Colorectal cancer (CRC) has become a growing concern in Black communities. Black Americans continue to be disproportionately affected by CRC, as they are 20 percent more likely to get the disease, and about 40 percent more likely to die from it than most groups. These disparities stem from a combination of systemic inequities, barriers to care, and social determinants of health.
Additionally, there has been a significant rise in early-onset CRC among younger adults, with young onset now accounting for about 10 percent of new CRC diagnoses, underscoring the need for earlier detection and intervention.
For clinicians, improving adherence among Black patients must go beyond simply telling them to get colorectal cancer screening. It’s critical to understand how culture can influence their interactions within the healthcare system and to find new ways to reach them.
Delayed screening is often tied to structural and cultural barriers rather than individual choice alone.
These barriers can include:
“A lot of people say they don’t like to go to the doctor because they feel like they’re in some type of conveyor belt where they just push them in and out,” said Charles R. Rogers, PhD, MPH, MS, MCHES, Founder & Chief Advisor of Rogers Solutions Group. “Patients can tell when they’re being rushed versus when they’re being truly heard.”
He added that Black communities have a long history of unequal treatment in the healthcare system, so it’s critical for providers to build trust through respectful communication, consistency, and transparency.
Culture plays a significant role in how Black patients think about vulnerability, masculinity, illness, and prevention.
“I’ve done a lot of work with men who feel like colonoscopies are violating their manhood and masculinity, so several men will not get any exams below the waist,” Dr. Rogers said. He further explained that cultural expectations around masculinity and caregiving responsibilities can discourage preventive care. “Some men feel it’s more important for them to be the provider for their family instead of going to the doctor.”
In some Black communities, it can be difficult to have conversations about cancer because of the fear surrounding the disease. “People won’t even say the ‘C’ word because life and death are in the power of the tongue, or, if I say it, I might get it,” Dr. Rogers said.
Culturally responsive communication can directly influence whether patients pursue preventive care. The American Cancer Society (ACS) recommends that patients at average risk of CRC begin regular screening at age 45, but conversations should begin much earlier. When discussing CRC screening, providers should address symptoms and family history during annual visits and use clear, understandable language rather than medical jargon. They should also create a judgment-free space for any questions or concerns patients might have.
It’s also critical for clinicians to educate patients on the different options for CRC screening. “Some patients say they don’t want to do the prep, but they don’t understand that there are actually various prep options,” Dr. Rogers said. Sharing different options, such as pill-based prep, lower-volume prep, or stool- or blood-based tests, may help ease the patient’s hesitancy to engage in preventive care and early detection. However, colonoscopy remains the gold standard, with Dr. Rogers stating, “It’s better to have a colonoscopy than to get cancer.”
When colorectal cancer is caught early, stages 0 and 1 often have a 5-year survival rate above 90 percent. However, stage IV disease has a survival rate closer to 13-18 percent. Effective, yet compassionate patient education is key to encouraging adherence to early CRC screening — particularly among Black communities.
Healthcare messaging is being increasingly shaped by influencers and social media. Many people are getting health information from TikTok, Instagram, or influencers rather than from providers. This can set a harmful precedent, as misinformation may discourage people from seeking professional medical guidance — especially around CRC screening. Providers will need to proactively address medical misinformation during routine visits, especially as younger adults increasingly rely on social media for health education.
The responsibility of improving CRC screening adherence among Black patients doesn’t fall just on the clinician — the healthcare system must take part, too. There are several logistical barriers that can keep patients from completing screening, which often influences the poorer outcomes in colorectal cancer.
A few strategies healthcare systems can adapt include:
For Black communities in particular, developing community partnerships with trusted healthcare facilities and organizations can make a meaningful difference in improving outcomes — but it’s important to reach the right places. “Federally qualified health centers (FQHCs) may have more respect than bigger hospitals because [patients] feel like they’re actually listening to them,” Dr. Rogers said. “But unfortunately, FQHCs are sometimes the least funded and least respected, so it’s important to know that outreach alone is not engagement.”
Improving CRC screening adherence in Black communities will require trust, cultural understanding, and systemic support. Providers should normalize screening conversations and prioritize culturally responsive communication. Early detection can save lives, especially as CRC continues to rise among younger adults.
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