How to Stop Young Black Men From Dying of Colorectal Cancer

Interviewer: Lauri R. Graham; Interviewee: Clarissa G. Clinkscales, BSN, RN


December 18, 2020

The recent death of Today anchor Craig Melvin's brother from colorectal cancer (CRC) at 43 years old comes not long after actor Chadwick Boseman's death from CRC at the same age. In the wake of Boseman's death, oncologist David Kerr spoke about disparities in screening and prevention of CRC among African Americans. Kerr's commentary prompted a response from Clarissa G. Clinkscales, BSN, RN, director of quality and risk compliance at Foothills Community Health Care in Clemson, South Carolina. Clinkscales wrote:

Thank you for acknowledging the wide gap in the research around CRC screening and prevention for African Americans. I am not only a nurse but I'm also from Chad's hometown where we graduated [high school] in the class of 1995 together. His untimely death has been difficult to understand personally but even more so professionally. A recent initiative with the Centers for Disease Control and Prevention (CDC) in South Carolina aims to increase CRC screening rates among African American men. It is imperative that African Americans are included in all efforts to prevent early death from CRC.

Medscape spoke with Clinkscales about Chadwick Boseman's death and her ideas on how to eliminate the disparity in CRC outcomes among the African American population.

You knew Chadwick Boseman. How did his death from CRC affect you?

Clarissa Clinkscales, BSN, RN

Chadwick portrayed iconic men of color on the big screen with grace and dignity. He was the first true black superhero, which affected children across the world. His death has resonated in many ways and has made an impression that has linked millions of people together in humility and awe.

Chadwick's death at the age of 43 highlights a tragic disparity in this country. The incidence of CRC is higher in African Americans, and the difference in mortality rate is even larger. Furthermore, African Americans are being diagnosed with CRC at increasingly younger ages, and with more advanced disease.

How do you account for the persistent disparities in CRC screening?

A lack of insurance and limited access to healthcare are major factors driving the reluctance on the part of some patients to be screened for CRC. Being uninsured or underinsured is a hindrance to receiving care. Even with the Affordable Care Act, Blacks are 1.5 times more likely to be uninsured than Whites. If a patient has a high deductible or premium, undergoing a colonoscopy may not be feasible.

But there are other reasons for the disparities. Many African Americans, particularly men, distrust the healthcare system and therefore may not seek early healthcare.

History shows that Black Americans have at times been coerced or misled in the healthcare sector. During the Tuskegee experiment of 1932, for example, informed consent was not sought from Black men for a study about the treatment of syphilis, nor were they told the real reason for the testing or offered effective treatment when indicated. These men were led to believe that the government was helping them get better when, in fact, doctors were experimenting on them without their consent. Many men went blind, transmitted the disease to their wives and children, or even died.

Trust in the medical community has to be earned, and this remains a work in progress in the African American community.

What can be done to close these gaps?

We need more participants in the research and scientific realm who look like the people who experience these gaps. Investing in STEM (science, technology, engineering, and mathematics) education and recruiting people of color to those fields is one way to help close those gaps. Then, enlist those scientists, doctors, nurses, and researchers to fill leadership roles in academic and medical institutions and in communities where the disparities are most striking.

Seeking out entities that offer or encourage CRC screening is one way to close the gap. I'd like to see patients more often advocate for themselves by asking their primary care providers about free or low-cost CRC screening, including noninvasive testing options.

Nurses also have a significant role in eliminating racial disparities in CRC screening and care. Collecting family and personal medical history takes patience, empathy, and earned trust, but it's essential to meeting this goal. Nurses can facilitate trust by speaking in ways that patients understand, avoiding jargon, and being culturally sensitive when communicating with patients.

You spoke of an initiative to increase CRC screening among African Americans in South Carolina. Would you tell us about that?

Before Chadwick Boseman's untimely death, initiatives were underway in the United States to increase CRC screening rates, especially among African American men.

The South Carolina initiative is still in the early stages. It's a 5-year project with the University of South Carolina and Communities Unite screening, funded by a grant from the CDC. The money will help health systems implement evidence-based interventions that will increase CRC screening participation among vulnerable populations. This effort will work toward the development of a medical neighborhood that will build sustainable screening and follow-up care to address the needs of the medically underserved. I believe that the impact will be significant as long as we have some true CRC champions lighting the way for others.

What's your message to healthcare professionals? What can they do to help prevent early deaths from CRC?

Educate, educate, educate. The risk for CRC is influenced by many different factors. Nurses should encourage patients, especially those with a strong family history, to talk to their providers about their own degree of risk.

Light a fire for the world to see. Be an ambassador for cancer screening and an advocate for sharing information. Refer patients to the American Cancer Society webpage or reach out to your local chapter, which has tons of useful information.

CRC is the second leading cause of cancer deaths in men and women combined. Although the mortality rate among those older than 55 years has declined, the rate among those aged 55 years and younger has risen 2% each year. Getting screened is the most important thing a patient can do.

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