New Research Highlights How Bias and Geography Can Shape Cancer Outcomes
- A Pennsylvania woman’s repeated ER visits for severe stomach pain were initially dismissed, delaying a colonoscopy that ultimately revealed stage 3 colon cancer, a pattern SurvivorNet notes is common among patients.
- A 2016 PNAS study found that false biological beliefs about racial differences lead many medical trainees to underrate Black patients’ pain and make less accurate treatment decisions.
- New AACR data shows rural residents are more likely to be diagnosed with and die from colorectal cancer, underscoring the need to remove barriers to screening, treatment access, and survivorship care.
- Doctors sometimes recommend chemotherapy before colon cancer surgery when the tumor is very large or has begun to spread, because “shrinking it first can make the surgery less difficult for the patient, and the recovery less challenging,” Dr. Paul Oberstein tells SurvivorNet.
“At the time, they were like, ‘Well, we don’t see anything that’s wrong. You know, if it continues, just come back,’” Wright told WHYY News.
“I cried like a baby,” she said. “Because there are only four [stages]. There are only four. And when you hear three, you feel like it’s the end.”
Wright underwent surgery to remove the tumor, followed by six rounds of chemotherapy, before she reached remission.
Wright’s experience is far from rare. SurvivorNet has documented numerous cases in which cancer patients’ symptoms were initially dismissed. Research shows several factors can contribute to this pattern.
WATCH: Understanding a colonoscopy
A 2016 study in the Proceedings of the National Academy of Sciences, led by University of Virginia researchers, examined why Black Americans are systematically undertreated for pain compared with white Americans.
The study found that people who believe false biological myths about racial differences tend to underrate Black patients’ pain — and this bias appears even among medical trainees.
About half of white medical students and residents endorsed these false beliefs in the 2016 study. Those who did rated the Black patient’s pain as lower and made less accurate treatment decisions. Those who did not endorse the myths rated the Black patient’s pain as higher but showed no bias in treatment recommendations.
“Health disparities persist for multiple reasons, and health communications alone cannot compensate for insufficient access to healthcare services and other structural problems. Nevertheless, health communications are extremely important to increase knowledge and awareness in the community and prompt proactive health behaviors (such as screening),” Dr. Stacy Loeb, professor of Urology and Population Health at NYU Langone Health, previously told SurvivorNet.
WATCH: Common Misconceptions About Colon Cancer
Geography adds another barrier. According to new data from the American Association for Cancer Research (AACR), “Residents of rural counties are 17% more likely to be diagnosed with colorectal cancer and 27% more likely to die from the disease compared with residents of metropolitan or urban counties.”
The AACR emphasizes that removing barriers to cancer prevention and care is essential.
“Policymakers should expand access to screening, clinical trials, treatment, and survivorship care. Rural and medically underserved communities, people with limited insurance coverage, and populations that have historically experienced worse cancer outcomes must be central to these efforts.”
Expert Resources on Colorectal Cancer
Colon Cancer Is Treatable and Curable When Caught Early
Colon cancer is very treatable and curable if caught early. Colon cancer screenings can involve at-home tests such as Cologuard, but a colonoscopy is more effective, according to SurvivorNet experts.
The cancer starts when abnormal lumps called polyps grow in the colon or rectum. It takes up to 10 years for a colon polyp to become full-blown cancer, according to SurvivorNet experts.
When you have a colonoscopy, the gastroenterologist looks for polyps inside your intestine. Although polyps can’t be felt, they can be picked up by screening tests before they cause a problem, such as colon or rectal (colorectal) cancer.
A polyp found during a colonoscopy can be removed, which can prevent the development of cancer. Almost all polyps that are removed are precancerous, meaning that they have not yet progressed to cancer.
WATCH: Does Alcohol Impact the Risks for Colon and Other Cancers?
The American Gastrointestinal Association lowered the recommended initial age for colorectal screening from 50 to 45. However, experts recommend screening earlier for some people who may be at an increased risk of developing colon cancer, such as those with a family history of the disease.
WATCH: Debunking misconceptions about colon cancer.
The most poignant signature of colon cancer is a change in bowel habits. Changes in the size or shape of bowel movements may cause constipation or diarrhea. A change in stool color, particularly black or tarry stools, can indicate bleeding from a tumor deep in the colon.
Other symptoms can be harder to pinpoint, such as abdominal pain and unintentional weight loss. Finally, some tumors bleed a small amount over a long period of time, resulting in anemia (low red blood cell count) that is picked up on blood work.
A Colonoscopy Explained
A colonoscopy is a screening test that allows doctors to examine the inside of the colon for signs of cancer or other abnormalities.
To prepare, the colon must be completely emptied. Your doctor will prescribe a bowel prep—a liquid solution taken the night before—that works as a strong laxative and triggers multiple loose stools to clear the colon.
With the colon clean, the gastroenterologist can carefully inspect the lining and remove or evaluate any polyps or suspicious areas.
Follow‑up timing depends on what’s found. If polyps are present, especially larger or multiple ones, doctors typically recommend repeating the colonoscopy in three to five years.
WATCH: What Doctors Look for During Colonoscopies
What Treatment Options Exist for Colon Cancer?
“There are a lot of advances being made in colorectal cancer,” Dr. Heather Yeo, a surgical oncologist and colorectal surgeon at NewYork-Presbyterian/Weill Cornell, previously told SurvivorNet.
Colon cancer treatment is more targeted, meaning doctors often test for specific changes or genetic mutations that cause cancer growth.
Biomarkers are key to tailoring specific treatments. Biomarkers are molecular patterns becoming more commonly used in colon cancer diagnosis, prognosis, and management. According to the National Cancer Institute, a biomarker is “a biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or a condition or disease,” such as cancer.
“In colon cancer, we’re starting to look more and more at people’s biomarkers, so we’re starting to take the cancers, sequence them, understand where the different mutations are to figure out whether or not someone has a normal gene here or an abnormal gene,” Dr. Yeo explained.
“Those are the areas that people want to be able to target a little bit more. We’re getting close to more of what we would call precision medicine, meaning we can start looking at people’s genetic mutations and think about how they might respond to different drugs.”
There are different types of biomarkers, including DNA, proteins, and genetic mutations found in blood, tumor tissue, or other body fluids. The biomarkers most commonly used in colon cancer management are:
- Genetic mutations within the tumor, such as MMR/MSI, KRAS, BRAF, and HER2
- Bloodstream carcinoembryonic antigen (CEA)
CEA is a protein produced by most tumor cells (but not all) and can be picked up in the bloodstream. High CEA levels do not establish a colon cancer diagnosis. However, higher CEA levels correlate with a worse prognosis and potential metastasis. Carcinoembryonic antigen is important for post-treatment follow-up to ensure the cancer hasn’t returned. Be sure to check with your doctor before treatment starts to ensure a CEA blood sample has been obtained.
More on Treating Colon Cancer
Surgery and chemotherapy are common approaches to colorectal cancer.
Some examples of Food and Drug Administration (FDA) approved chemotherapy drug treatments include:
- FOLFOX: leucovorin, 5-FU, and oxaliplatin (Eloxatin)
- FOLFIRI: leucovorin, 5-FU, and irinotecan (Camptosar)
- CAPEOX or CAPOX: capecitabine (Xeloda) and oxaliplatin
- FOLFOXIRI: leucovorin, 5-FU, oxaliplatin, and irinotecan
- Trifluridine and tipiracil (Lonsurf)
WATCH: Understanding Your Options with Metastatic Colon Cancer
Among metastatic colon cancer patients, multiple treatment options exist, including surgical and non-surgical options.
One treatment option includes an oral treatment called Fruquintinib, which is a targeted therapy for adults with metastatic colorectal cancer who have tried other treatments. Results from a trial published last year showed the drug improved overall survival and progression-free survival, which measures the amount of time before the cancer returns or spreads. It works by blocking the growth of blood vessels, which increases tumor growth.
Once you get to the metastatic setting, many patients “just run out of options,” Jennifer Elliott, head of solid tumors at Takeda, explained to SurvivorNet at the ASCO Annual Meeting. So it was critically important for Takeda to do this deal to in-license fruquintinib. We hope to give patients another option.”
Fruquintinib has been approved in China since 2018 and was originally developed by the Chinese biopharmaceutical company HUTCHMED. In January 2023, Takeda Oncology acquired the exclusive worldwide license for the drug outside of mainland China, Hong Kong, and Macau.
Questions to Ask Your Doctor
If you are facing a colon cancer diagnosis, here are some questions you may ask your doctor.
- What are my treatment options based on my diagnosis?
- If I’m worried about managing the costs of cancer care, who can help me?
- What support services are available to me? To my family?
- Could this treatment affect my sex life? If so, how and for how long?
- What are the risks and possible side effects of treatment?
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Contributing: SurvivorNet Staff
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