It’s increasingly difficult to find words to adequately express the sorrow that is 2020. The death of Chadwick Boseman to colorectal cancer at the age of 43 is devastating news. Our magnificent, gifted, and noble King T’Challa, as he is often referred to for his leading role in the Marvel film Black Panther, was regal to so many, and especially to Black people. If we are forced to gain some modicum of positivity from this incredible loss, it is that it has brought colorectal cancer to the spotlight.
Colorectal cancer is the second leading cause of cancer deaths among men and women in the United States. But despite the availability of both noninvasive (stool-based tests) and invasive (virtual colonoscopy, flexible sigmoidoscopy, and colonoscopy) screening modalities to allow for early detection, we still struggle with getting patients screened in a timely fashion.
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Racial Disparities in Colorectal Cancer Screening Persist
In 1997, key stakeholders from the private and public sector with the shared goal of raising screening rates formed the National Colorectal Cancer Roundtable (NCCRT), and established an initiative entitled “80 Percent in Every Community,” with a goal of getting 80 percent of average-risk Americans appropriately screened.
The NCCRT has done phenomenal work in screening and prevention efforts. But as seen with other conditions where health disparities are rampant, gains were seen in some, but not all, communities. A review published September 2019 in the journal Clinical Gastroenterology and Hepatology found that only white, Hispanic, and Asian communities had significantly higher screening rates each year, while screening rates in Black Americans did not change with time.
During the COVID-19 pandemic, in which long-standing health inequities have become increasingly apparent, it is imperative to underscore that Black people have the highest incidence and mortality from colorectal cancer of any racial or ethnic group, per research published in July 2016 in Clinical and Translational Gastroenterology.
Moreover, the incidence of young-onset (under the age of 50) colorectal cancer has also escalated over the past decade, so much so that it prompted the American Cancer Society to break away from the United States Preventative Task Force (USPTF) and other national gastroenterology societies to amend their colorectal cancer screening guidelines and begin screening average-risk individuals at age 45, and not 50.
Given the stark colorectal cancer disparities seen with Black patients, The United States Multi-Society Taskforce on Colorectal Cancer, represented by three major national gastroenterology organizations, recommends that screening for this population begin at age 45.
With this understanding — and with data showing that, amid COVID-19, colorectal cancer screening rates have declined drastically — we can expect that the pandemic will create collateral damage to prevention efforts and likely widen disparities.
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Tips to Prevent Colorectal Cancer
We must leverage the opportunity Mr. Boseman has tragically afforded us as a young Black man with immeasurable promise who died too young from colorectal cancer. As a gastroenterologist working to raise awareness about colorectal cancer and its prevention, below are a few life-saving tips:
Colorectal cancer screening begins at age 50, and at age 45 if you are Black. If you have a family history of colorectal cancer, especially in a first-degree relative, screening should begin at age 40, and sometimes even earlier. Screening is highly effective. Colonoscopy, generally considered the preferred screening test, can actually prevent colorectal cancer by removing precancerous growths called polyps before they grow into a cancer. Noninvasive screening, which can be done amidst the COVID-19 pandemic, serves as an alternative that has also shown to save lives with early detection of colorectal cancer.
Know Your Family History
Because people with a family history are at increased risk of getting colorectal cancer themselves, you must talk to your family about everyone’s medical history and colonoscopy findings. This knowledge and information can literally save a life.
Practice Healthy Habits
Avoiding a sedentary lifestyle, abstaining from smoking and excess alcohol consumption, eating a fiber-rich diet, and limiting red meats are behaviors in your control that will help decrease risk.
Don’t Ignore Symptoms
Blood in the stool, unexplained abdominal pain, unintentional weight loss, or a change in bowel habits should prompt a visit to your physician. Don’t shy away from discussing these important symptoms.
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Closing the Gap: Chadwick Boseman’s Lasting Legacy
As a Black woman gastroenterologist who is committed to closing the gap on colorectal cancer disparities, and an admirer of all that Chadwick Boseman gave to his fans — his humility, talent, intelligence, and charity — this is an emotional and gut-wrenching plea for us to raise colorectal cancer awareness, and to get screened.