When I read that Chadwick Boseman had died the first thing I did was the math. He was 39 at most when the cancer began to grow and that is a lot younger than 45, which is when The American Cancer Society recommends colorectal cancer screening. I wondered, was age 45 too late? It certainly was for Chadwick. The recommendation is based on scientific data gathered on patients determined to represent the general population. I was curious, who comprises this general population exactly? I wanted to know--and really for the sake of my own black life I needed to know--if screening at the age of 45 was advisable for Black people, too. Are we a part of this general population?
Centuries of exclusion and legacies of white supremacy led me to believe black people were likely underrepresented in the designated "general population", especially considering we are frequently and systematically excluded elsewhere. I had to investigate.
As it turns out, there are multitudes of studies that find very different realities of colorectal cancer between races. I discovered that in the United States African Americans have the highest rate of colorectal cancer out of all racial groups. Studies on this cancer in African-Americans show an earlier age of onset and a greater incidence of death. Not only does the cancer hit as many as five to eight years earlier but it appears to hit harder as well. There is also evidence that the nature of the cancer in African-Americans is often unique. These scientific findings were not hard to unearth. In fact, I had a hard time choosing which studies to cite because they were so abundant. Clearly the data isn’t lacking, but for some reason it isn’t guiding medical practice either.
I realized that I had seen racial health inequity in the flesh before, my own flesh. Around age 24 I began suffering from frequent rashes and irritable bowels. Eventually I found I was lactose intolerant, but it would take more than four years to arrive at that conclusion. I was surprised to discover that many descendants of slaves are lactose intolerant. The gene for digesting lactose is most often found in the genomes of pastoralist groups who kept animals like cows and goats. These populations lived mostly in Europe and Asia, but also in northern, eastern and central Africa. Whereas most slaves came from western sub-Saharan Africa, few would have ancestors that were pastoralists. Only 35% of humans are able to digest lactose from milk and among those that are slave descendants this number may be much lower.
When my lactose and tolerance did come to light, it was a Black physician who revealed it. I didn’t go to see him for my lactose intolerance symptoms but he had enough knowledge about my racial group to recognize a problem that was common. On the other hand, when I initially saw her for my symptoms my White primary care physician was preoccupied with one possible cause, heroin. She asked me multiple times if I was doing heroin and suggested I had imagined bugs and created the rashes myself by scratching. She persisted even when I told her I was sure this was not the case. Mind you she was well aware I had just graduated from Harvard. How I could manage to get a Harvard diploma and maintain a heroin habit simultaneously was beyond me. I left that appointment without a single test ordered and without a suggestion for treatment; not a cream, nothing. While my ailment was not life-threatening it did impact my performance at work and my overall quality of life—a life that should have mattered enough to treat. To my doctor my symptoms were a figment of my imagination and so my suffering was invisible. It seemed my melanin was an impediment to my treatment. I had to wonder, did she believe I was as human as her white patients?
The feeling that one’s humanity goes unnoticed in the doctor’s office is a reality for many black, indigenous and people of color, and in so many aspects of our lives. It is akin to the experience of the black protagonist in Ralph Ellison’s Invisible Man. When he refers to the way he is seen in the world he remarks; “they see only [his] surroundings, themselves, or figments of their imagination -- indeed, everything and anything except [him].” As a Black woman I can say that I have felt that invisibility relentlessly throughout my life, not only at the doctors office but in the classroom, at the grocery store, at my regular coffee shop, at the car dealership, even in my own workplace--and that's only the beginning of the list. Black people are often treated based on stereotype and bias instead of symptoms and science. Since colorectal cancer appears and progresses so differently in African-Americans, medical professionals should be made aware of this racial and ethnic disparity. Data indicates that in African American populations screening rates for cancer are significantly lower than average and when there is screening the rate of follow-up care is lower as well. This can be attributed, in part, to physicians' failure to advise their black patients and the general lack of cultural competency in the medical research and practice. Medical professionals are uninformed and too often uninterested in the racial disparities and variation of symptoms in different races. Physicians are less likely to treat black patients with adequate care, if at all.
To put it plainly, when black people go to the doctor their symptoms are
overlooked and their diagnoses are untimely, at which point their treatment falls short.
African-American people must be represented in the medical profession and the research. In the doctors office they must be treated like they are just as human as their white counterparts. This means medical professionals, researchers and even pharmaceutical companies need to get training and education on systems and approaches designed for racial equity. The health care field must operate with data and treatment approaches applicable to each and every racial group, instead of use the white-man-fits-all approach. If I hadn’t met a black doctor aware of racial realities would I still be suffering from something so easily treatable? If there were more black scientists elevated to positions in medical research, would one of them have noticed that their test subjects were virtually all white? I wonder if Chadwick might be here had his doctor known to look for the symptoms that statistically occur more frequently in younger African-Americans, or even better, suggested a colon cancer screening at age 37 instead of 45? Would Black children be missing the Black superhero of their generation? If we constructed our society based on principles and practices of racial equity over white supremacy, I don't believe they would be.
The Dalai Lama has said that "it is not enough to be compassionate, we must act". Without action there will be no change. We can say black lives matter all day, but those words won't save my life when my doctor overlooks me. Do right by Chadwick. Don't just say black lives matter, make it so. It's time we honor our words and get to work.
2. Berry, J., Bumpers, K., Ogunlade, V., Glover, R., Davis, S., Counts-Spriggs, M., Kauh, J., & Flowers, C. (2009). Examining racial disparities in colorectal cancer care. Journal of psychosocial oncology, 27(1), 59–83. https://doi.org/10.1080/07347330802614840
3. Carethers J. M. (2015). Screening for colorectal cancer in African Americans: determinants and rationale for an earlier age to commence screening. Digestive diseases and sciences, 60(3), 711–721. https://doi.org/10.1007/s10620-014-3443-5
4. Dou, R., Ng, K., Giovannucci, E. L., Manson, J. E., Qian, Z. R., & Ogino, S. (2016).Vitamin D and colorectal cancer: molecular, epidemiological and clinical evidence. The British journal of nutrition, 115(9), 1643–1660. https://doi.org/10.1017/S0007114516000696
5. Ranciaro, A., Campbell, M. C., Hirbo, J. B., Ko, W. Y., Froment, A., Anagnostou, P., Kotze, M. J., Ibrahim, M., Nyambo, T., Omar, S. A., & Tishkoff, S. A. (2014). Genetic origins of lactase persistence and the spread of pastoralism in Africa. American journal of human genetics, 94(4), 496–510. https://doi.org/10.1016/j.ajhg.2014.02.009
6. Gerbault, P., Roffet-Salque, M., Evershed, R. P., & Thomas, M. G. (2013). How long have adult humans been consuming milk?. IUBMB life, 65(12), 983–990. https://doi.org/10.1002/iub.1227
7. Ellison, R. (1995). Invisible man. New York: Vintage International.
8. Royston, K. J., Adedokun, B., & Olopade, O. I. (2019). Race, the microbiome and colorectal cancer. World journal of gastrointestinal oncology, 11(10), 773–787. https://doi.org/10.4251/wjgo.v11.i10.773
9. Coughlin, S. S., Blumenthal, D. S., Seay, S. J., & Smith, S. A. (2016). Toward the Elimination of Colorectal Cancer Disparities Among African Americans. Journal of racial and ethnic health disparities, 3(4), 555–564. https://doi.org/10.1007/s40615-015-0174-z