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Has Chadwick Boseman's death made you curious about colon cancer screening?

Darcel Rockett
Chicago Tribune

Chadwick Boseman's legacy extends beyond Hollywood. His dying of colon cancer has started conversations about the health of one's gut. Per the American Cancer Society, African Americans are 20% more likely to get colorectal cancer and 40% more likely to die from it than other groups (with Black men having the highest incidence).

Medical professionals are advocating for more screenings in communities of color. The Tribune spoke to Dr. Karen Kim, professor of medicine, director of the Center for Asian Health Equity and a gastroenterologist of more than 20 years working at UChicago Medicine.

Chadwick Boseman during arrivals at the 91st Academy Awards on February 24, 2019, at the Dolby Theatre at Hollywood & Highland Center in Hollywood.

"I would say all communities of color either suffer from lower screening or higher mortality," Kim said. "But particularly African American men, they get colon cancer much more so than any other population and die from it. From any stage -- late stage, early stage, middle stage -- they don't do as well, in general, compared to any other population, and we certainly need to understand why."

Kim said screening has to start earlier if polyps (abnormal tissue growth) in the colon are to be caught before they turn cancerous.

"We think we usually have about a 15-year period before a polyp becomes a cancer," she said. "The one thing we know is the only way colon screening works is by giving people choices. And that choice is not just colonoscopy. There's lots of choices, and it really depends on what kind of insurance you have, what kind of access you have, and what your personal preferences are."

Depending on your lifestyle, one choice may be better than another, Kim said. Here are some alternatives to the traditional colonoscopy.

The fecal immunochemical test (FIT) is a colon cancer screening test that can be done at home using a kit from your doctor. There's no prep involved with this stool test. All you do is mail your sample to a lab. A FIT test typically costs $15 and can be coordinated with your primary physician annually, Kim said.

The cheapest route, Kim said medical professionals like to link FIT tests to the flu shot. "Because people are pretty good about getting annual flu shots, we do a flu/FIT: Get a flu shot, and then pick up your FIT kit at the same time, so you remember around the fall to do it."

Cologuard is another stool-based test that can be taken in the privacy of your home. This test looks for genetic mutations in the stool. Kim says it's a great test that has to be taken every three years. This test ranges from $500 to $700, but is covered by Medicare and most insurances, she says.

"These are great. These tests look for blood in the stool. It takes no time whatsoever. These tests are really great options for people who are scared about having a colonoscopy," Kim said.

A CT colonography is a CT scan of the large intestine -- a "virtual colonoscopy," Kim said. These have to be ordered through your primary care physician or nurse practitioner, to make sure the results are tracked.

A flexible sigmoidoscopy is a procedure in which a scope is inserted into a person's rectum and lower colon.

"It's like a colonoscopy, but it only goes through a third of your colon," Kim said. "The reason it may be appealing to some is because you don't have to have a GI doctor or surgeon to do the exam. In some rural areas or places, they might try to use that modality."

During a traditional colonoscopy, a long, flexible scope with a video camera is inserted into the rectum, and air is pumped through the tube into the colon to get a better view of its lining. The patient is under sedation. According to the Mayo Clinic, the procedure takes about 30-60 minutes. According to Kim, if a person opts for a traditional colonoscopy and anything looks abnormal during the procedure, it gets taken care of there and then. But if any of the earlier modalities yield positive findings, a colonoscopy will be required anyway.

"Sometimes when I tell my patients this, they're like: 'If the final road is colonoscopy, I'd rather do that if I can,'" she said. "The colonoscopy is every 10 years unless you find a polyp, and then it may be three or five years depending on what the results are and what your personal risks are -- sometimes you have to do them much more frequently. I think the downside about the colonoscopy is you have to take time off work, you have to do bowel prep, and you need someone to take you home after the procedure."

Some organizations recommend colorectal screenings begin at age 50, while the American Cancer Society suggests they start at age 45. But Kim says that regardless of what these groups say, paying attention to symptoms is incredibly important in younger adults, who don't fit into the age groups for screenings. If all of a sudden you're getting constipated, you see a change in the way your stools look, if you're bleeding, if you have sudden new abdominal pain or unexplained weight loss, talk to your physician.

"Pay attention and talk to your family," Kim said. "Who has cancer? And not just colon cancer -- ovarian cancer, gastric cancer, endometrial cancer. Those all put you at risk. First generation relatives, those are the most important, but if you have multiple people with cancer spanning generations, then that sets a pattern that makes this at risk.

"We talk about breast and cervical cancer, we talk even about prostate cancer, but people feel very uncomfortable about talking about colon cancer, and we just need to get over it because, unlike all those other cancers, this one is preventable, beatable and treatable."

Kim, the principal investigator for the Illinois Colorectal Cancer Alliance to Reduce Mortality and Enhance Screening (IL-CARES), said screenings for colon cancer have gone down about 85% during the pandemic. She's concerned that the populations being affected the most by COVID-19 aren't getting back into preventive care and getting their screenings. She hopes IL-CARES will help increase colorectal cancer screenings among underserved and rural communities in Illinois.

A spokesperson from the American Cancer Society said page views to the group's "colorectal cancer signs and symptoms" page went from 985 (Aug. 21-23) to over 80,488 the weekend of Boseman's death. And during Aug. 21-23, the ACS site had 73 visits to "colon"-related pages, but the weekend of Boseman's death, the site had 42,870 visits to those pages.

"With something as tragic as Chadwick Boseman dying, there's a period of time when people are open -- they feel like they want to learn," Kim said. "He was such a powerful person and a role model. I think a lot of people are coming to the table wanting to know more. But this is a long game, you have to stay on it for a long time."