Update: March is National Colorectal Cancer Awareness Month. The number of colorectal cancer cases — and those at advanced stages — are rising among younger people. Early detection is key.
According to a 2023 report by the Iowa Cancer Registry, Iowa has the second highest incidence rate for cancer in the U.S. Kentucky is first.
- Iowa is the only state with an increasing rate of cancer.
- For the most recent five years, Iowa has the 2nd highest incidence rate and the 3rd highest mortality rate for all cancers combined in the Black population.
- Iowa also has one of the greatest differences between the rate of cancer deaths in Blacks compared with whites, according to the report.
- The three cancers with the largest racial disparities include prostate, female breast and uterine cancer, the report found.
This story was updated 3/5/2023.
Cough syrup. Dishwashing liquid. Salt.
That’s what the Suprep bowel prep kit I drank tasted like – not that I really know what dishwashing liquid tastes like – as I prepared for my Oct. 6 colonoscopy.
When my doctor first suggested some years ago that I have a colonoscopy to screen for colorectal cancer, I told her about a New York Times story I’d read that discussed possible complications, and I opted for a less invasive at-home test instead. The fact is, getting a colonoscopy seemed scary and invasive, and I used the concerns raised in the story to avoid it.
Nobody wants a colonoscopy. Most people don’t like to talk about their bathroom habits, and they also don’t like to think about cancer, cancer treatments and their own mortality. But Chadwick Boseman, of “Black Panther” fame, died in 2020 of colon cancer at 43 years old. Boseman’s name in the headlines kept reminding me I hadn’t gotten the test. It also served as a stark reminder about Black health.
According to the American Cancer Society, colorectal cancer is the third most commonly diagnosed cancer and the third most common cause of cancer-related death in both men and women in the U.S. However, it ranks second in cancer-related deaths overall and is the leading cause of cancer death in men younger than 50 years of age, the organization found.
The American Society of Clinical Oncology estimates that colorectal cancer will kill 52,580 men and women in the U.S. this year.
According to the American Cancer Society, most colorectal cancers start as a growth, or polyps, on the inner lining of the colon or rectum. It can take years for the growths to progress to cancer, and the goal is to catch the polyps early and remove them during a colonoscopy.
Source: Canva Pro
People with an average risk of colon cancer should begin screenings at age 45 (earlier with a family history), according to the cancer-fighting organization. The age decreased from age 50 to 45 in May of 2021. The American College of Gastroenterology has recommended Blacks have a colonoscopy at age 45 since 2005, according to its website.
Black people are 20% more likely to get colorectal cancer and about 40% more likely to die from it than other groups, and it’s being found in younger people, according to the cancer organization. A variety of factors contribute to the disparities, such as the conditions in the environments where people are born, live, learn, work, play and worship, known as the social determinants of health, researchers have found.
Warning signs of colon cancer:
- No symptoms
- A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
- A feeling that you need to have a bowel movement that’s not relieved by having one
- Rectal bleeding with bright red blood
- Blood in the stool, which might make the stool look dark brown or black
- Cramping or abdominal (belly) pain
- Weakness and fatigue
- Unintended weight loss
When the pandemic struck in March of 2020, I didn’t want to risk catching the virus to get a test I didn’t really want. No colonoscopy with a side of COVID-19 for me. I put it off until this summer. I put on my N95 and began to catch up on the medical appointments I had delayed:
- Annual exams✅
- Dilated eye exam✅
I scheduled my colonoscopy during the summer, but when the nurse called to gather my information, I asked about masking, and she replied masks weren’t required at the center, so I canceled the colonoscopy and vowed to reschedule it later.
During that time, my sister began talking about needing one. Peer pressure works. When I scheduled mine for Oct. 6, she set hers for the same date. Although she lives in a different state, it was something we could go through together. As the test neared, excuses again filled my head. I’m too busy right now, I thought. COVID-19 is still a concern. But I realized something else had bothered me: I’d get a sedative for the procedure, and I’d be at the total mercy of health care workers. That required a level of trust I didn’t have.
Interacting with the health care system as a Black woman comes with its own set of challenges. The pandemic has underscored longstanding health care disparities. How would I be treated? Would the nurses and doctors view me as worthy of their best efforts? Could their biases or anti-Blackness unknown to me harm my health – or kill me?
“Health and health care disparities are often viewed through the lens of race and ethnicity, but they occur across a broad range of dimensions. For example, disparities occur across socioeconomic status, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation,” according to Kaiser Family Foundation’s explainer: Disparities in Health and Health Care.
The majority of Blacks surveyed reported having to speak up to get proper health care, and they reported being treated with less respect than other patients, according to a Pew Center survey. I know some of my initial angst about the colonoscopy – aside from not wanting to drink the prep – included concerns about being at the mercy of a white-dominated health care system that doesn’t always treat Black patients equitably.
My sister and I can talk for hours and hours. Just ask our husbands. We researched the prep and the procedure, watched colonoscopy videos online and compared each other’s prep solutions. We created checklists and began our countdown.
As Oct. 6 approached, I received conflicting information about my colonoscopy prep, because the nurse had initially sent me the wrong prep instructions. Then I found out I’d need to abstain from eating for two days instead of one and cut back on fiber five days before the test. I felt hangry by day two when my husband ate Taco John’s (which I don’t even like). I endured two days of apple juice, broth, Sprite Zero and water. Two. Whole. Days.
The last thing I’d want to risk is getting to the center and then not being able to complete the procedure, which requires your colon to be empty so the doctor can look for polyps and abnormalities.
If my doctor was going to boldly go there, I wanted her to have the best possible view.
I’d heard horror stories about the prep. I expected it to have a horrible smell and taste even worse. A doctor suggested taking a sip of the prep followed by a sip of apple juice. I opened the Suprep and sniffed it. I felt relieved it had no odor. Chasing the concoction with gulps of apple juice helped the solution go down easier.
If the prep was the worst I had to encounter, maybe the colonoscopy wasn’t going to be so bad. The prep quickly did what it was supposed to do. I had to drink the second prep around 3:30 a.m. because my colonoscopy was scheduled for 8 a.m.
I wore an N-95 into the center. My nurse Mike answered my questions and put a warm cover over me as I waited for 8 a.m. to strike. At about 8:03 a.m. he pushed me down to the examination room. I saw the black colonoscope and thought about the videos I’d watched. I willed myself to stay awake because I wanted to watch the procedure on the screen. It didn’t happen.
After 20 minutes, I woke up in recovery without my face mask. I wondered how long it had been off. I sighed, hoped for the best and looked forward to finally eating. Preparing for the colonoscopy, negative thoughts invariably entered my mind. What would the doctor find? How many polyps would I have, if any? How would it affect my life?
I wondered: Would delaying my colonoscopy during the pandemic lead to a cancer diagnosis like it had for Katie Couric with breast cancer?
My doctor told me she’d found and removed four benign polyps. I knew what the word benign meant (growths that aren’t cancer). I felt relieved and incredibly blessed. She labeled one of the polyps as advanced, however, and told me I’d need to get my next colonoscopy in three years to look for new or recurrent polyps. She also said my first-degree relatives would need to get their colonoscopies every five years. (Sorry, sis.) Thankfully, my sister’s test revealed no polyps.
One thousand and ninety-five days until my next colonoscopy. I could handle that.
A week later, controversy ensued when a European study seemed to cast doubt about the effectiveness of colonoscopies. I worry that people will see those headlines and use it as an excuse to forgo the test without conducting any research or having a discussion with their health care providers.
If your doctor suggests having a colonoscopy or you’ve reached age 45, research it and have the test. It’ll be over and done with before you know it. If you’re concerned or grossed out, seek out facts and anecdotes. I talked to several of my friends about their tests and it helped lessen my ambivalence about what ended up being a minor inconvenience at most.
It also helped to get my colonoscopy performed on the same day as my sister’s. We gave each other pep talks and shared our concerns and results with each other. We kept each other accountable, and our results ultimately brought us relief. Maybe a similar strategy can work for you.
Think about getting a colonoscopy in relation to the people who love and need you. Use them as your motivation, if necessary. Allow your mind, for a moment, to consider all the possible outcomes. Then remember: What is an unpleasant drink, several trips to the bathroom and a 20-minute test — compared to a scary diagnosis in your future because you chose to delay or skip your colonoscopy?