Actor Chadwick Boseman became a king in 2017 when he played the starring role of King T’Challa in the Marvel Studios film Black Panther. Beyond that, he became a symbol of Black power and heroism for Black communities everywhere. And so it was a tremendous loss when he passed just three short years later at the young age of 43. Even more poignant was that he succumbed to a four-year battle with colon cancer (colorectal cancer, or CRC), which he kept secret from the public and even his coworkers until the announcement of his death.
Boseman’s death calls attention to the issue of high CRC rates among younger Black men compared to other demographics. Across all races, CRC rates are 30% higher in men than in women. Black people have the highest rates of all racial groups in the U.S., according to the American Cancer Society (ACS). A 2017 study published in the Journal of the National Cancer Institute shows that people born around 1990 have twice the risk of developing colon cancer compared with those born around 1950.
From 2012-2016, CRC death rates among Black people were nearly 40% higher than that for non-Hispanic Whites and double the rates for Asian/Pacific Islanders.
Image Source: Thomas Barwick
Experts are unsure why exactly CRC cases in younger people – especially in Black communities – are increasing. Mark Pochapin, MD, the president of the American College of Gastroenterology, states that some experts believe changes in the microbiome – the bacteria in the gut – are involved in the youth factor, though research on a direct link between microbiome changes and the youth factor is still in its early stages. Use of antibiotics may explain microbiome changes, though other unknown environmental factors may also play a role, he says.
As for the race factor, “This in part may be due to socioeconomics and access to health care, but there may be other factors that we just do not understand,” says Dr. Pochapin. Stacey Cohen, MD, an associate professor at the University of Washington School of Medicine’s division of medical oncology, believes systemic racism provides an explanation. Overall, doctors are less likely to recognize Black patients’ medical conditions as quickly as for White counterparts.
Of the multiple screening tests available for CRC, the two most common are colonoscopy and fecal immunochemical testing.
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Warning signs of CRC include blood in the patient’s fecal matter, difficulty passing stool, development of pain, weight loss, and anemia. Risk factors for this cancer include a family history of CRC, an alcohol- and red meat-rich, low-fiber diet, and already having inflammatory bowel disease (IBD). The two most common CRC screening tests are colonoscopy and fecal immunochemical testing. The ACS recommends that everyone starts regular CRC screenings at age 45, but Dr. Cohen notes that anyone experiencing symptoms should speak with their primary care provider.
With the current attention on systemic racism, there is hope that the issue of higher CRC rates in young Black men may be fully recognized and addressed by policy makers and health care providers.
The Association of American Medical Colleges (AAMC), for example, held a press teleconference in June titled “Racism and Health: How and Where to Make Changes,” during which several leadership members discussed how to combat racism in academic medicine and the overall health care community.
David Acosta, MD, the AAMC chief diversity and inclusion officer, states that “medicine does have a legacy of racism,” and eliminating its modern consequences means “we must acknowledge it, own it.” He continues on to openly cite the AAMC’s refusal “to take a stand against segregation and discrimination in medical schools” in response to prompts from the National Medical Association in 1949. Echoing a previous AAMC statement on racism, he states that “academic medicine must come together in solidarity” to “speak out against all forms of racism, discrimination, and bias.”
Malika Fair, MD, MPH, the AAMC senior director of health equity research and policy, shares other effects of racism in medicine, such as 2016 research showing that “half of medical students and residents all believed that Black people don’t experience pain the way other races do,” and the current reality that “Black patients presenting with fever and cough are less likely to receive a referral for [COVID-19] compared to white patients.”
Specific anti-racist actions in health care listed during the AAMC’s June teleconference on racism include collecting crucial patient and community data for developing effective intervention, and engaging in anti-racist health advocacy.
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Dr. Fair called for anti-racism training for physicians, explaining the importance of understanding race, knowing racism’s history and impact on clinical practice, and being proactive in discussing racial justice policy and racist acts in healthcare.
Everyone can take cues from the AAMC and address unconscious racism in medicine. Collective anti-racist efforts will prevent future untimely losses of Black icons like Boseman and those within the larger Black community.
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