The untimely death of actress Natalie Desselle-Reid at the age of 53 from colon cancer served as a stark reminder of the prevalence and dangers of this disease. Her passing also highlighted the significant racial disparities in colorectal cancer incidence and mortality rates in the United States. While advancements have been made in reducing overall colorectal cancer deaths, Black Americans continue to experience disproportionately higher rates of diagnosis and death, highlighting a critical need for systemic change and improved healthcare access. This article will explore the complexities of this health disparity, examining the biological and systemic factors contributing to this crisis and outlining actionable steps toward a more equitable future.
Understanding Colorectal Cancer: A Silent Killer
Colorectal cancer, affecting the large intestine (colon and rectum), often begins with the development of precancerous polyps. These small growths often present no symptoms in their early stages, allowing the disease to progress undetected. While anyone can develop colorectal cancer, certain risk factors increase susceptibility. These include age (risk significantly increases after age 50), a family history of the disease, a diet low in fiber and high in processed foods, insufficient physical activity, obesity, and smoking.
Early symptoms, such as alterations in bowel habits (constipation, diarrhea, or a change in stool consistency), blood in the stool, and persistent abdominal discomfort, are often subtle and easily overlooked. This underscores the critical importance of regular screenings for early detection, as early diagnosis drastically enhances the chances of successful treatment and survival.
Stark Realities: Racial Disparities in Colorectal Cancer Statistics
The statistics paint a grim picture of racial disparities in colorectal cancer. Black Americans consistently experience higher incidence and mortality rates compared to white Americans. This difference isn't marginal; it's substantial and deeply concerning. Furthermore, access to preventative screenings and quality care is often significantly lower in Black communities. This disparity is not simply a matter of chance; it stems from a complex interplay of biological and systemic factors.
| Characteristic | Black Individuals | White Individuals | Explanation |
|---|---|---|---|
| Incidence Rate | Higher | Lower | A greater number of Black individuals are diagnosed with colorectal cancer. |
| Mortality Rate | Significantly Higher | Significantly Lower | Tragically, a greater percentage of Black individuals die from colorectal cancer. |
| Access to Screening | Often Lower | Often Higher | Fewer Black individuals receive timely and appropriate screening tests. |
| Access to Quality Care | Frequently Lower | Frequently Higher | Black individuals often encounter barriers to accessing necessary specialists and timely treatment. |
According to the CDC, the five-year survival rate for colorectal cancer is about 65%, and there has been an overall drop in colon cancer diagnoses and deaths over the last few decades. However, as of 2017 (the most recent year available for CDC data), a racial disparity in colon cancer cases and deaths remains. For every 100,000 white women, there were 32 cases of colorectal cancer and 11 deaths, which increased to 35 cases and 15 deaths among every 100,000 Black women. Colon cancer is more common in men-for every 100,000 white men, there were 41 cases of colorectal cancer and 16 men died. Among the same number of Black men, there were 48 cases of colorectal cancer and 22 deaths.
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Unraveling the Complexities: Why the Disparity?
The reasons behind these disparities are multifaceted and complex, involving both biological and systemic factors. While research into the exact genetic and environmental interplay is ongoing, several critical components have been identified:
- Healthcare Access: Limited access to quality healthcare, often due to lack of insurance or financial constraints, significantly contributes to delayed diagnosis and treatment, resulting in poorer outcomes. This is further exacerbated by geographical limitations, leading to reduced access to specialist care for many Black Americans.
- Socioeconomic Factors: Lower socioeconomic status, disproportionately affecting Black communities, limits access to healthy food options and increases exposure to risk factors like processed foods and lack of physical activity. The cost of regular screening and treatment itself can be a significant barrier for those facing financial hardship.
- Cultural Beliefs and Mistrust: A history of systemic racism and discrimination within the healthcare system has understandably fostered mistrust among some members of the Black community, leading to hesitancy in seeking medical care, even in the presence of concerning symptoms.
- Implicit Bias: Studies suggest that unconscious biases, even among well-intentioned healthcare professionals, can impact the quality of care received by Black patients, potentially leading to less thorough examinations, delayed referrals, and less effective treatment.
It’s not entirely clear why these disparities exist, though as SELF previously reported, experts are considering how symptoms may present differently across races as well as the structural inequities that create barriers to health care, appropriate screening, and treatment for communities of color. Inequity does seem to be a foundational factor behind colon cancer disparities. Research suggests that doctors don’t recommend colon cancer screening often enough, especially to Black people. And once Black patients are diagnosed, there’s further evidence that they’re less likely than white people to receive surgery and chemotherapy, which can be life-prolonging and life-saving treatments. Eliminating systemic racism that contributes to these kinds of disparities will depend on the health care system rooting out structural inequities that deprive Black people and other people of color of years of health and vitality.
Natalie Desselle-Reid: A Human Face to the Statistics
Natalie Desselle-Reid's death serves as a powerful and heartbreaking illustration of the human cost of these disparities. While the specifics of her individual case remain private, her story underscores the urgent need to address the systemic issues at play and improve access to equitable healthcare. Desselle-Reid was best known for her work on the TV show Eve, as one of the stepsisters in the 1997 retelling of Cinderella starring Brandy and Whitney Houston, and as a star of the 1997 comedy hit B.A.P.S. Desselle-Reid’s family announced her death on her Instagram page on December 7. “It is with extremely heavy hearts that we share the loss of our beautiful Natalie this morning from colon cancer,” the statement read. “She was a bright light in this world. A queen. An extraordinary mother and wife. Her diverse career touched so many and she will be loved forever. Naturally, we are grieving and processing this profound loss and we thank you in advance for respecting our privacy at this extremely difficult time.”
Along with Desselle-Reid, Black Panther star Chadwick Boseman is another recent high-profile tragic loss to the disease.
Pathways to Change: Charting a Course Toward Equity
Addressing these disparities requires a comprehensive, multi-pronged strategy:
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- Enhanced Awareness: Targeted public health campaigns, designed specifically to reach Black communities, are crucial. These campaigns must utilize culturally appropriate messaging and address existing mistrust and lack of awareness.
- Improved Access to Care: Expanding access to affordable healthcare, including insurance coverage and financial assistance programs, is paramount. This must also include ensuring that geographic barriers do not prevent access to necessary screening and treatment.
- Mitigation of Systemic Bias: Systemic change requires proactive measures to address implicit bias within the healthcare system through extensive training on cultural competency and unconscious bias for healthcare professionals.
- Community-Based Initiatives: Collaborating with established community leaders and organizations is fundamental for fostering trust and increasing access to healthcare in underserved communities. This engagement must be built on mutual respect and a deep understanding of specific community needs.
The Importance of Screening and Early Detection
Colorectal cancer (which includes cancer of the colon, or large intestine, and of the rectum, or the last section of the colon) is the fourth most common and fourth most deadly cancer in the United States. In both areas, it's behind female breast cancer, prostate cancer, and lung and bronchial cancer, according to the Centers for Disease Control and Prevention (CDC).
According to the Mayo Clinic, colon cancer typically begins as non-cancerous clumps of cells in the colon called polyps. These polyps often don’t cause any symptoms, especially early on, but can become cancerous over time. (This can take up to 10 to 15 years, according to the American Cancer Society.)
A person with more advanced colon cancer may begin to notice symptoms like a change in bowel habits (such as more frequent diarrhea or extended bouts of constipation) or a feeling like they haven’t completely emptied their bowels after using the bathroom. Symptoms can also include rectal bleeding, abdominal pain, fatigue or weakness, and unexplained weight loss, according to the Mayo Clinic. The exact symptoms and their severity depend on how advanced a person’s cancer is and exactly where it is within the colon.
Screening for colon cancer can sometimes make it easier to catch and treat. Stool tests and colonoscopies are the main screening method for colon cancer, according to the Mayo Clinic. Stool tests can screen for changes in DNA or hidden blood that might indicate an issue, but they are not as sensitive as colonoscopies. A colonoscopy requires people to thoroughly cleanse their bowels (often through laxatives) before the procedure, and then a doctor investigates the entire colon with a camera attached to a thin tube. During this procedure, a doctor can remove visible polyps and take samples of any abnormal-seeming tissue to further investigate. “Virtual” colonoscopies-another name for CT scans in this context-are also a possibility, though they still require complete emptying of the bowels, and any abnormalities require a follow-up appointment for a traditional colonoscopy.
For people without additional risk factors, the American Cancer Society recommends that colon cancer screening begin at age 45, no matter a person’s race. The US Preventive Services Task Force previously recommended screening at age 50 but is currently considering lowering their universal age for screening to 45. This change could help get screening covered as a zero-copay preventive test for insured people starting at 45 instead of 50, according to CNN. In turn, this move may help save lives.
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Some experts have been pushing for earlier colon-cancer-screening recommendations for Black people based on these disparities. For example, in 2009, the American College of Gastroenterology updated its guidelines to recommend screening Black people with an average risk at age 45. Preventive Services Task Force makes its new screening guidelines official, it would match this recommendation for all races.
When it comes to your personal colon cancer risk, there are a few things you can try to do if you’re concerned. First, be aware of any risk factors you have for the disease and monitor your bathroom habits for any changes that could indicate an issue. If you have a doctor you trust, whether that’s a primary care doctor or gastroenterologist, bring up your concerns and see what kind of screening they recommend. If that involves doing any testing or having doctor’s appointments while the pandemic is ongoing, the very thought of that might be scary, and that makes sense. Still, experts are generally recommending that people continue to keep up with potentially life-saving preventive care depending on their personal health histories.
A Personal Story of Facing Colon Cancer
This year, 150,000 people in the United States will walk into a doctor’s office where they will discover that their biggest fears have come true - they have colorectal cancer. The hope for a condition other than cancer is shattered into a million little pieces, leaving a tempered glass look into the unknown future of a life now fighting for survival. This diagnosis is particularly devastating for those that sought treatment because of symptoms they were experiencing, as these symptoms rarely present themselves in a contained cancer found in the colon.
One individual shared their experience, saying, “I had a mixture of emotions. I was devastated, I was afraid, and I was angry. You see, I had gone to the ER multiple times with pains in my stomach, nausea, and vomiting. I was losing a lot of weight, and I was getting really concerned. Now, don’t get me wrong - I was still cute and all! But, something clearly wasn’t right. They gave me medicine to treat those symptoms, and they would work for a little while. But, the pain would always come back. One Sunday morning, I was in so much pain that I had to call my sister, Alaine, to come and take me to the hospital. So, there I was in the ER again. This time, there was this young doctor who asked if he could do a scan of my belly. I said alright, and I was actually thinking that this doctor really didn't know what he was doing. I mean, he looked young enough to be one of my students! My immediate reaction was anger. I could not believe that I had sat in that ER, with this young doctor, only for him to "mistakenly" tell me that I have cancer. He had to be mistaken, right? At least that was my hope. I have to admit, though, that bubbling behind my anger was a growing sense of fear that his diagnosis was really true. Cancer is in my family history, and even though I’m not sure which types of cancer they had, my grandmother and two of my aunts lost their battle with it. After a few moments to collect myself, he then referred me to Dr.”
The individual continued, “I had heard of colon cancer, but I did not know very much about the disease at all. All I knew was it was a disease that people should get screened for around the age of 50. Well, I was 44 when I was diagnosed. I was not even the age to be screened. When I met Dr. Jimoh, he was very kind to me. Dr. Jimoh told me that he read the ER report and saw the scan. He then scheduled me for an immediate colonoscopy. Within 48 hours, I was having that done. After the colonoscopy, when I woke up, Dr. Jimoh came to talk to me. I fully expected him to tell me the ER doctor was wrong, and I hoped he could just prescribe me something to take care of whatever must have been wrong with me. However, Dr. Jimoh confirmed that it was indeed colon cancer. I burst into tears, and Dr. Jimoh embraced me. He said that he knew that was not the news I wanted to hear. I remember saying to him "I just graduated with another Master's, I don't have time to be sick"…."what about my job"…."I have so many other things to do and focus on right now"….and then Dr. Jimoh said some very piercing words to me. He said, "let's focus on saving your life". It was really hard because I’m the type of person that likes to be strong - both for myself and for others. It was hard to be strong, though, when I was losing my house, as I couldn’t work and didn’t have money to pay my bills. It was difficult to be strong and be faced with going back and living with my parents.”
“And then, something just changed. I was writing a lot - I love to write, and writing really helped me face some of my fears. It even helped change some of my perspectives. I’d write songs, write out prayers, write out encouragements, and write how I was feeling - whether bad or good. And in the middle of writing one day, I realized I needed to have a change in perspective. I was letting cancer beat me down, and that realization hit me like a ton of bricks. I was always so focused on the why. And you know what? While I was focused on the “Why?”, what I really needed to be focused on was the “What”. You see, my life had always been about the ‘what’. It’s ingrained in me. The “why” questions, though, clouded my thoughts and gave me a negative, ‘woe is me’ type of perspective on so many things in my life. I realized that in order to do what Dr. Jimoh said - to focus on saving my life, I had to focus on the ‘what’. What am I going to do to beat this? It’s not like there aren’t moments where I’m sad, afraid, confused, or even feel defeated. I was diagnosed with another form of cancer a year later after having been diagnosed with colon cancer. That diagnosis was really difficult to handle at first. However, with my new perspective, I was able to look at this diagnosis through a different lens. The blessing is that if I had not already been receiving cancer care, then this could have gone undiagnosed Just as God is keeping me in His care through my colon cancer, He is keeping me in this too. Yes, the battle continues, but God is there completely with me, so I know He is covering me. I do wish, in retrospect, that I had been more knowledgeable about colon cancer in general, about the signs and symptoms and even how to prevent it. I was most afraid of dying. I was most afraid that cancer was going to be the end and/or sum total of my life. I was afraid of impending changes and turns that my life was getting ready to take into the unknown. No one truly knows how they will handle a situation until they are actually faced with it. I have grown spiritually during this time of sickness. This is growth that perhaps I would not have made if I had not been made to stop and be still. My experience with CDHA has been nothing but professional and personal. Everyone has been so kind. Everyone has made me feel that I matter. Dr. Jimoh has always taken excellent care of me. He has always greeted me with a smile. He has also made me feel like he was right in all of this with me. He never made me feel like I was alone. He referred me to an excellent oncologist which has managed my cancer treatment in a way that makes me feel like I am important and getting the best care possible.”
The individual encourages others by saying, “I would encourage him or her to PLEASE go get screened. I have actually been an advocate for screening since my diagnosis. Then, when Chadwick Boseman and Natalie Desselle-Reid, who are famous, died from the disease, it actually put a face to the disease. I have been telling my friends and family to get screened. I believe the recommended age is 45 now. This is especially important for African-Americans because we, as a community of people, often neglect our physical health. I know I was guilty of that. Sometimes, we often do it because of the disparities in healthcare that minorities have to deal with. However, it is better to be proactive instead of reactive. I would rather err on the side of caution. I think, if we were all to be honest with ourselves, we all would. Even through the tears I cry, even when I don’t understand, it is not my responsibility to “figure it out”. Instead, my responsibility is to “faith it out”. The bottom line simply is that God’s ways are not my ways, and His thoughts are not my thoughts. Why? If you have questions or concerns about colorectal cancer, do not wait tocall us at Carolina Digestive Health Associates. We want to help everyone, but especially young people, avoid a colorectal cancer diagnosis.”
Risk Factors and Prevention
Some people are at higher risk for colon cancer, including those with a family history of the illness or with underlying conditions affecting the intestines (like Crohn’s disease and ulcerative colitis). Certain lifestyle risks can also indicate a higher risk of colon cancer, such as excessive alcohol use, not eating sufficient amounts of fiber, and smoking. But people with these risk factors don't always develop colon cancer, and people without these risk factors can wind up with the disease as well.