Like Kobe Bryant and George Floyd and John Lewis and the other Black men whose untimely deaths have occurred this year, the passing of Chadwick Boseman at the age of 43 sent shock waves through not just the Black community, but the entire world. His death from colon cancer leaves a vacuum in the world; on the silver screen Boseman embodied legendary men and myths that transcended race and appealed to the best in us all — historical figures, cultural icons and superheroes that it seemed he alone could portray. And off-screen, he graced us with his wisdom, strength, and compassion for others in a way that only a real-life superhero could.
I was not his doctor and cannot speak to the specifics of his clinical course with colon cancer, but as a physician and cancer researcher who has focused her career on disparities in colorectal cancer, I take no pride in sharing that my profession has failed at controlling this disease.
The impact of colorectal cancer is unrelenting. And without diligently addressing four key features of this disease, it will continue to be so.
No longer a disease of older adults
I had the honor of participating in a public tribute to Mr. Boseman the weekend after his death. In the impossible circumstance of mourning a fallen hero while also fulfilling a responsibility to provide education on a disease that is killing too many, I found strength in the example Chadwick Boseman set. If he could continue to inspire millions in the face of his own mortality, I can surely exercise my craft in the midst of my sadness and shed light on this common disease far too often shrouded in mystery.
Symptoms too often ignored
In many cases, symptoms that are classic for colorectal cancer go unevaluated in young adults, largely because the disease is not highly suspected. Too often, the classic signs — blood in the stool, new abdominal pain or rectal pain– are explained away by the patient or by medical providers as benign conditions like hemorrhoids or chronic gastrointestinal conditions. For these individuals, work-up and diagnostic studies are delayed and the diagnosis is missed or pushed further along in time until the best options for treatment or cure are no longer available.
With the changing epidemiology of colorectal cancer, we must be more alert when signs of it are present in young adults. Gone are the days of this being 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
Latinos and people of Native American or Alaskan Native descent also face unique barriers to colorectal cancer screening that contribute to low screening rates and poor outcomes.
Cancer will not wait for Covid-19 to go away.
A lasting legacy through awareness
In the passing of Chadwick Boseman, I find only one sliver of solace: 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 be screened for colorectal cancer.
For those with a family history of disease, screening should start at age 40 — or 10 years before the age the earliest family member was diagnosed (whichever is earliest). To get this right, those diagnosed with colorectal cancer must share their medical history with other family members so that we avoid missed opportunities for screening. In addition, genetic testing should also be performed for families with multiple cases.
Individuals with predisposing medical conditions like inflammatory bowel disease or a history of radiation to the abdomen or pelvis should discuss with their medical providers the timing of colorectal cancer screening, as early screening is also likely indicated.
“Every community” specifically refers to elevating screening rates not only for majority populations that have access to high-quality health care but also among low-income, underserved populations and Black and brown communities where we often see the lowest screening rates. These are also the communities in which we see countless barriers to screening, the highest rates of Covid-19 and the greatest potential to stem the impact of colorectal cancer in our nation.
We will never fully resolve the loss of such an extraordinary soul as Chadwick Boseman. He helped remind a generation of African Americans of the greatness from which they came and stirred our imaginations to dream of the heroes we can become. He has earned a place in our collective memory, and through his movies, we will celebrate his legacy.
As we honor him, we can also continue to highlight the disease that took this remarkable talent too soon. We must increase attention to the factors associated with colorectal cancer risk and the importance of symptoms and screening regardless of age, race, or historical marginalization. In doing so, we can continue to increase public awareness, patient empowerment, and health care access– and perhaps prevent another brilliant star from fading too soon.