When news broke that Chadwick Boseman suddenly passed away from colon cancer, I was completely shocked.
The news has been a wake-up call for everyone, especially the African-American community, to start paying closer attention to our health.
I recently was a guest on the Ask Nurse Alice podcast, hosted by the amazing nurse and online personality, Alice Benjamin, RN. We had a great conversation where I was able to share my expertise and knowledge about colorectal health and colon cancer.
Listen to the full episode here:
Nurse Alice: Hi, friends welcome to another episode of Ask Nurse Alice. The show where we talk about health, wellness and lifestyle and I give you all the tea with no co-pay. And so you don’t miss your next cup of tea and you don’t have to pay a co-pay, make sure you like and subscribe to Ask Nurse Alice the podcast show on your favorite podcast platform. And you can also watch the video on youtube.com/asknursealice. And while you’re there, subscribe, share. There’s tons of great health and wellness stuff to watch. Share with your buddies and those that you love.
And speaking of those that you love, recently…it’s going to get a little tough to talk about, but there was the unfortunate passing of Chadwick Boseman. Someone we all adored, admired for his talent, his philanthropy. We’ve seen him on the big screen and even though we might not have personally known him, we feel like we know him. Because we welcomed him into our homes as we watched him onscreen as James Brown, Thurgood Marshall, King T’Challa. Brought us Black Panther and he literally was our Black superhero. Taken too soon from something that from early detection, screening and intervention and those things – hopefully can be preventative – and that’s colon cancer.
It’s a somber moment to have to talk about these things, but we really want to honor Chadwick Boseman and empower ourselves to learn more so we can do more to check on our health and wellness. To prevent any unnecessary or decrease the loss of our future Black kings and queens.
To join me in this conversation, you know I had to get the expert. I’m “Nurse Alice” and I can talk about health and wellness, but listen here, I had to get one the top experts here in our nation. Dr. Lynn O’Connor, world-renowned Colorectal Surgery Specialist. She is the Chief of Staff at two hospitals: at Mercy Medical Center as well as St. Joseph Hospital, both of those in New York. She has two offices as well. She’s very accomplished. Her mission is to provide her patients, especially Black women, the foremost treatment, technology and information related to preventative health issues and colon and rectal health. Welcome to the show, Dr. Lynn O’Connor. Hi, Dr. Lynn!
Dr. Lynn O’Connor: Hi, how are you? Thank you.
Nurse Alice: I’m so glad that you could join us because for one, I love the Black Girl Magic. I’m just gonna go ahead and say it. Educated, beautiful, in a position where she is truly the authority and expert figure on something that’s very important and significantly impacts people, and especially our communities. So she’s going to drop some knowledge and some gems, and talk to us in a way that we really need to be talked to. It’s not always about what you want to hear, but what you need to hear. You are the expert in this and it’s not always easy to talk about our colon and rectal health because it’s one of those things that’s taboo. It’s always kind of been, exit only, don’t talk about it, kind of taboo-ish if you will.
For a variety of reasons, some people aren’t able to go to their doctor or have access to healthcare or have quality healthcare or they’re under insured. So, let alone being seen for a “listen to my heart and lungs” type thing, getting to a specialist like yourself is not always an easy task. So, we welcome all of the knowledge and expertise. Like I said, no co-pay because she’s a specialist.
Dr. Lynn, if you could share with us, some people have heard the term, “colon cancer” it’s short for colorectal cancer. Can you give us a basic definition of what that really is and what that entails?
Dr. Lynn: Colorectal cancer actually embodies the colon and the rectum. Part of the large intestine is the colon, the rectum and the anus is the end part. We use colorectal cancer to mostly refer to colon cancer, but it does include rectal cancer as well. It’s the lower part of the colon.
When you’re thinking about colon cancer or colorectal cancer, that’s the third most common cancer diagnosed in America. And it’s the second-most cause of cancer deaths. So when you’re breaking that down, colon cancer and colorectal are used interchangeably.
Nurse Alice: Dr. Lynn, we don’t really hear as much about colon cancer. We’re hearing about it now because of Chadwick Boseman. And by the way, he was diagnosed in 2016 with Stage III cancer. Didn’t talk about it with the general public. But still, during that time while he was filming many of these movies that we all adored him in, he was getting surgeries, he was getting treatments. All the while keeping this information personal.
We’re talking about it now because he died at an early age, 43. But we hear so much about breast cancer, lung cancer…how come we don’t hear as much about colon cancer if it’s the third most common cancer?
Dr. Lynn: Like you said, it’s really kind of taboo. And for the most part, colon cancer used to be…it’s mostly a disease of older folks. 68-72 years of age is the average age where a patient is going to be diagnosed with colon cancer. But the issue is that we are seeing more and more younger patients now. So it’s an anomaly. It’s odd to see somebody 43 years of age die of colon cancer.
But the problem is, since 1994 we’ve seen a 51% increase in young early onset colorectal cancer. We’re talking about people 50 years of age or younger. So that’s what’s driving this. It’s phenomenal. You don’t expect that it’s going in the wrong direction and it’s drawing a lot of attention. So we’ve had colon cancer on the radar, but now colon cancer is occurring more frequently and increasingly in the younger folks.
Nurse Alice: Do you know why that’s happening? Does it have to do with our diet, our lifestyles, is it something in our milk? Because they’re always talking about but anit-biotics in cows. But what do you think in your expert opinion and your colleagues think about this shift – for this to be an earlier onset?
Dr. Lynn: If you think about, we’re in a much more sedentary lifestyle. You can sit on your couch and grab Uber Eats if you want. We’re not exercising. The American Heart Association recommends 30 minutes of exercise 5 days a week at moderate intensity, which is just getting up and walking around. We’re not exercising, our sedentary lifestyle and our diet. Not a lot of fruits, not a lot of vegetables and we are in an obesity epidemic. We are larger now than we have ever been before and we continue to get larger. We’re in “Supersize Me”, you know?
Nurse Alice: Oh yeah. Supersize Me. Value size.
Dr. Lynn: We’re just eating and it’s a lot easier. We’re not active. I think a lot of those things and our lifestyle plays a role in that. I personally believe that our foods are not – they’re genetically modified, there’s antibiotics, our foods are coming from farther away. You’re not supposed to have grapes in the middle of the winter, you know? Your fruits should be your seasonal fruits and we’re not doing that.
And the other problem is access to care. That’s something that affects African American groups a little bit more so than everyone else. And when you talk about young people, you have to talk about African American people because they’re presenting with more advanced stages, our mortality is higher and our survival is less. So it’s drawing attention rightly so, and I think Chadwick Boseman’s death has really highlighted it.
Nurse Alice: You named so many reasons as to why it makes sense as to why we’re seeing this earlier on. Let me talk about screening. Screening is supposed to occur before you have any symptoms. So you mentioned that colorectal cancer historically has been something more for those who are older but we’re seeing a shift, they’re getting younger and younger. At what age should someone be going to get their initial colorectal cancer screening?
Dr. Lynn: Let me just clarify, it is still a disease for the older folks. And that’s primarily the people who have colorectal cancer. We are seeing it in younger and younger patients and that’s what’s causing the alarm. And as we’re seeing it in younger and younger patients, the American Cancer Society has decided to decrease the age at which screening should occur. So normally, it’s supposed to be 50 years of age. We’re now at 45 years of age for the average risk patient for screening.
And when talking about average risk, you’re talking about someone who does not have a history of colon cancer, who doesn’t have a family history of polyps or personal history. You’re talking about someone who does not have IBS like ulcerative colitis or Crohn’s disease or a genetic predisposition. That’s the average risk. Anyone else who has those other issues and symptoms would likely need to be screened sooner.
Nurse Alice: So if you do have those risk factors, then you need to have a conversation with your physician about being screened earlier. And when we talk about screening usually this done before having any symptoms.
Now, the second question I want to go to is, and it’s a two-parter, what are those symptoms? And what if I’m going to see my healthcare provider after I’ve already had symptoms that’s a longer screening, right? That’s symptomatic care? Is that correct?
Dr. Lynn: That is correct to a point. The whole premise behind screening is you want to get this before it becomes a cancer. That’s why they lowered the screening age to try and get their diagnosis before it becomes advanced or before you have a polyp which can be removed before it becomes a cancer. That’s the whole issue with the screening.
But if you do have symptoms – and this could be rectal bleeding, change in bowel movements, change in bowel habits, weight loss, loss of appetite – those are some things that are symptomatic and concerning but they may not necessarily mean it’s due to colon cancer. So if you are having those, they are signs and you should go get checked but it doesn’t necessarily mean you are advanced and it doesn’t necessarily mean you have colon cancer.
That’s the key and sign for you to get checked and especially the thing to know is to know your normal. If you move your bowels every 3 days, that’s you. But if that goes to every 5 days, every 6 days that’s not normal.
Nurse Alice: Guys, take a look at your stool. I know it sounds like, Nurse Alice why did you say that? You need to! I understand, that’s exit only, that’s gross. But you need to know is it shaped like a pencil? Does it float? Does it sink? What color is it? And I’m not saying you need to showcase this to the world and you don’t have to tell anybody when you’re doing it but you should know. Like Dr. Lynn was saying, knowing what your normal is, the pattern, the color, the consistency.
A lot of what we eat influences our stool And you mentioned looking for blood in your stool and rectal bleeding. Bottom line is you’re going to have to talk to your doctor anyway because you might eat something that changes the color of your stool, but at least you went to your doctor so you could have a conversation and identify it. Is this something that I ate that did something to my stool? Or is it something more concerning?
Dr. Lynn: Absolutely. You could have people eat beets and when they make their way throught the system you look down there and see all this red. And you’re like, Oh my god what’s going on? Or certain medications can change the color of your stool.
Nurse Alice: Oh, like iron.
Dr. Lynn: Iron can make it look more black and darker. So just knowing your normal is something that you can speak about with your doctor. And if it’s something that continues, that’s when you should get screened. You are aware of what’s different. You are aware of what’s changed. Then you can catch it before it becomes advanced or a problem.
Nurse Alice: I know we talked about being a supersized nation. Everything supersized from your Super Gulp, to your fries to everything else. One of the symptoms of this was weight loss, but more specifically unexplained weight loss. Because everyone could be like, ooh yes. I lost that extra 5 pounds. But when you start to lose weight and it’s unexplained, it’s excessive, you’ve had changes in your appetite, bellyaches and stuff, that is a sign of when something else is going on.
Because I think, not that we exactly knew what Chadwick Boseman was experiencing, but there were a couple photos and video that he posted on his social media that were a lot thinner. His face looked sunk in. And people were like, is he on drugs? And others were like, no he’s preparing for a role! We saw that he was a lot thinner than what he normally was compared to King T’Challa.
Dr. Lynn: That unexplained weight loss is one of those symptoms. But the other thing is that he had this advanced disease and was presented with this advanced disease and he was treated with chemotherapy. And some of the side effects of chemotherapy are that it decreases your appetite, sometimes patients experience diarrhea, things run through.
Change in taste, a metallic taste, not really hungry. Food doesn’t taste the same, doesn’t feel the same. Sometimes really cold foods can hurt the mouth. So that’s why people tend to lose weight during that time frame as well. So not only are they battling a cancer, they’ve got chemotherapy in their body and they’re trying to fight. So it’s important if you’re at that stage, try to have as much proper nutrition as you can take in. More protein, you can use Boost and Ensure shakes. You want to give your body the tools it needs to fight this.
Nurse Alice: Now before we get into treatment options and things like that I want to ask about screening. Because there’s this C-word, colonoscopy. Which, a lot of people know about colonoscopies but the first thing they say is, you’re not gonna put that tube up there like that. They’re so fearful of it. One, if you could explain how helpful a colonoscopy is because it can go in and look and do treatment and take things out, but I’ll let you explain that. But if I am really shying away from a colonoscopy, there are some other options on how I can screen myself during this time until I get a colonoscopy, right? Could you walk us through what those tests are?
Dr. Lynn: There are many test options. The most important thing is finding a screening modality that works. The most effective screening modality is the one that you do. That’s the most important thing. Colonoscopies are one option that are both diagnostic and therapeutic. Diagnostic meaning if you see the polyp, you can diagnose it and therapeutic meaning you can remove it then and there. Thus preventing the polyp from growing and developing into a cancer.
If patients don’t want to do that, there’s other tests that are out there. There’s Colo-Guard, where you hear it on TV, “Get, Go, Gone”. In the privacy of your own home, you put the canister in the commode, you don’t have to touch it because your stool goes into the canister, and you close it and send it off. That’s another screening modality but you have to understand there are false positives. And if there are false positives with that, they’re going to refer you to have a colonoscopy.
There’s also something called fecal occult blood testing where you would take a piece of your stool, put them in a jar and them send it away to the doctor to send into the lab. The problem with fecal occult blood testing is like what we just talked about. Certain foods can give you a false positive, certain medications can give you a false positive. And if there’s a false positive, you’re gonna have to have a colonoscopy. If you do have a polyp, some polyps bleed one day and not bleed the next. You might not get the piece of stool that you need to get tested.
Nurse Alice: And there’s also something called the virtual colonoscopy, right?
Dr. Lynn: Virtual colonoscopies are basically you have a catscan, and you have air that is blown into the anus just like you would have air blown in during a colonoscopy but it’s a little bit different because you don’t have the hose going through. The thing that people don’t realize with a virtual colonoscopy is that you still have to clean out as well. And if you have the virtual colonoscopy sometimes there’s a little residual stool left in there and you can’t tell if it’s a polyp or a piece of stool. So once again, you have a false positive. There are screenings, but like I said if you follow up with your doctor and you figure out which one is right for you because the best test is the one that’s done.
Nurse Alice: And just for clarity, some of these tests would be done annually, you don’t do a colonoscopy annually?
Dr. Lynn: No.
Nurse Alice: So it’s done every 10 years, is that correct? 5 to 10 years?
Dr. Lynn: Yes, it depends on what problems you find. If you have certain inflammatory bowel diseases like ulcerative colitis or Crohn’s disease and you have for quite some time, you are going to want to get screened every 2 years. If you have a genetic predisposition, family history, your screening is going to start very young. And you may want to go 1 to 2 years.
If you have polyps and you’ve had multiple polyps, your doctor might have you do it every 3 years. I tend to do it every 5 years for my patients although the guidelines say to do it every 10. I’ve found that 10 clinically and personally in my practice is a little too long. A lot could happen in those 10 years. So I recommend 5.
Nurse Alice: Yeah I wouldn’t remember. Did I have 7, 8 years ago? And sometimes people change providers, they move around. You don’t want to drop the ball on that. Now, let’s say someone does the screening and then they’re diagnosed with colon cancer. Can you briefly tell us about the stages? Because we said Chadick Boseman had advanced stage cancer…
Dr. Lynn: Yes, Chadwick had advanced stage. He had Stage III which means that the cancer had gone through the colon wall and reached the regional lymph nodes. Stage IV is when it goes through the wall of the colon and it spreads to other organs such as the lungs, the liver. Stage I is the best one because it’s confined to the wall and that one has a 95% chance of survival. And Stage II is into the wall but not through. You want to make sure you get it as early as possible which is why we all benefit from screening. So there’s different stages and those stages have different survival. And the problem with younger people is that they’re often mis-diagnosed and then they’re presented with advanced disease.
Nurse Alice: And I can imagine why. For one, we’re a little embarrassed to talk about our stool to our physician because we’re thinking, it’s not like I had a heart attack or I have high blood pressure. My stool is just a little not right right now. It might be something I ate and I don’t want to talk about it or I might just be embarrassed.
So don’t be embarrassed. I’m looking at our engineer. We’re talking about colon screening. But don’t be afraid to look at your stool, to talk about your stool Our health will manifest through our stool.
So Chadwick Boseman died at 43. He was diagnosed in 2016 so that put him at 39? He was 39 and was already Stage III. If we reverse engineered this, he was probably asymptomatic for some time with Stage I and II and then III came in. At what age do you think polyps presented themselves? How long does it take for someone to get to Stage III?
Dr. Lynn: It’s very difficult to say but usually it takes 5 to 10 years to go from normal regular tissue to a small polyp to a large polyp to a cancer. So it’s during that time frame. But you will start to have some symptoms and when those symptoms come they’re more advanced. We don’t really know much about it because, rightly so, he was private about his disease. He kept it very close to the vest.
We don’t know if there was a family history. We don’t know if he was having some difficulty. We don’t know if he was misdiagnosed. We don’t know if he had to see multiple doctors before he got to that diagnosis because when you think about it, look at him onscreen. He’s young, he’s healthy, he’s buff. The last thing someone is gonna think about it Chadwick Boseman at 36, 37 has something wrong with him in that way.
Nurse Alice: He was one of our superheroes!
Dr. Lynn: Exactly! It’s important to be vigilant about it, know your normal and know when something is wrong.
Nurse Alice: And we know, Chadwick Boseman was our King T’Challa. He was fearless on screen. He was a very kind soul. Although hindsight is 20/20 you can go back and see videos where he would do outreach and work with kids and went to visit people who had cancer.
So for those of you who might feel like, why didn’t he tell us? Well, he didn’t have to. The only person he needed to talk to was his provider, his healthcare provider because that is a very personal matter. I know, we all cherish King T’Challa and we all love to see him onscreen but also have to know that people deserve the right to privacy when it comes to healthcare.
This should generate some ideas or conversations among your family or amongst your friends because one thing is certain, even though he didn’t talk to the general public it sounds like he had a support system. He shared this news with his team and with his wife. When you’re going through health challenges and things like that, it can probably feel very lonely. But having a support system while you’re going through this journey will be helpful. Is that right Dr. Lynn?
Dr. Lynn: Absolutely. Having a support system is key because it changes your entire life. It changes the way you think about things and it impacts everyone around you. So this is something where you do need that support group. Think about him not telling everyone else. That speaks to his character on and off screen. That speaks to who he is and his inner strength and his decision, and his battle and the way he wanted to do it.
And I think that leaves us with a legacy of an amazing actor, a phenomenal human being, and it’s a wake up call and message to all of us to do what we need to do to take care of ourselves. If there’s anything that Chadwick Boseman left us it’s that. The entire community has shed attention on a disease that’s starting to attack younger people.
Nurse Alice: Absolutely. Dr. Lynn this has been some wonderful information. I’m sure there are people who are at the top of this podcast who were not as familiar with colon cancer: the signs, the risks, the screening and the treatment. You’ve been instrumental to helping and educating people through your work. I really appreciate you working so hard in trying to prevent and treat people with these conditions. I know it probably isn’t very easy for you. So how do you deal with it? You’re seeing some very sick patients, conducting surgeries a lot. How do you manage your health while doing this?
Dr. Lynn: You know, it’s hard. I feel that when I help patients, when I operate on them, I don’t go in there alone. I believe I’m doing God’s work. I believe he lives through me. That gives me a lot of strength and courage to do the things I need to do.
In order to fortify myself and to continue to do the things I do and keep up this pace and stamina it’s important that I eat right. It’s important that I rest, and it’s important that I exercise. That’s one of the key things I do to cope with stress and to deal with these issues is exercising. And for us during COVID-19 a lot of us, our coping mechanisms have been taken away. So being able to get to the gym, to see our family, to see our friends, the fellowship. It’s trying to stay connected as possible, understanding my journey, praying, putting God first, and taking care of my body is really by the grace of God I’m allowed to do what I need to do.
Nurse Alice: And we are so fortunate to have somebody doing the things that you do. We appreciate it. I want to remind you guys, social distancing does not mean social isolation. Still stay connected. Reach out. Check on a friend. If ever there was a time we need to lean on each other it’s now. Use the community to check on each other. We’re all in this together. Dr. Lynn O’Connor this has been amazing.