Chadwick Boseman’s death from colorectal cancer underscores health gaps for African Americans

Chadwick Boseman’s death from colorectal cancer underscores health gaps for African Americans

Actor Chadwick Boseman at the GQ Men of the Year party at the Chateau Marmont in Los Angeles, Dec. 3, 2015.
Jordan Strauss/Invision/AP

The tragic death of Chadwick Boseman at age 43 following a four-year battle against colorectal cancer underscores two important public health concerns.

First, the incidence of colorectal cancer has risen dramatically among adults under age 50 in the U.S. and in many countries around the world. Second, African Americans have a much greater likelihood of being diagnosed and dying from the disease at any age. Both issues are important to the public health community and efforts are ongoing to address them.

Colorectal cancer remains a major source of cancer incidence and death in the U.S. The American Cancer Society estimates that in 2020, about 147,950 people will be diagnosed with colorectal cancer and 53,200 will die from the disease, making it the fourth most prevalent form of cancer and the second leading cause of cancer mortality.

As a scientist conducting basic research on colorectal cancer, I have been generally aware of these sobering trends.

Increases in adults younger than 50

In 2017, Dr. Rebecca Siegel and colleagues published detailed and compelling statistical data clearly bringing the issue into sharp focus, stimulating greater coverage in the media.

Analysis of trends in colorectal cancer incidence and mortality have clearly shown a decline in the general U.S. population overall during the past few decades. Unfortunately, this has not been the case for young adults.

For example, incidence has decreased by an average of 4% per year between 2007 and 2016 in those over 65 years of age, in contrast to an increase of 1.4% per year during the same period in those under 50. The observed decrease in older adults is likely due to preventive screening, which is recommended and advocated for people over 50 and has been undertaken by a larger fraction of the population.

Similarly, colorectal cancer mortality has declined by 3% per year between 2008 and 2017 in those over 65, while it has increased by 1.3% per year in those under 50.

The American Cancer Society predicts 17,930 new cases of colorectal cancer within the under-50 population and 3,640 deaths in 2020. Expectations are that the fraction of cases occurring in young adults will increase even more over the next decade, and may carry over to those over 50.

I have met a number of young people, including several in their 20s and 30s, who had been diagnosed with colorectal cancer and were in the midst of fighting it. I have also met parents who lost young adult children to the disease, and were still trying to understand how this could have happened.

I have been struck by the intensity and complexity of emotions displayed by these people, including anger, resentment, embarrassment, hopelessness, fear and resolve. While a cancer diagnosis at any age is scary and disorienting, it extracts a particularly powerful psychological and social toll on young adults.

What is causing the increase in young adults? We do not know for certain. Several studies have indicated that the disease in young people is different with regard to the specific location of the tumor within the colon or rectum.

Also, the pathology, genetics and response to treatment differ. Lifestyle trends, such as overweight and obesity, lack of physical activity and changing diets, have been suggested to play roles. Studies have indicated that obesity is associated with increased risk of early-onset colorectal cancer in women.

While these trends may contribute, they are not fully explanatory. Physicians have told me anecdotally that many of their younger patients are thin, fit, physically active and in general good health, suggesting that something else must be going on.

What could that something else be? One intriguing possibility may lie in the billions of microbes, collectively termed the microbiota, that live on and within our bodies. Preliminary findings reported at the 2020 Gastrointestinal Symposium recently indicated that there may be differences between the microbiota within tumors from younger versus older colorectal cancer patients.

Microbes that make up the microbiome affect health in different ways.
Kateryna Kon/Shutterstock.com

African Americans and colorectal cancer

The death of Boseman has also underscored the long-standing racial disparity for colorectal cancer. African Americans suffer from high incidences and mortalities, regardless of age. Incidence in African Americans was 18% higher than in whites during 2012-2016, while mortality was 38% higher during the same period. For reasons we do not yet know, incidence in younger African Americans has been relatively stable in contrast to that in younger whites.

Increased incidence and death from colorectal cancer in African Americans is likely a consequence of lower rates of screening, as well as environmental, socioeconomic and lifestyle factors. Reduction of the disparities may depend upon addressing these factors.

Screening can prevent colorectal cancer

Precancerous growths called polyps can be easily removed during a colonoscopy.
Sezer33/Shutterstock.com

Screening for colorectal cancer not only detects the disease but is also highly effective in preventing it. Screening can readily identify precancerous growths called polyps, as well as early-stage cancers. These often can be removed before they progress to life-threatening stages.

Any of a number of methods for colorectal cancer screening are now available, including colonoscopy, flexible sigmoidoscopy, imaging and several stool-based tests.

In addition, research is underway to find new methods for colorectal cancer screening based upon analysis of easily obtained body fluids such as blood and urine.

Based upon the knowledge that about 90% of colorectal cancer cases occurs in those 50 and over, the U.S. Preventive Services Task Force currently recommends that screening should begin at age 50 for those who have no predisposing symptoms. This population is experiencing the decrease in colorectal cancer incidence and death that is currently being observed overall.

But screening is not typically recommended for those under 50, and most health insurers do not pay for screening in this group.

This lack of screening, combined with a general lack of awareness about colorectal cancer and its symptoms among young people can result in late diagnoses. Later diagnoses can often result in more advanced stages of the disease, when it is harder to treat and significantly more lethal.

Recently, the American Cancer Society recommended lowering the screening age to 45, in order to catch a good percentage of the younger people whose risk may be increasing. Health-related professional organizations such as the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention have yet to adopt them. This may change, as discussions are ongoing.

There is also a need to increase screening in the African American community. At present, recommendations vary. In contrast to the U.S. Preventive Services Task Force and the CDC, the U.S. Multi-Society Task Force recommends that screening in African Americans should begin at age 45 rather than 50. I hope these influential organizations will reach a consensus on this issue.

Sorting out the causes of age and race disparities in colorectal cancer incidences and mortalities, and understanding the nature of the disease more thoroughly, will take time.

As Boseman’s untimely death reminds us, colorectal cancer is a difficult and emotional disease for all people at any age. Awareness of signs and symptoms, along with engagement in screening as appropriate, will lead to the eventual eradication of the disease as a major form of cancer.

Editor’s note: This article is an updated version of an article originally published March 26, 2019.The Conversation

Franklin G. Berger, Distinguished Professor Emeritus of Biological Sciences, University of South Carolina

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Health is Wealth

Health is Wealth

In the middle of lively conversation over dinner with a friend recently, he paused, closed his eyes, and took a deep breath while placing his hand over his chest. The pain was evident on his face. When I asked what was wrong, he shared that he had been experiencing chest pains and fatigue with regular occurrence.

“Have you been to the doctor?” I asked.

“Nah. It’s probably anxiety. I’ve been stressed at work lately.”

We talked honestly about the severity of his symptoms and when they started. And because we’re cool, I asked about the results from his latest physical examination. Turns out, not only had he not seen a doctor about his recent episodes, he had not had a regular check-up in three years. I urged him to go to the doctor as soon as possible in the event that his symptoms were evidence of a significant illness.

Health is wealth.

African Proverb

If health is wealth, and it is, then many African Americans are guilty of not knowing the balance in our accounts. Meaning, annual check-ups and preventative care are not what we do. For my friend, it was a perceived lack of time that moved annual doctor’s visits to the bottom of his list of priorities. I can identify with him. While I do not skip my annual visits to my primary care physician and gynecologist, often when I am sick, I ignore the symptoms. My husband has to gently encourage me to call the doctor. Between keeping up home, shuttling our girls to their activities, ministry, and work, who has time to sit in a waiting room for hours?

For others, lack of insurance coverage, fear of disease, and historic exploitation of black bodies in medical science that fostered a distrust of doctors keeps them from scheduling preventative exams and following up on symptoms. The reality is that preventative care costs less than treating a preventable disease and browsing Dr. Google can invoke more fear that having concrete information and making informed decisions about your health. There is also the systemic racism, trauma and devaluing of our bodies that African Americans have and continue to face — experiences that have caused us to normalize pain to the point that we ignore the signs when our bodies are suffering. I am reminded of the woman recorded in Luke 13:10-17 who was bent over for eighteen years. The Bible does not tell us that at any point she sought healing. She went about her business living in chronic pain until Jesus saw her and healed her.

We are living in grind culture, where many of us skimp on sleep and spend countless hours scrolling on devices while eating conveniently packaged foods packed with sodium, fat, and sugar. And although African Americans are living longer in general, reports show that younger African Americans (18-49) are afflicted with and dying of treatable diseases like heart disease, stroke, and complications from diabetes at an alarming rate, according to the CDC. In fact, younger African Americans are living with diseases that commonly affected older adults. The stressors from unemployment, underemployment, poverty, and lack of access to healthcare negatively impacts their health. We are living longer, but we are getting sick earlier.

I shall not die, but I shall live, and recount the deeds of the Lord.

Psalm 118:17 (NRSV)

What are we to do? The first thing is to make a decision to live. Part of that decision is to make annual physical examinations a priority. As the proverb goes, “An ounce of prevention is worth a pound of cure.” I schedule all of my appointments—annual physical, gynecological exam, mammogram, and eye examination around my birthday. Doing so helps me to remember my appointments and also helps me to recognize the blessed gift of life that God has given me to steward.  The other part of that decision to live is to listen to our bodies and to follow up with a doctor if even the slightest thing is off, with the recognition that we are worthy of care and that we do not have to live with chronic pain and disease.

Because our health is so valuable and important, I would suggest finding doctors that you feel comfortable with, that you can trust, and that are sensitive to your particular needs. Word of mouth from family, friends, and coworkers is the best way to find a good doctor. Developing a relationship with a doctor will also allow them to know your baseline levels, recognize patterns in your health, and know immediately when something needs additional attention.

The bottom line is that we have to see our doctors as if our lives depend on it…because they do. Whether you need to cram in a visit to the health center in-between college classes or you are scheduling your very first mammogram, here’s a list of the exams you need by decade, courtesy of Tri-City Medical Center:

For informational purposes only. The information in this article is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.


Rev. Donna Olivia Owusu-Ansah is a preacher, chaplain, teacher, artist, writer, thinker, and dreamer who loves to study the Word of God, encourage others, and worship God. Rev. Owusu-Ansah holds a BS in Studio Art from New York University, an MFA in Photography from Howard University, and a Master of Divinity, Pastoral Theology, from Drew University. You can check out her website at https://www.reverendmotherrunner.com.