Actor’s death shows risk to Black Americans
The death of Chadwick Boseman at 43 was a deep and poignant loss. An inspiration to fans, in his film roles — particularly those in which he played historic Black figures — Boseman told a new generation rich stories of the men he portrayed. In death, he tells another powerful story: the alarming rate at which young adults and Black Americans are dying from colorectal cancer, a complex disparity in both incidence and survival that must swiftly and aggressively be addressed.
Colorectal cancer is the third-most common cancer in the U.S., estimated to affect nearly 148,000 new patients in 2020. Yet, colorectal cancer is highly preventable; screening and detection vastly improve outcomes, and early diagnosis is key to survival.
Black colorectal cancer patients are more likely to be diagnosed at a younger age, present with more advanced disease and have worse survival outcomes. More than other cancers, the advanced stage of diagnosis for Black patients may account for up to 50 percent of the difference in survival in colorectal cancer between races. While this disparity stems from an array of causes — environmental, societal and genetic — attacking disparities in screening can make a marked difference in the survival of Black Americans.
Colonoscopy is the gold-standard screening exam for colorectal cancer. The American Cancer Society recommends average-risk adults begin screening at age 45. People with a family history of colorectal cancer should begin screening 10 years younger than the age their first-degree relative was diagnosed. We can look to one state for an example of how proactive screening programs can impact disparities in cancer survival.
In Delaware, state legislators took an aggressive stance on curbing rising rates of colorectal cancer. In 2004, The Delaware Cancer Treatment Program was established, addressing cancer care for two years for the state’s uninsured. Special programs were enacted to reach the Black community, including local efforts pairing nurse navigators with community organizations and targeted educational outreach. Combined, these programs gave every Delaware citizen universal colorectal cancer coverage. In the first five years of the program, colorectal cancer screenings increased 25 percent among Black people in Delaware, rising to mirror the white population. Among Black patients, rates of diagnosis at advanced stages were slashed nearly in half, and importantly, incidence and mortality rates soon equalized.
If implemented nationally, a similar program would mean 4,000 fewer Black Americans would get colorectal cancer each year and 2,700 fewer would die from it.
Unfortunately, colorectal cancer rates are also rising in patients under the age of 45. Based on research from our team at MD Anderson, we expect to see colorectal cancer rates increase 90 percent in patients ages 20 to 34, far below the screening age, by the year 2030. We don’t yet know the exact cause, or causes, of this alarming rise, but many researchers are working hard to understand why it’s happening and what we can do to reverse the trend.
In the meantime, it’s important for both young adults and their primary health care providers to be aware of the symptoms that could indicate colorectal cancer. The high proportion of colorectal cancers diagnosed in people under the age of 50 are at a more advanced stage, which are more difficult to treat. If you or a loved one is experiencing unexplained abdominal pain, weight loss, bowel changes or blood in the stool, don’t dismiss it. These could be early warning signs of colorectal cancer and should be brought to your doctor’s attention. With extensive precautions in place due to COVID-19, people should continue to visit their doctor to discuss symptoms and to maintain cancer screening guidelines.
Addressing disparities in colorectal cancer is a complex problem and solutions won’t emerge overnight. However, promoting screening and education is an achievable first step, so we can’t let the enormity of the problem freeze us into inaction. In this case, it’s a matter of life and death.
Boseman’s rich life taught us that education, passion and determination yield great success. I hope his untimely death can serve as a reminder to everyone that colorectal cancer is not just a disease of the elderly. It should remind us all to pay attention to our bodies and seek medical care should symptoms develop. Let us also learn a lesson from his all-too-early death and honor not only the impact of his life, but the painful reality that we still have a long way to go to address disparities in colorectal cancer diagnosis and treatment.