March is Colorectal Cancer (CRC) awareness month. Colorectal cancer affects the colon and rectum, which make up the large intestine located at the latter end of the digestive tract. CRC is the third most common cancer in the United States and the second most common type of cancer within the Asian American community. Sampan interviewed bilingual gastroenterologist Dr. Zhuo Geng, Gastroenterologist, at St. Elizabeth’s Medical Center Digestive Disease Center to learn more about the disease.
Originally from Shandong province, China, Dr. Geng came to the U.S. at 16 years old, and attended Johns Hopkins University for her undergraduate degree. Later, she went to University of Texas Southwestern Medical Center for medical school. Dr. Geng said that while there, she was first “involved in research focused on colon cancer screening and prevention in the underserved community.” She then completed her residency in Cleveland, Ohio, and finally completed her gastroenterology fellowship in the University of Minnesota before coming to Boston.
Being able to speak in both Mandarin Chinese and English, Dr. Geng stressed the importance for Asian Americans to get screened for CRC. “Asian American actually have one of the lowest screening rates of colon cancer in the United States. So it’s about 52%, up to date with their screening, which means that about half of the Asian American are not up to date with screening according to recommendations. This is compared to 66% of non Hispanic whites,” said Dr. Geng. “Overall, I would say the awareness of the need for colon cancer screening is actually relatively high among the general population. But it has limited penetration to the Asian American community, that’s why the screening rate is relatively low compared to non-hispanic whites.”
There are several reasons for the lower screening rates among Asian Americans, according to Dr. Geng. One major reason is the language barrier. Dr. Geng said, “Not all Asian Americans are fluent in English. There are some studies showing that more than 30% of Asian American actually have limited English proficiency.” Adding to this problem, there are oftentimes limited access to interpretation services and limited healthcare providers who speak another language. For this reason, “it is difficult for healthcare providers to initiate the conversation on colon cancer,” said Dr. Geng.
In addition, there seems to be the stereotype and perception that Asian Americans are healthy and in general at lower risk of cancer. Dr. Geng said that this is not true. “If you look at the cancer rate for Asian Americans compared to other ethnicities, the cancer risk is actually not that high compared to other ethnicities, but the issue is the screening,” she said. There is also a culture of only going to see a doctor when one is exhibiting symptoms. However, “colon cancer can be completely asymptomatic and only present symptoms in its late stages,” said Dr. Geng. “Screening is for patients who have average risk and are asymptomatic.”
There are a few different types of CRC screenings. According to Dr. Geng, there are different tiers. The first tier is the colonoscopy, which is considered the “gold standard” of CRC screening. It is a direct visualization of your colon, and the detection rate for early stage cancer or for pre-cancerous polyps is 95%-98%. If declined, the following tiers and options for those who are at average risk, include options such as the fecal immunochemical test (FIT) which is a stool study to check for hidden blood in stool. The sensitivity of FIT to detect cancer is 80% for cancer for those who have cancer, and the sensitivity for advanced adenoma (benign tumor cells), is only 30%. If a FIT test is positive, the patient must also go through a colonoscopy. Another type of screening is FIT DNA test which is a combination of FIT and checking DNA markers. This is an expensive test, and must also be conducted more frequently, recommended every three years. Other types of tests include computerized tomography (CT) colonography which is a CT imaging test and sigmoidoscopy, which is a short version of colonoscopy. The most suitable type of test is up to discussion between the patient and doctor.
Average risk patients that have no family history of the disease or any risk factors or symptoms such as inflammatory bowel disease (IBD) or Crohn’s disease, were originally required to be screened by age 50. However, in November 2020, the Multisociety Task Force on Colorectal Cancer Screening recommended screening to begin at age 45 due to the observed increase in younger patients of CRC.
While the exact cause of CRC is unknown, Dr. Geng said some factors that may increase one’s risk of developing CRC. These include smoking, obesity, eating processed red meats and having a low fiber diet. There is also some genetic component to the disease, such as if someone in the family has a history of CRC, then there is a predisposed risk.
There are also ways to prevent it upon early detection of polyps in the colon through screenings. Dr. Geng said, “Not all polyps are cancerous, but some can take years to develop into cancer.” Hence, screenings are important to be able to detect, and even prevent colon cancer. “When we talk about prevention, we are preventing cancer from forming,” she said. This is a regular part of colonoscopy procedure, wherein all types of polyps are removed from the colon.
CRC screening is generally offered by one’s primary care provider during a regular check-up. No matter what type of screening one does, Dr. Geng emphasizes that, “The best modality to screen colon cancer is the one that gets done. The physicians are responsible to discuss all kinds of options for cancer screening, but the ultimate choice is up to the patient.”
