The State of Our Health - Men's Health: Colorectal Cancer

Cancer of the colon or the rectum, combined into the "colorectal" category, is the second leading cause of death from cancer for the population as a whole and the third most common cancer death for men (coming after lung and prostate cancer respectively). It also ranks third among women (coming after breast cancer and lung cancer).

The graphic shows death rates per 100,000 population for different categories of men and for all women (dotted line). For all men, the death rate has declined 21.4% from 1979 to 1998, but results for racial groups are mixed: for white males, the rate is down 23.6%, for black males it is up 9.7%. For females as a whole, it has declined 23.5%.

Colorectal cancer is a disease strongly correlated with animal fat consumption. Less pronounced is the correlation with the consumption of red meat and meats prepared at high temperature (broiling and frying). Colorectal cancer rates are significantly lower in underdeveloped countries — but high among their upper socioeconomic strata.

In the United States, at the beginning of the period shown, blacks, whose median income is lower than that of whites, had a lower colorectal death rate. By 1982, the situation was reversed. Active promotion of colorectal screening, changes in diet, the push to eat more "high-fiber" foods and less fat, had begun to bring down the death rate of white males. The improved earnings of blacks caused a movement in the other direction for African Americans. Declines in the death rate, from a peak in 1990, did not begin until much later. The non-white group, which includes blacks, had a similar pattern but at a delay in time; that group also includes Asian Americans and American Indians, populations that have a lower colorectal death rate than whites.

Here, again, we observe different health outcomes for the races. Again, we see that women's death rate is lower, perhaps due to a generally healthier style of life or a greater willingness to undergo medical procedures.

As is the case in most cancers, survival depends on early detection. Colorectal cancer screening can be done by the individual by collecting a fecal sample (as instructed) and submitting it for a fecal occult blood test (FOBT). The doctor can examine the rectum and the lower colon with a lighted instrument in a sigmoidoscopy. A colonoscopy is similar in nature but enables the doctor to examine the entire colon. X-ray examination of the colon and rectum, after a barium enema, provides a picture of these organs (DCBE or, Double-Contrast Barium Enema). A digital rectal exam (DRE) is used to detect abnormal areas in the rectum. Energetic efforts are made by the government (CDC, National Cancer Institute) to persuade people over 50 to undergo screening at least once a year.

Colorectal death rates are heading down because significant numbers of people are willing to change their diets and to undergo tests the names of which are acronyms or run on for five Greek syllables. Better that than the alternative…

Source: Centers for Disease Control and Prevention. National Center for Health Statistics. National Vital Statistics System. Online. Available: http://www.cdc.gov/nchs/default.htm. May 29, 2002. Background information: MEDLINEplus. Online. Available: http://www.nlm.nih.gov/medlineplus/ency/article/001566.htm and National Cancer Institute, Schatzkin, MD, Arthur G., "Risk Factors: Colon and Rectum." Online. Available: http://rex.nci.nih.gov/NCI_Pub_Interface/ratrisk/risks129.html.