Chadwick Boseman is a superhero who will forever be remembered for his role in “Black Panther,” a movie that challenged institutional bias. But even a young superhero was susceptible to cancer. Boseman was just 43 years old when he died last week of hereditary colon cancer. He was diagnosed at age 39.
The shock of Boseman’s tragic death brought patients to my clinic, concerned for their own health. An African-American female who had refused a colonoscopy in the past, was now in my office saying she was ready to get her screening. Another female patient who was only 35, wanted to know the guidelines for cancer screening as she noticed some changes in her bowel patterns.
Most physicians begin screening patients at the age of 50 for colon cancer. Although the American College of Gastroenterology recommends screening for African Americans at age 45. This recommendation is still not followed in many primary care clinics across the country. Most provider automated electronic reminders for colon cancer screenings are set at age 50 regardless of race/ethnicity. This needs to change.
In addition to institutions recognizing screening guidelines based on race/ethnicity, it’s also important to know your family history to get the most accurate test. According to the Michigan Department of Community Health, more than 4,600 cases of colon cancer are diagnosed each year in Michigan, and more than 1,700 die a year from the disease. Colorectal cancer is the second-leading cause of cancer deaths, after lung cancer. African Americans bear a disproportionate burden with an incidence of colorectal cancer that is 20 percent higher than in whites and even a larger difference in mortality. African Americans are more likely to have an advanced stage of disease when they’re diagnosed with colon cancer and therefore, are more likely to have a fatal diagnosis.
Screening standards are not always delineated by race and ethnicity and these recommendations are what guides insurance coverage. Research shows that when a doctor recommends screening, it increases the chances of getting screened by nearly twofold. This further emphasizes the importance of educating healthcare providers of the significance of tracking health data based on race and ethnicity. However, if the right family history is not available, this puts physicians at a disadvantage to recommend the best screening test.
Colon cancer, if caught early, is treatable and curable. The three most common screening tests are fecal immunochemical test (fit test) every two years, colonoscopy every 10 years or the fecal occult blood test every two years. However, what guides the doctor to pick the right test for you, often has to do with family history.
It’s imperative to know the details of one’s family history for all cancers. If a family member had cancer, be sure to know what type of cancer, the age of diagnosis, and the primary form of the cancer before it spread. These details can save your life.
Too often, patients aren’t able to provide the details of their family history. This is sometimes due to estranged or deceased family members, or lack or health literacy. Knowing your mother had breast cancer isn’t enough. Knowing the type of breast cancer, like BRCA 1 or BRCA 2, Ductal Carcinoma In Situ, makes a difference. What kind of heart disease did your dad have? Was it congestive heart failure or coronary artery disease? Was the mental illness in your family diagnosed schizophrenia or bipolar? One should make a family tree that lists family history in detail and share it with immediate family members. With patients having access to their own electronic medical records, obtaining one’s official diagnosis is easier.
There are some barriers. Patients who don’t want screening tests or vaccines often push back on such ideas of prevention. Some avoid preventive measures such as blood draws or physical exams due to fear. There are also families that don’t believe in telling their close relatives the details of their disease for cultural or personal reasons. This may call for a family conversation, as your opinions and choices can impact the care of other family members.
Boseman’s tragic demise served as a stark reminder that physicians need to work harder to encourage patients to get their screening tests and know their family history. Obviously, every patient has the right to refuse. But it’s the physicians’ job to make them understand the benefits and the increased risk for specific populations based on race/ethnicity.
If something seems wrong don’t shrug it off, even if you’re young. Signs of colon cancer can be blood in stool, change in bowel habits, change in stool consistency and or weight loss. Cancer is not always associated with pain. It’s nerve-wracking to go in for tests, but doing so can save your life. COVID-19 has brought attention to disparities in care based on race and ethnicity, and colon cancer is just one of many illnesses that researchers and clinicians need to do better with.
One step you can take is make that detailed family health history tree. This can be passed down through generations. Whether you are new parents, going off to college, or retiring this might be the time to start that family health history tree. It will help guide your physician and ultimately benefit you and your entire family.