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OPINION | Chadwick Boseman's Death Shone Much-Needed Light on Colorectal Cancer

2020-09-04T20:45:23.606Z


The impact of colorectal cancer is relentless. And if four key features of this disease are not addressed diligently, it will continue to be.


Editor's Note:

Dr. Fola P. May is a gastroenterologist and cancer researcher at UCLA Health and the Veterans Health Administration, and director of quality for UCLA Health.

She is on the faculty of the Kaiser Permanente Center for Health Equity at UCLA, where her research focuses on health care delivery, health equity, and health policy.

The opinions expressed in this comment are those of the author.

Read more opinion at cnne.com/opinion

(CNN) -

It's more difficult because it was so sudden.

It is more difficult because it is a disease that I know very well.

It's harder because he was young, talented, and black.

It is more difficult because our community has already endured so much in this cold and cruel year that is 2020.

Like Kobe Bryant, George Floyd, John Lewis, and the other black men whose untimely deaths have occurred this year, the passing of Chadwick Boseman at age 43 sent shockwaves not just to the black community, but to the entire world.

His death from colon cancer leaves a void in the world.

On the big screen, Boseman embodied legendary men and myths that transcended race and appealed to the best of us all: historical figures, cultural icons, and superheroes that it seemed only he could represent.

And off screen, he honored us with his wisdom, strength, and compassion for others in a way that only a real-life superhero could.

I was not his physician and I cannot discuss the details of his colon cancer medical process, but as a cancer researcher and physician who has focused his career on disparities in colorectal cancer, I am not proud to share that my profession has failed to control this disease.

Colorectal cancer is the second most common cause of cancer-related death among men and women combined in the United States.

Although traditionally a disease of older adults, it has infiltrated younger and younger age groups.

There are also racial and ethnic groups that see its devastating consequences more often.

This high death toll is particularly ironic given that the disease is largely preventable and 90% of cases are curable if caught early.

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The impact of colorectal cancer is relentless.

And if four key features of this disease are not addressed diligently, it will continue to be.

It is no longer a disease of older adults

I was honored to participate in a public tribute to Mr. Boseman the weekend after his death.

In the impossible circumstance of mourning a fallen hero and at the same time fulfilling the responsibility of providing education about a disease that is killing too many, I found strength in the example that Chadwick Boseman set.

If I could continue to inspire millions in the face of their own mortality, surely I could exercise my trade in the midst of my sadness and shine a light on this common disease shrouded, all too often, in mystery.

Boseman's diagnosis of colon cancer at age 39 is rare and far from the typical presentation of the disease.

Traditionally, we think of colorectal cancer as a disease of the elderly.

And, in many ways, it is.

The mean age of onset is 66 years for men and 69 years for women.

The American Cancer Society estimates that only about 11 in 100,000 people will develop colorectal cancer between the ages of 35 and 39, compared to about 120 in 100,000 people 65 to 69 years old.

But the unfortunate reality of the last two decades is that we are seeing this condition more and more in young adults, whom we define as those under the age of 50.

The number of colorectal cancer cases in that age group is increasing by 2.2% per year.

Currently, 11% of colorectal cancer cases occur in this age group.

Symptoms are too often ignored

In many cases, the symptoms that are classic colorectal cancer are not evaluated in young adults, largely because the disease is not widely suspected.

All too often, the classic signs (blood in the stool, new abdominal pain, or rectal pain) are explained by the patient or medical providers as benign conditions such as hemorrhoids or chronic gastrointestinal conditions.

For these people, evaluation and diagnostic studies are delayed and the diagnosis is lost or advanced until the best treatment or cure options are no longer available.

  • MORE: OPINION |

    Being young, talented and Chadwick Boseman

With the changing epidemiology of colorectal cancer, we must be more vigilant when signs of it are present in young adults.

Gone are the days when this was a disease of the elderly.

All patients with worrisome symptoms should be evaluated and considered for a colonoscopy, regardless of age.

The role of race and ethnicity

African Americans must also recognize their elevated risk.

The incidence of colorectal cancer is 20% higher in blacks than whites, and blacks are 40% more likely to die from the disease than whites.

These disparities stem from long-standing policies and social determinants of health that include living environment, lifestyle factors, medical comorbidities, differences in the use of screening and health insurance, as well as unequal treatment by health care systems.

As a result, blacks see disparities in all aspects of the course of colorectal cancer, from prevention and early detection to treatment and survival.

Latinos and people of Native American or Alaska Native descent also face unique barriers to colorectal cancer screening that contribute to low detection rates and poor outcomes.

Although public health efforts have focused on addressing disparities in these groups, there is an urgent need for national attention to these health differences.

In particular, at a time when the covid-19 pandemic has increased apprehension about going to health centers, we must inform patients that there are safe procedures for screening.

Cancer will not wait for covid-19 to go away.

A lasting legacy through conscience

In the passing of Chadwick Boseman I find only a shred of comfort: by honoring his memory and teaching young people, the black community and other underserved populations about this devastating disease, we may be able to save lives.

Everyone needs to get screened for colorectal cancer.

For those with a family history of disease, screening should begin at age 40, or 10 years before the age the first family member was diagnosed (whichever occurs first).

To do this well, people diagnosed with colorectal cancer should share their medical history with other family members to avoid missing screening opportunities.

Additionally, genetic testing should also be done for families with multiple cases.

People with predisposing medical conditions, such as inflammatory bowel disease or a history of radiation to the abdomen or pelvis, should speak with their medical providers about the timing of colorectal cancer screening, as early detection is likely also indicated.

  • LOOK: The moving tribute of a 7-year-old boy to Chadwick Boseman

For African Americans without a family history of colorectal cancer, screening should begin at age 45.

And non-black people with no family history should begin screening at age 45 or 50.

Fortunately, there are many screening options, including home stool tests, in addition to colonoscopy.

The implementation of programs to promote screening in the United States has dramatically decreased the number of annual colorectal cancer cases and deaths attributed to the disease since the 1990s.

However, with almost 150,000 cases per year, more than 50,000 deaths per year, and very few people using life-saving screening tests, it is clear that our efforts to prevent the disease are insufficient.

A public health priority set by the National Colorectal Cancer Roundtable, a coalition dedicated to reducing the incidence and mortality of colorectal cancer in the United States, challenges us to reach the goal of getting 80% of Americans undergoing colorectal cancer screening in all communities.

"Every community" specifically refers to raising detection rates not only for majority populations that have access to high-quality health care, but also among low-income, underserved populations, and black and Hispanic communities where we often see the lower detection rates.

These are also the communities where we see myriad barriers to detection, the highest rates of covid-19, and the greatest potential to halt the impact of colorectal cancer in our nation.

We will never completely solve the loss of such an extraordinary soul as Chadwick Boseman.

It helped remind a generation of African Americans of the greatness they came from and sparked our imaginations to dream of the heroes we can become.

He has earned a place in our collective memory, and through his films we will celebrate his legacy.

As we honor him, we can also continue to highlight the disease that took away this remarkable talent too soon.

We must pay more attention to factors associated with colorectal cancer risk and the importance of symptoms and detection, regardless of age, race, or historical marginalization.

In doing so, we can continue to increase public awareness, patient empowerment and access to healthcare, and perhaps prevent another bright star from fading too soon.

Cancer Colorectal Cancer Chadwick Boseman

Source: cnnespanol

All news articles on 2020-09-04

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