Yes, You Need a Colonoscopy—Here’s What to Expect
The news of Chadwick Boseman’s death produced an instant shockwave. Many of us were blindsided and unable to comprehend the tragedy. But what… but why… but how?
As we learned more details, we had to deal with reality. Boseman was not the king of Wakanda, he was not imbued with super healing powers, and he did not have access to space-age technology powered by vibranium or a heart-shaped herb to bring the sick back to health.
Chadwick Boseman was a Black man who died of colon cancer, the third most common form of cancer for both men and women. And he was only 43 years old.
Fans took it hard. Black men, already feeling under attack in BLM America, were reminded of yet another supervillain determined to take us down. But despite the despair, there is hope for the rest of us — if we’re willing to take responsibility for our health. No matter how uncomfortable we think the procedure can be.
“I’ve had countless patients in the last 18 months who I think wouldn’t have come in had it not been for their spouses. And we’ve found significant diseases.”
Dale C. Holly, MD, a board-certified gastroenterologist, hopes Boseman’s untimely death will be a wake-up call. As a Black man, Holly has seen up close how prevention can help save lives, particularly for Black men — and how misinformation and reluctance to discuss health issues can lead to fatal outcomes for Black men. While Boseman did not speak publicly about his illness and struggles, Holly hopes to bring this conversation out of the shadows.
Erik Parker: One of the reasons men aren’t doing their proper screenings is because they don’t even know what these organs do and which doctors treat them. You’re a gastroenterologist. What exactly does that mean?
Dale C. Holly, MD: Gastroenterology is a large specialty. It involves your esophagus, your stomach, your small intestine, your pancreas, your liver, your gallbladder, colon, and rectum.
Given your specialty — and being a Black man in your field — were you shocked by the recent death of Chadwick Boseman?
As sad as it is, and as shocking for the public, Boseman’s case is emblematic of what we’ve been seeing. In younger patients, colon cancer is much more aggressive; he was diagnosed at 39, which is young, and he died at the age of 43, with stage 3 colon cancer.
What does stage 3 mean?
It’s now outside the colon, but it hasn’t spread to distant organs like the liver and lung.
So, by the time Boseman was diagnosed, was it already too late?
When you look at the five-year survival rate in patients with stage 3 colon cancer, it’s less than 20%.
What does Boseman’s death tell us about colon cancer for people in their thirties and forties?
A group of researchers from the American Cancer Society did a study about three years ago, and what they found was really striking. They found that in people born in 1990, the risk of colon cancer was twice as high — and four times as high for rectal cancer — as in those born around 1950.
But we’ve always been taught that it was older people who were more at risk. This makes no sense.
This seems to be a new type of disease, because it has distinguishing characteristics that are uniquely different from the kind of typical colorectal cancer that we’re seeing, and it’s occurring in younger people.
Have you noticed this in your practice?
I’ve had patients as young as 28 years old with colorectal cancer, and this was 15 years ago, even before this study. So we’ve begun to see a paradigm shift.
Do you typically see many Black men come into the office for exams?
It’s a challenge, getting Black men into the office. What I am beginning to see, for a lot of the Black men who are married, their wives are bringing them in. There’s a determination on the spouse’s mindset to where she will say, “I made this appointment, Dr. Holly. Now I want to make sure we talk about all the issues going on with him.”
Do these spouses help their husbands open up to you?
When talking with most men I say, “How’s everything going?” And the man will say, “Everything’s fine.” Then I ask, “Are you having any symptoms?” And I’ll get, “No.” Then the spouse says, “No, wait a minute, you’ve been having abdominal pain and rectal bleeding for the last six months!”
She puts all his business out there, huh?
Yes, and it’s saving lives! I’ve had countless patients in the last 18 months who I think wouldn’t have come in had it not been for their spouses. And we’ve found significant diseases. For some of these patients, it made a difference in their lives and in their survival.
Speaking of prevention, when should people start getting screened?
The recommendations for the average-risk patient is to start at 45. And depending on what we find on that exam, that determines when the next exam will be.
But that’s for average risk? What determines if you are high risk and need to test earlier?
Let’s say, for instance, a person’s mother or father or grandparents had colon cancer. That’s what we call a positive family history. Therefore, you’re at a higher risk. If there is a history of inflammatory bowel disease — Crohn’s disease, colitis — those conditions increase your risk of colon cancer. So you have to be screened. There are genetic conditions, like familial adenomatous polyposis, or FAP, that predispose people to increased risk of colon cancer. Those people have a much higher risk, and you’ll find multiple family members who’ve had cancer, usually at a very early age.
When family medical history is so important, do you find that Black people share that information with one another?
It’s a real dilemma within the African American community, because historically, Grandma and Grandpa don’t tell us about our health. And even our own parents sometimes will not discuss that until they’re critically ill. I tell my patients, sit down with your mom, sit down with your father, sit down with your grandparents if they’re living. The more people you can talk to in your family and discuss a family history, the better it’s going to be for you and your family. That’s how you make a difference.
I’ve had a prostate exam, and it was no fun. It involved a very uncomfortable moment with a doctor and a gloved hand and a room full of anxiety. Please tell me a colonoscopy exam isn’t more of the same.
The prostate exam is a totally different exam. That’s what we call a digital rectal exam. Yes, it’s uncomfortable. But here’s the thing: If we’re at a higher risk, we’ve got to get past the fears and the myths. We want to be here for our family and our children, our spouses. We’ve got to be responsible.
This is true. Okay, so walk us through the colonoscopy exam process.
You’re on a liquid diet the day before the test. So, popsicles, Jell-O, really light food. And then you drink this bowel prep the evening before, which cleans you out. Now, the day of the procedure, the nursing staff hooks an IV in your arm. They give you some medication to help you relax. And then you’re totally asleep for about 20 minutes.
That’s kinda the part that’s uncomfortable.
But there is no pain. The procedure normally lasts 20 to 30 minutes. If you have to remove polyps, obviously that takes a little bit longer. And then you’re in recovery waking up and you go about your day. I’m very careful to make sure my patients have a seamless experience, because that’s really what it’s all about.
To avoid being scared to death by WebMD, can you tell us what symptoms we should take seriously for colon cancer?
If you have a drastic change in your bowel habits, even though you’ve been eating and living the same way, that’s something to tell your doctor. I also tell my patients, look at your bowel movements. Stools have a healthy and unhealthy appearance. Really thin stools tell us that’s a change in the character of the stools. That’s striking. If you have rectal bleeding or severe abdominal pain or drastic weight loss that can’t be explained. These symptoms are very, very drastic, and they’re not subtle.
We all know diet is a contributing factor, but what about access to health care? How have you noticed that affecting health outcomes?
As much as half of cancer-survival disparities between Black and White patients is related to insurance access. That’s why Obama wanted universal health care — because he understood the major disparities with Black folks is that we don’t have the access. A lot of times, if a person is uninsured, they’re not going to come in.
After Chadwick Boseman’s death, have you seen more Black men coming in to get checked?
I saw a patient just last week who had a friend with colon cancer. And then after that news, he heard about Chadwick Boseman. He said that scared him straight, and he made an appointment right away. As tragic as it is, I think Chadwick Boseman’s death is gonna do tremendous good as far as making the public more aware. That message often gets lost in the African American community. And that’s really what it’s all about.