Chadwick Boseman’s death shines a light on younger Black people with advanced disease
ABOVE: Dr. Angela McGee, Gastroenterologist at Kelsey-Seybold Clinic
“Black Panther” star Chadwick Boseman’s death in late August, at age 43, focused attention to the unfortunate intersection of colon cancer in younger patients and its disparate impact on African Americans.
His family posted a statement about his passing on social media, explaining that Boseman learned he had Stage 3 colon cancer in 2016 and that the illness had progressed over four years to Stage 4, the most advanced.
That means the sought-after leading man knew he had cancer in 2017 when he filmed the 2018 superhero movie, which would become a billion-dollar blockbuster. The eminently talented actor also portrayed real-life Black icons during his career, including U.S. Supreme Court Justice Thurgood Marshall, barrier-breaking athlete Jackie Robinson and “The Godfather of Soul” James Brown.
According to the National Cancer Institute, colon cancer is the second-leading cause of cancer deaths in the United States with rising rates among people under 50.
Africans Americans are at an increased risk of colorectal cancer compared with other racial and ethnic groups. Black people also are more likely to develop colorectal cancer at a younger age and are more likely to have an advanced stage of disease when diagnosed.
That’s a challenge because the U.S. Preventive Services Task Force recommends screening beginning at age 50, though some groups – including African Americans – are urged to start earlier at age 45.
That “screening” means a colonoscopy. And let’s be real: The colonoscopy is probably nobody’s favorite medical screening, but it’s necessary and lifesaving. A probe traveling through your rear end and your large intestine looking for signs of trouble ahead is the way physicians identify polyps or abnormal areas that could lead to cancer.
In this Q&A, Dr. Angela McGee, a gastroenterologist at Kelsey-Seybold Clinic in Houston, offers more details about colon cancer prevention and screening. She earned her medical degree from Morehouse School of Medicine in Atlanta and completed her internship and residency in internal medicine at The University of Texas Health Science Center at Houston (UTHealth). McGee also finished a fellowship in gastroenterology, hepatology and nutrition at UTHealth and MD Anderson Cancer Center.
Q: What’s the most important thing Houston Forward Times readers should know about colon cancer?
A: The most important thing to know about colon cancer is that there are cases of patients who have colon cancer with no symptoms at all. It’s very important to stress the importance of routine colon cancer screenings to catch these cases early to prevent any further complications. I think it’s important for people to understand the importance of screening, to discuss the screening guidelines and to understand this is a condition that could be, potentially, curable. When you think about the screening we do for other types of cancer, like breast cancer and prostate cancer and cervical cancer, those things detect cancer after it’s already developed a lot of times and every now and then we can find some precancerous lesions that can be caught. Colon cancer is not unlike any of the others. Once you find a polyp that may be precancerous or an early cancerous polyp, if that polyp is removed at the time of the colonoscopy, then you’re pretty much preventing someone from developing colon cancer. That’s something that people need to understand and maybe that would encourage them to have a screening colonoscopy where otherwise they may not have it.
Q: Have you had more patient inquiries since Chadwick Boseman’s high-profile death?
A: A lot of patients are mentioning the fact that we’ve had a celebrity who passed away from colon cancer at a very young age who happens to be an African American man. That’s been brought to my attention many times by patients. I’ve had quite a few calls from my nursing staff mentioning that people are calling in with questions.
Q: National stats show that colon cancer patients are tracking younger. Have you seen that trend during your 20-year career?
A: Yes, I have. Not only colon cancer, but we are finding more advanced colon polyps in patients at younger ages. That’s why anyone who comes in and wants a colonoscopy just for screening, even without symptoms and despite their age, I never discourage them from doing that because you never know. My youngest patient with colon cancer was an African American lady who was 27 and when I scoped her, she already had metastatic colon cancer and no family history. That was several years ago.
Q: What is metastatic colon cancer?
A: Metastatic is if it’s already spread to other organs outside of the colon or if it’s involved in the lymph nodes surrounding the colon. That’s Stage 4. End stage. The goal with colon cancer and treatment is to catch it early before it spreads, when it’s more difficult to treat.
Q: Tell me about your career as a gastroenterologist.
A: I’ve been practicing gastroenterology here at Kelsey for 20 years. I started in August 2000 just after my fellowship training at The University of Texas in the Texas Medical Center. It’s a very large, community-based GI (gastrointestinal) practice. I treat all different types of GI illnesses – everything from rectum bleeding, reflux and abdominal pain to liver disease including Hepatitis C, cirrhosis and other chronic liver disease.
Q: What are some common symptoms of colon cancer?
A: Some symptoms they could experience are changes in bowel habits, rectal bleeding, abdominal pain, new onset constipation, sometimes diarrhea – any of those types of things could be signs of early colon cancer.
Q: How do lifestyle and environment impact colon cancer?
A: The lifestyle preventive measures are kind of controversial in that just because you follow these lifestyle guidelines doesn’t mean that you absolutely will not develop colon cancer. Things that possibly have been shown to increase the risk are being overweight, smoking, eating red or processed meat, low-fiber diet, lack of physical activity – those things are definitely concerning factors that could potentially increase the risk for colon cancer.
Q: Explain the different screening recommendations for certain populations.
A: It’s definitely been recommended that African Americans have a screening colonoscopy at the age of 45 rather than 50 because we know that African American patients see a higher mortality rate with colon cancer, clearly a higher incidence of colon cancer and the survival is a lot lower in African American patients who develop colon cancer. That’s not something new. Early screening is definitely beneficial. The problem is that the insurance sometimes doesn’t pay for it. That’s when we really have to depend on our GI organizations like the American College of Gastroenterology and the American Gastroenterological Association to hopefully continue to encourage insurance companies to cover those screening exams a lot sooner. Most patients – when they present for symptoms – the insurance will usually pay for it, but sometimes it’s a higher co-pay. Once you turn 50, those are done for patients who have no symptoms at all who just need a routine screening.
Q: What challenges do you face in convincing people to have a colonoscopy?
A: I can’t tell you how many 50-year-olds I’ve seen who have insurance and have access who still say they don’t want a colonoscopy. Not only are you struggling with the patients who need it and want it who can’t get access to it, but you also struggle with the people who do have access who refuse it. The problem becomes convincing that person that they really do need to have this test done and that’s something that I deal with on a daily basis, believe it or not. There are a lot of misconceptions about the colonoscopy and the whole process. You are sedated. Most people go to sleep and wake up when the procedure is done.
Q: What reasons have your patients given for not wanting a screening?
A: A lot of them don’t feel like they need it because they don’t have symptoms and people are afraid that they’ll be awake and uncomfortable. I saw a lady just yesterday who was infuriated that her primary care doctor even suggested that she needed a colonoscopy. She’s 62, never had colonoscopy and she’s an African American lady. She told her primary care doctor that she did not want a colonoscopy and got scheduled for the appointment anyway. She was angry at me and everyone else involved in her appointment because she did not want a colonoscopy. It was not a pleasant scene. I explained to her why and she said she was healthy, she had no family history, she didn’t need the test done and had heard that it’s painful. She got up and left. This is a patient with insurance and resources who had never had a colonoscopy before. That was an extreme, but it shows that we still have a lot of work to do convincing patients that this is what they need to do to stay healthy.
Q: How does colon cancer’s disproportionate impact on Black people affect your actions as a Black gastroenterologist?
A: I tend to be more proactive about screening and convincing patients to have a colonoscopy who otherwise wouldn’t. I take the time with all patients to explain the procedure and ask about their concerns and why they don’t want to have it done. Most of time I find out that those patients have a preconceived notion about the procedure or the prep. Once they describe that to me, I’m able to clear up the myths. Usually, I’m able to convince them that they need to have it done and that it’s a good thing to do. You’d be surprised about the hang-ups people have just based on what they’ve heard or what their friends have told them. I had my first one a couple of years ago and I’ll be 52 in October, so not only have I done them – now, I’ve actually had my own. No matter what the patients come in for – if I see a patient for acid reflux or something totally unrelated – if they are 50 years of age or older, I make it a point to inquire about if they’ve had a colonoscopy for screening or any other type of screening test done and encourage them to do so. I think that’s what we as physicians really need to do more. We need to really encourage patients to have the procedures done. Some patients see their primary care doctors and, unfortunately, some of them don’t mention the fact that they need a colonoscopy done. Patients figure: ‘Since the doctor didn’t mention it I must not need it’ – even though I’m over the age of 50.
Q: Consider this conversation as a say-it-loud community megaphone. As a Black gastroenterologist, what do you want to convey to Black Houstonians?
A: The most important thing is to convince them that a colonoscopy, done every 10 years if everything is normal, could potentially save their life. Some people think that they have to have this done every year. It can prevent your family from suffering as a result of your loss. I try to stress the fact that they’re sedated during the procedure and that this is something that could totally prevent colon cancer by simply removing a precancerous polyp. The prep is another thing people are leery about, but it’s not as difficult as it seems.