Why Colorectal Cancer Risk Is Higher for African Americans

African Americans are 20 percent more likely to be diagnosed with colorectal cancer compared to other races and ethnic groups. Our experts dig into the complex reasons why and how to protect yourself.

Mar. 1, 2023 5   min read

A Black man, woman, and two young children smiling

Data from the American Cancer Society shows African Americans are about 20 percent more likely to be diagnosed with colorectal cancer and about 40 percent more likely to die after being diagnosed as compared to most other groups.

There is no single reason to explain this gap. In fact, there is a complicated combination of factors behind this disproportionate increase in risk.

Patrick Okolo III, MD, is the Division Chief of Gastroenterology with Rochester Regional Health and digs into the complexities behind this disparity and how African American patients can best prevent colorectal cancer.

Different types of risks

Several factors place people at an increased risk of contracting colorectal cancer. Some risk factors are modifiable – able to be changed by personal choice – and some are non-modifiable.

A person’s family history and growing older are two of the most significant risk factors that cannot be changed. However, it is important to know your family history and tell your health care provider if a relative – parent, brother, sister, or child – has had colorectal cancer or colorectal polyps.

On the other hand, things like diet, alcohol consumption, smoking and tobacco use, and obesity/high BMI (body mass index) are considered modifiable risk factors. However, there is an added layer for African American patients when it comes to modifiable risk factors.

For example, eating red meat and processed foods, coupled with not eating enough fruit, vegetables, and fiber, contribute to a higher risk of colorectal cancer. But changing this behavior can be more challenging for African American patients. A higher number of African Americans live in urban areas, which tend to have fewer farmers’ markets and grocery stores.

“A lack of fresh fruits and vegetables, and a culture that makes processed foods and animal products normal is a very important risk factor that unfortunately skews toward African Americans,” Dr. Okolo said.

Social determinants of health

There are also circumstances that play a significant role in the risk that African Americans have of being diagnosed with and/or dying from colorectal cancer. Social determinants of health is a term used to describe these circumstances in which a person lives, works, and plays – which include access to:

  • transportation
  • grocery stores and farmers’ markets
  • employment
  • education
  • health care

For example, not having a reliable vehicle or access to other means of transportation would be considered an influence of social determinant of health since it makes it harder for patients to get to their healthcare appointments.

Urban neighborhoods tend to have fewer farmers markets and grocery stores making healthy foods and fresh fruits and vegetables less accessible.

Additionally, research suggests African American employees are less likely to have access to health insurance or health insurance that is transparent about what is covered. This affects the ability for people to schedule preventative screenings such as colonoscopies.

“The availability of proper nutrition, good jobs, reliable transportation, and other similar things allow people to be freer about voicing their health preferences,” Dr. Okolo said. “Your socioeconomic status drives these things in ways that are not always easy to see at first glance.”

Symptoms of colorectal cancer

Colorectal cancer is difficult to diagnose because it often comes with few to no symptoms. Many cases start small as polyps; most polyps cause no symptoms until they begin to grow.

There are some people who experience sudden changes, which should lead to an immediate conversation with a primary care provider. These include:

  • sudden changes in bowel movements
  • sudden abdominal pain/bloating
  • blood in stool
  • unintentional/unexplained weight loss


The American College of Gastroenterology and U.S. Preventive Services Task Force recommend regular colorectal screenings begin at age 45 for average risk adults (patients who do not have a history of cancer or are not at increased risk of colorectal cancer). Screenings can detect pre-cancerous polyps (small growths on the inner lining of the colon or rectum) and early stage colorectal cancer before they become symptomatic.

Studies show regular colorectal cancer screenings result in the removal of polyps prevent as many as 90 percent of colorectal cancer cases. But data shows colorectal cancer screening rates are lower among African American patients compared to white patients. As a result, African American patients go undiagnosed for longer periods – leading to delayed treatment that can sometimes result in death.

The gold standard for colorectal screening is a colonoscopy, which requires proper planning and the flexibility to take time off work, which may be hard to do for a number of reasons. It also requires a second person to take time off work to accompany the patient to and from the appointment. But patients should be aware that there are many screening options – including simple tests that can be done at home. To put it simply, any exam is better than none.

“A colonoscopy is easy,” Dr. Okolo said. “It’s comfortable. It’s not undignified or disparaging. After age 45 or if you have symptoms, having a colonoscopy will yield positive results for people who may be at risk. There is no reason to avoid a colonoscopy. It saves lives.”

Lessening the risk

The most powerful and proven tool in reducing the diagnosis and mortality rates of colorectal cancer is awareness.

Raising awareness allows people to navigate some of the hurdles that prevent more African American patients from being screened. As everyone starts to see their own implicit biases, we can work together to reduce the effects of those biases.

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