Culling colorectal cancer, a silent killer of Black Americans

For years, Black Americans have been about 20% more likely to get colon cancer and about 40% more likely to die from it than most other ethnic and racial groups. The disease has tragically taken the lives of Black celebrities, including actor Chadwick Boseman, soccer legend Pelé, and singer Eartha Kitt. 

The American Cancer Society (ACS) reported that this year, about 153,020 people will be diagnosed with colon cancer and 52,550 will die from it, including 19,550 cases and 3,750 deaths in individuals younger than 55. In New York City, colorectal cancer is the second-leading cause of cancer death.

Black hospital leadership, electeds, and church groups are launching innovative new ways to screen for colon cancer, as well as promoting local and national awareness about the risks. Often, colon and colorectal cancer does not show signs or symptoms of growth until it spreads. More importantly, when colon cancer is detected early, it has an almost 90% survival rate. 

“The risks of not getting [screening] done are death and dying from a terrible disease,” said NYC Health + Hospitals (H+H)/Harlem Chief of Gastroenterology Dr. Joan Culpepper-Morgan. “I hope that this demystifies and takes away some of the fear that people have, especially that Black men may have. We are here as a resource.”

“The best way we can help end glaring disparities in colorectal cancer occurrences and mortality is public education. As with most cancers, early detection is key,” said Councilmember Mercedes Narcisse, who chairs the council’s Committee on Hospitals. “Of course, as with all healthcare disparities, the fight must be centered on bringing equity to our healthcare delivery system. This starts with appropriately funding H+H facilities and safety-net hospitals. As chair of the council’s Committee on Hospitals, this remains a top priority.”

Most insurance plans, including Medicaid and Medicare, cover colon cancer screenings starting at age 45. There are two common ways to test and screen regularly for colon cancer: a colonoscopy or an at-home fecal immunochemical (FIT) test, which is less invasive and samples can be sent in by mail. A colonoscopy is a simple procedure where a doctor checks a patient’s rectum with a finger-sized camera for signs of cancer. 

NYC H+H/Harlem CEO Georges Leconte, 62, shared his personal experience to try to destigmatize the process for other men and women his age. Leconte said his first colonoscopy was at age 50 after his primary doctor and friend encouraged him to get it done. They didn’t find any growths or polyps—pre-cancerous growths the size of a microscopic mushroom—to worry about. Most people need to return every 10 years to get checked.

This time, Leconte allowed cameras to follow him as he prepped and underwent the routine colonoscopy. He began the night before with a regimen of laxatives and cleansing solutions. The next day, he was put to sleep with anesthesia during the 30-minute procedure. 

“Especially in the African American community, we don’t look at going to the doctor as prevention, and if you catch things early, you can make a difference,“ said Leconte. “Chadwick Boseman was probably one of the most gifted actors, and to lose him at such a young age to colon cancer was something that should wake us all up. It’s so preventable.”

Generally speaking, symptoms of colon cancer can include blood in the stool or rectum, nausea and vomiting, sudden weight loss, and diarrhea or constipation that doesn’t go away. Culpepper-Morgan, who performed Leconte’s colonoscopy, stressed that these are often late presentations of the cancer and may indicate a serious progression. 

“The bowel is large and it can stretch—it takes a lot to cause a blockage. By the time there is a blockage, it has spread already beyond the walls of the bowel to other organs,” she said. “We definitely don’t want anyone to get to that point.”

Sometimes the presumed sexual connotation of a colonoscopy prevents people from wanting to get it done, according to Culpepper-Morgan. “I think the thought of it is much worse than the reality,” she said. 

The journey to lowering the risk of getting colon cancer starts with a conversation about awareness with a trusted doctor, which is understandably difficult for many in Black and brown communities that have been subject to the whims of a systemically racist healthcare system, said Culpepper-Morgan. 

She added that Black and brown people are prone to environmental factors, like food deserts and redlining, that contribute to poor diets and poor health outcomes. Processed meats, such as hot dogs and deli meats, fast foods, and sugary foods overly available in food deserts can lead to unhealthy weight gain and potentially to colorectal cancer, according to research. 

“High-fructose corn syrup has, of course, been linked to diabetes, obesity—a tremendous uptick—but now we’re coming into a generation that has been weaned, if you will, on high-fructose corn syrup their entire life,” said Culpepper-Morgan. “We’ve seen in animal models that this substance increases the rate of growth of colorectal cells.”

Dr. W. Franklyn Richardson, chair of the Conference of National Black Churches (CNBC), concurred that it’s often not easy for people to trust doctors. In communities of color, “trusted voices” tend to be a pastor or church when it comes to health matters, which was evident during the COVID-19 pandemic. He said that the culture of health neglect and fear, sexual connotations about getting a colonoscopy, and mental health must be addressed in the church and in the community.

The CNBC represents more than 25 million people and 31,000 Black ecclesiastical congregations. The network has been dedicated to improving access to health and beating back comorbidities, and launched a series of efforts this March for Colorectal Cancer Awareness Month, since many congregants missed doctors’ appointments and skipped screenings and follow-up during the pandemic. 

“There’s a stigma attached to any kind of health challenge in the African American community, [including] prostate cancer among men,” said Richardson. “Men have a tendency to avoid the health experience, and it’s the lack of trust in the health experience. It doesn’t matter what illness is going on, the Black community has hesitancy and it’s borne out of a history of neglect and barriers to healthcare.”

Pastors were immediately confronted with the realities of health disparities when members were dying and unable to bury loved ones because of the high number of COVID deaths, he said. Richardson worked with the Centers for Disease Control and Prevention (CDC) on vaccination efforts and soon agreed to expand the operation. 

“Every statistic regarding health, Black people are at the bottom of,” said Richardson.

CNBC is also partnering with Lab Corp to distribute test kits at congregations across the country.

People are also more likely to have a higher risk of developing colon cancer if they are older, have a history of polyps or cancer in their family, have inflammatory bowel disease, exercise irregularly, are obese, drink alcohol, or smoke.

To consult with a NYC Health + Hospitals healthcare provider about colon cancer risk and with your insurer about your coverage for a screening test, visit NYC Care. For more information, call 1-646-NYC-CARE (1-646-692-2273). 

Ariama C. Long is a Report for America corps member and writes about politics for the Amsterdam News. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today by visiting https://bit.ly/amnews1.