3.18.22
By Son of Inequity
For those of you who have followed my blogging, you know I never write about myself. There’s one very good reason for that. But for this post, I’m going to make an exception because who I am is central to this story.
I’m a black American man living on borrowed time.
At age 41, I’ve outlived both my parents and three of my grandparents. Both of my parents died of colorectal cancer before age 40.
While cancer killed them, soda, fried food and substance abuse were definitely accessories after the fact.
My paternal grandmother died in her 30s of an unknown cancer and my paternal grandfather died violently at 40. But he was diagnosed with lung cancer just months before he passed. Maybe he was even receiving treatment, but that’s unlikely. He was reckless and his cancer diagnosis was likely his first and last doctor’s visit as an adult.
My maternal grandfather died at 36 or 37 of lung cancer. My maternal grandmother, who avoided early death and raised me, died from complications of COPD and diabetes within a year of retiring at age 65.
Thanks to her, I didn’t make the same mistakes my parents made. I finished school and avoided drugs. I got a degree and was working in a medical lab full time by the time I turned 22.
Working in healthcare, I learned things my parents and grandparents never did, especially the importance of prevention, of genuine health care, not sick care. So, based on my family history and consultation with my doctor, I was eligible for a colonoscopy when I turned 40. But then coronavirus showed up and changed everyone’s plans.
All colonoscopies were cancelled so my doctor order an at-home screening test. For those with delicate stomach’s I won’t go into too much detail. You basically collect a stool sample and mail it to a lab that looks for early signs of colorectal cancer.
If those signs are present, you get an immediate colonoscopy to see if and where you have colon tumors, how big they are and what stage they are in. If there are no signs, you’re off the hook for another few years before you have to repeat the test.
As it turns out, there are two very different kinds of at-home colorectal screening tests:
The Fecal Immunochemical Test (FIT) detects blood in the stool sample. Blood isn’t a sure sign of cancer. Several other less dangerous health problems can leave blood in your stool as well. For example, hemorrhoids.
The other major at-home test for colorectal cancer is the multi-target stool DNA (mt-sDNA) test, better known as Cologuard, which you’ve probably seen on TV commercials. The multi-target DNA markers that Cologuard can identify are 11 genes that are very strong indicators of colorectal cancer.
In the same way there is a specific gene for brown eyes, there are specific gene mutations that are specific for tumors. If you find those gene mutations, there’s likely a tumor growing inside that patient somewhere.
This kind of cancer testing, called molecular diagnostics, is increasingly becoming a major new weapon against colorectal cancer and, in fact, all kinds of cancers. By identifying telltale genes that reveal tumor growth, molecular diagnosis allows for the early detection of tumors, often long before tumors cause symptoms or are even big enough to detect.
One of the genes detected by Cologuard is a gene called KRAS. In particular, the Cologuard test finds the sequence of the KRAS gene with a specific mutation that causes colorectal cancer. This 2015 paper titled Racial Differences in BRAF/KRAS Mutation Rates and Survival in Stage III Colon Cancer Patients revealed that the KRAS gene mutation was very common in black people with colorectal tumors, much more common than in whites, Hispanic and Asian Americans patients with colorectal cancers.
“KRAS mutation rates were highest in tumors from blacks,” the researchers write. Almost half (44.1%) of the tumors from black colorectal cancer patients had the KRAS mutation. They also found that KRAS tumors were much harder to treat that other kinds of colorectal cancer.
KRAS tumors were also more likely to lead to death or tumor recurrence in young patients. “Among patients younger than age 50 years, blacks had shorter Disease-Free Survival (HR = 1.80, 95% CI = 1.21 to 2.66, P = .004) and Time To Recurrence (HR = 1.77, 95% CI = 1.18 to 2.65, P = .006) compared with whites,” according to this research.
In a 2014 head-to-head comparison of FIT and Cologuard, published in the New England Journal of Medicine, Cologuard detected colorectal cancer accurately 92 percent of the time while FIT was accurate only 73.8 percent of the time. Cologuard was also better at detecting early tumors, or advanced precancerous lesions, than FIT, with a 42% accuracy for Cologuard and 23% accuracy for FIT.
According to the National Cancer Institute, African Americans have lower colorectal cancer screening rates than white Americans. This disparity in screening has increased as a result of the Covid-19 pandemic. The NCI anticipates a significant increase in colorectal cancer fatalities in the coming decade due to a decrease in screening from the Pandemic.
Finally, according to the National Cancer Society, African Americans are about 20 percent more likely to get colorectal cancer and about 40 percent more likely to die from it than most other groups.
So, when my colonoscopy was cancelled, guess which test I was sent?
Keep in mind that I’m an African American at high risk of colorectal cancer, one of the most deadly cancers to African American men and women. Also don’t forget that one of the tests specifically detects a gene that is very common in colorectal tumors that are frequently fatal to young African American men, just like me.
If you guessed the FIT test, you are correct.
In fact, FIT is the test that most African Americans are given for at-home screening of CRC.
Why? Because it’s cheaper than the Cologuard test.
As they say, you get what you pay for. Maybe this explains the elevated fatality rate of colorectal cancer among black Americans.
In my next post, I’ll tell you about my test results from FIT and the results when I was retested.