COMMENTARY

Chadwick Boseman's Legacy May Be Bigger Than His Films

David J. Kerr, CBE, MD, DSc

Disclosures

September 08, 2020

This transcript has been edited for clarity.

Hello. I'm David Kerr, professor of cancer medicine at the University of Oxford in England.

I thought it might be worthwhile to pause and reflect on the death of Chadwick Boseman, a fantastic young actor.

The world was shocked by his recent death and the fact that he had kept his battle with advanced colorectal cancer so private. It must have come as an enormous shock to millions of fans. How could someone of this youth and vigor succumb to a disease we usually associate with the elderly and those who are less fit? But for those of us who are interested in the biology of colorectal cancer, perhaps it came as less of a shock.

We know that good data from a variety of studies suggest that African Americans tend to present with colon cancer at a younger age, and they tend to have a more biologically aggressive type of colorectal cancer. This is often correlated with socioeconomic factors. We also know that African Americans are less likely to be able to interact with the healthcare system for screenings.

I do a lot of work in sub-Saharan Africa, and we know that colorectal cancer is gradually increasing in incidence there. Again, we see patterns of referral at a young age, usually with an aggressive type of tumor.

As many of you know from listening to these short video commentaries, I'm very interested in the genetics of colorectal cancer and what we can do to develop genetic algorithms that identify individuals at high risk of developing the disease, as well as individuals who have the disease who we want to treat with drugs like 5-FU and using genetic markers that will identify individuals more at risk for the side effects of chemotherapy.

For 15 years, we've published numerous papers — in Nature Genetics, Nature, and other journals — looking at the germline genetic structure of colorectal cancer. We've developed an algorithm combining many single nucleotide polymorphisms that now allow us to begin to identify individuals who are at a three- to fivefold higher-than-average lifetime risk of developing colorectal cancer.

Prompted by the death of this fine young actor, I looked back to see how many of our large published genetic studies, now including more than 100,000 individuals, could detect the disease at an early stage in African Americans. The answer is, there are some large data gaps. The vast majority of all the data that we collect is based on White patients and controls. In collaboration with colleagues in China and Japan, we're extending our understanding of the genetic basis of this disease in Asian populations. Although there are some relatively small substudies in Africa and in African Americans, it remains a huge data gap that we need to fill.

If we talk about personalized cancer medicine, we should start to think about how we personalize preventive cancer medicine. We need to fill the large data gaps that are there. We need to reach out to underrepresented communities — those communities, perhaps because of socioeconomic factors, that cannot gain access to the healthcare system as easily as a White population.

Chadwick Boseman has a fantastic canon of work that will be his legacy. But perhaps one other enduring aspect of the death of this young man is that it has led people like me to recognize that we need to do more to understand the biology of this disease, and how we can improve and personalize things like screening at a younger age for African Americans.

So much thought has been precipitated by the death of Chadwick Boseman, but that may allow us to build a better future for others within this wider population.

Thanks for listening. I would be very keen at any comments you choose to make. But for the meantime, this is David Kerr saying thank you, Medscapers. Over and out.

David J. Kerr, MD, CBE, MD, DSc, is a professor of cancer medicine at the University of Oxford. He is recognized internationally for his work in the research and treatment of colorectal cancer, and has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. In 2002, he was appointed Commander of the British Empire by Queen Elizabeth II.

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