Kenneth L Abbott, MD, FACP  |  11/2/2022

Colorectal Cancer and the Black Community in America

The forthcoming and much-anticipated release of Wakanda Forever, the sequel to Black Panther, one of the most popular and honored entries in the Marvel Cinematic Universe superhero series, poignantly reminds us of the loss of the first movie’s charismatic young star, Chadwick Boseman. In his portrayal of King T’Challa of the mysterious African nation of Wakanda, Boseman exuded such vitality, strength, charm, and gravitas that his death in August 2020 shocked the world. Few people knew he had been ill. In fact, he developed stage III colon cancer in 2016. Despite appropriate treatment, his disease progressed, sadly costing him his life at just 43 years of age.

How could such a young and vibrant life be too soon extinguished? Boseman’s experience highlights a frightening health phenomenon in the United States. While colorectal cancer incidence and deaths due to the disease are waning in older white populations, the traditional group at higher risk, in recent years we have seen a rise in incidence in younger Americans, particularly those younger than 35 years, an age group rarely thought to have much concern for such disease. Black men in the US constitute a particularly at-risk group, 24% more likely than white counterparts to get colorectal cancer, and 47% more likely to die of the disease. Diagnosis more often occurs at a later and harder to treat stage, with devastating consequences. Cancer treatment success rates are always higher when the disease is found at the earliest possible stage. Couple this with the disturbing national trend of rising incidence of colorectal cancer in young persons, including those under 35 years of age, and we have the makings of a public health disaster.

What might explain this nightmare? Certain physical factors such as diet (increased consumption of animal fats and reduced consumption of fiber sources, including fruits and vegetables), tobacco use, obesity, reduced physical activity, and reduced intake of vitamins C and E all contribute. The American black community also disproportionately must deal with obstacles to health care access, including poor or absent health insurance, transportation problems, reduced income, and lack of good quality clinics and treatment centers in or near neighborhoods. Individually, these factors create problems; taken in combination, as they often are, the difficulties can seem insurmountable.

But not necessarily, as recent experience in Delaware has proven. A program to improve colorectal cancer care provision resulted in remarkable benefits. State monies were made available to enhance access to screening colonoscopy and to cover costs not just of this procedure but the subsequent required treatment for underinsured persons. The program aggressively utilized nurse navigation to come alongside affected persons, guiding them through the often confusing and complicated process of obtaining quality cancer care. A public health outreach and education program, frequently working in tandem with churches and other institutions important in the black community, raised awareness of the disease and the importance of early diagnosis. The outcome? Astoundingly, but logically, outcome disparities have virtually disappeared. Other states would do well to scrutinize Delaware’s program and think hard about similarly prioritizing public health care resources.

I cannot presume to speak to Chadwick Boseman’s perspective. The impression I have of the man, however, tells me he might consider knowing that multiplied thousands can be spared what he suffered by the heightened awareness and positive action taken brought about by his example removes some of the sting of his sacrifice. This might become for him an even greater legacy, worthy of a true king.
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