoscopy after an abnormal result, and how fast treatment starts. Screening rates are already close: in 2023, 64.8 percent of Black adults aged 45 to 75 were up to date, against 63.5 percent of the total population [3]. The gap is downstream of the first test.

What to ask a clinician

• Which test are you recommending for me, and why that one?
• If I do a stool test and it comes back positive, who books the colonoscopy, and how quickly?
• What is my family history worth here, and does it change the age I should start?
• What does the prep involve, what does it cost, and is the colonoscopy covered if it follows a positive stool test?
• When is my next one due, and who reminds me?

What good care looks like

The Task Force recommends screening all adults aged 50 to 75, a grade A recommendation, and screening adults aged 45 to 49, a grade B recommendation [1]. Adults aged 76 to 85 are screened selectively, based on health and prior screening [1]. The current statement recommends starting screening for everyone at age 45, including Black adults, and the Task Force was not able to make a separate specific recommendation for Black adults from the limited evidence available [1].

The tests are not interchangeable in what they ask of you. A colonoscopy uses a thin lighted instrument to look at the colon directly and can remove growths in the same visit [2]. Stool tests include the guaiac test, which checks a card with chemicals, and the immunochemical test, or FIT, which uses antibodies to detect blood in stool [2]. Stool tests are done more often and at home, but a positive result is not the end of the process. It is a referral for a colonoscopy.

That referral is the single point where good care and bad care separate. The Task Force encourages clinicians to ensure their Black patients receive recommended screening, follow-up and treatment [1]. Ask, before you take the kit home, exactly what happens if it is positive.

When it is urgent

Screening is for people without symptoms. Symptoms are an appointment now: blood in the stool or on the paper, a persistent change in bowel habit, stools that have become narrow, cramping or pain in the belly that will not settle, unexplained weight loss, or unexplained tiredness that turns out to be anemia.

Heavy rectal bleeding, or severe abdominal pain with vomiting and no bowel movement, is emergency care.

What to do next

If you are 45 or over and have never been screened, book it this month. Ask which test your clinician recommends and take the one you will actually complete.

If a stool test comes back positive, do not wait to be called. Ask for the colonoscopy appointment in writing. See Black gastroenterologists for the procedure and Black oncologists if a cancer is found.