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Gastroenterologist Dr. Darrell M. Gray II and Stand Up To Cancer’s Health Equity Committee member and radiation oncologist Dr. Karen Winkfield break down what Black people need to know about colon cancer---from symptoms and risk to diagnosis to treat
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LifestyleTranscript
00:00good afternoon and thank you for joining us today my name is tanya christian i'm the news
00:14and politics editor at essence magazine and today we have a very important wellness check-in um as
00:21everyone knows we unfortunately lost an amazing actor in chadwick boseman on friday night and we
00:28wanted to invite two doctors on today to just speak with us about colon cancer you know the signs the
00:35effects and um we have them with us today they are dr karen wingfield and dr daryl m gray dr karen
00:44wingfield is a member of stand up to cancer's health equity committee and director of the office
00:49of cancer health equity at wake forest baptist health dr daryl is a gastroenterologist and
00:56associate professor of medicine at the ohio state university wexner medical center and deputy
01:03director of the center for cancer health equity at osu comprehensive cancer center thank you both so
01:09much for being with us today thank you thank you yeah you know we're going to jump right in um as i
01:16said before we really wanted to have this discussion because so many questions are going around um since
01:24the passing of chadwick boseman so i want to give you both an opportunity to kind of just tell us
01:30people who don't necessarily know exactly what colon cancer is or what it affects an opportunity uh
01:36to just learn more about it so dr wingfield i'll start with you what should we know about colon cancer
01:42well again i want to thank you so much i'm so pleased that essence is taking the time to educate
01:47our community uh colon cancer is um a growth in the in the colon and the colon is essentially the
01:53large bowel um and you know a lot of times we don't talk about these things in our community
01:59cancer is an abnormal growth of tissue it can happen anywhere in the body but colorectal cancer
02:04happens in an area that we don't necessarily check very often and so it's really important for people
02:09to know the signs and symptoms and i know dr gray will talk a little bit about what types of
02:14screening there are the biggest thing that i want to say is that colorectal cancer is not a death
02:19sentence and it's important for our communities to talk about it early detection saves lives and i
02:25think that is an important message so folks don't come out with any other thing from today's discussion
02:30please know that early detection is key and it's important to get screened and to talk to your
02:36doctor if you have symptoms and dr gray what are some of those symptoms what should we be looking out for
02:45yeah thank you for again bringing attention to this topic and and our hope is that um we can turn
02:50this pain we're experiencing this grief we're experiencing in the wake of chadwick boseman's
02:54death into purpose and so part of our purpose is to really number one have these discussions amongst
03:00our family and with our health care provider and even if it's about those symptoms that are
03:04embarrassing so symptoms like blood in the stool for example or unintentional weight loss or abdominal
03:11pain bloating changes in our stool caliber meaning going from a regular stool to something that may
03:16be pencil thin or even maybe you've had blood checked and your doctor notices or says something
03:22about anemia which means lower than normal blood count investigating that further but like uh dr
03:28wingfield said it's so important that we have these discussions that it goes from being something that
03:33is embarrassing or taboo for us to talk about amongst our family and with a health care provider to
03:38something that is just natural and regular we have to break the stigma because we know that
03:43and i'll use words of a friend of mine candlest candace henley who has the blue hats foundation
03:48family secrets kill families and so we have to be we have to have more regular discussions about family
03:54history and even just our bodies with our family and certainly with a health care provider that knows us
03:59yeah so one of the things that i think really um kind of touched people was the fact that chavik
04:07bosan was very young i mean 43 is i mean it's just ridiculously young and i think for a lot of young
04:15people like myself just the idea that um that these things happen to us as well so you know dr wingfield
04:23for you uh how often do you see colon cancer show up in your younger patients you know that's a great
04:31question i think unfortunately over time the past decade or so we've started to see colorectal cancer
04:38appearing in younger and younger individuals and so it's really important again as dr grade mentioned
04:44that if you are having signs or symptoms that you actually have conversations with your doctors about
04:49them but we know that right now there is some confusion about when people should get screened
04:54because the u.s preventative services task force states age 50 whereas the american cancer society and
05:01stand up to cancer we recommend age 45 and definitely you know the gastroenterology societies have been
05:08saying particularly for african americans for black individuals because we know that blacks are
05:12diagnosed with colorectal cancer more frequently at younger ages and often at more advanced stages
05:19so they have been recommending that blacks and african americans get tested and get screened at
05:24age 45 but to your point chadwick boseman would not have even met criteria for screening and so it's
05:31really important for us to think about ways that we can not only prevent colorectal cancer but also
05:36making sure as dr grace said that we are having those conversations albeit they may be embarrassing but
05:42having those conversations with our doctors and our providers is really really important
05:46yeah and um so one thing that i think between men and women it's like men make sure you check out
05:54your prostate women make sure you check your breath but you know for something like colon cancer that's
06:00not necessarily something that's top of top of mind and so dr gray for you i want to know does it affect
06:07men and women in equal amounts and um is there anything that men should be looking into as far
06:15as symptoms or women should be looking into like does it show up differently in different sexes
06:20yeah colon cancer colorectal cancer involving the colon and or rectum is the second leading cause of
06:25cancer-related death in the united states amongst men and women so it's important that both men and women
06:32know that they are at risk for getting colorectal cancer and about one in five is about the lifetime
06:38risk of developing colorectal cancer and so it's really important that as you're talking to your
06:42doctor whether it's about your mammogram or you're you're um in you know above age 40 or you're seeing
06:49your doctor about routine things such as a pap smear or you're seeing your doctor in regards to a
06:53prostate exam gentlemen it's important that you also talk about colorectal cancer screening and what can be
06:59done and we have several options that are available for people to explore in regards to colorectal
07:04cancer screening uh dr wiffle can you kind of walk us through the process of screening so if we feel
07:12that we have a symptom and we alert our doctors what does the screening process look like yeah so you know
07:21when we look at folks who are symptomatic um if you're having blood in your stools or you're having
07:27other issues as dr gray mentioned maybe a change in the caliber of the stool it really becomes a
07:32little bit more of a diagnostic procedure um oftentimes again there could be individuals who
07:38won't even have symptoms and so the screening process there are several different types of
07:42screening some of them are stool based tests where we're looking for blood within the stool itself so
07:48it sounds kind of crazy but yeah sometimes you've got to put a little stick in the stool and get a
07:52little sample and test it to make sure there's not blood in it and that test can be done with
07:57chemicals or immunohistochemistry so people may have heard of fit testing that's fecal immunohistochemical
08:03tests um and then also looking for dna or the products of dna that could be in the stool as well
08:09those are all stool based tests but my go-to and i must say i'm a huge proponent of colonoscopy
08:15and you know again you've got dr gray here who's a gastroenterologist and tell you all about that but the
08:20reason why i like colonoscopy as a screening tool and if somebody's having symptoms is because if
08:26there's a problem that's found if there's a polyp or an abnormal growth even if it's benign
08:32person goes in the gastroenterologist goes in takes a look if a polyp is removed you have just
08:37prevented cancer the majority of polyps if they're left alone eventually will become cancer and so the
08:42colonoscopy as a screening test is both a screen but it also can be a prevention it can prevent cancers
08:50yeah dr gray do you have anything to add to that yes there's just like dr wingfield said there's a
08:57a plethora of options that we have for our patients who are considering screening and certainly it's so
09:02important for you to talk to your health care provider about what may be the best option for
09:05you i'll tell you if you do do the stool based test and it's a a good choice particularly stool based
09:11tests are great at cancer detection they're less than great uh for polyp detection so like dr wingfield was
09:18saying finding those really tiny minuscule sub centimeter polyps or growths uh stool based testing
09:24is not as good as for example colonoscopy at seeing them and certainly not for removing them but if you
09:30were to get a stool based test or even something like a ct colonography for example which is a virtual
09:35colonoscopy where you get a ct scan to look for polyps the next step if that test or any the stool
09:42base or the ct colonography is abnormal would be the colonoscopy so it's important that as
09:47you have these discussions about your options with your health care provider that you be well aware
09:53that if you do stool based testing for example and it's abnormal your test your screening is not
09:58complete until you get the colonoscopy to look for why it was abnormal dr ringfield you mentioned earlier
10:06that colon cancer is not a death sentence and um i i think someone who has not had cancer but has lost
10:14loved ones to cancer um i think that the cancer just in our minds often means or you know we often
10:23associate it with death um so what are some of the other myths that that come along with with cancer
10:31with colon cancer you know i mean it's very interesting tanya because i think a lot of those
10:36myths are based in reality frankly um we know that blacks are dying of cancer at a much higher rate
10:43than any other race or ethnic group and that's why you know dr gray and i both work in health equity
10:48we both are very passionate about community outreach and engagement ways that we can educate our
10:53community because again if there is a growth in the breast for example and it's found early that can
11:00be curative breast cancer is curative prostate cancer is curative colorectal cancer is curative when
11:06it's found very early and i think the challenge is that you know there are these myths about the fact
11:14that cancer the big c word um is a death sentence but it isn't number one but i think the other thing is
11:21that people think that the treatments might be really difficult and we've come so far with respect to
11:27cancer therapies now i'm a radiation doctor and so i use x-rays to treat cancers but there are lots of
11:33different types of different types of systemic therapies whether they be chemotherapies or
11:38targeted agents that have less side effects so people can go through colorectal cancer treatment
11:43and not even lose their hair or really seem to have many side effects um surgery is usually a part of
11:50colorectal cancer treatment and that obviously takes a toll on his body but as we saw chads chadwick boseman
11:57was able to continue acting and continue his career while he was undergoing cancer therapies and so
12:03i really wanted to dispel that myth that people think that because you're undergoing cancer treatment
12:08that you're going to be horrifically sick and i'm not to say that he had an easy path i mean this was a
12:12strong brother but it's really important for us to know the facts yeah and um dr gray i'm curious because
12:22often with cancer uh we associate with a stage right so you know stage one i believe chadwick boseman had stage
12:30three how does it move from detection to then the different stages yeah so we think about cancer
12:40kind of like dr winkfield described it starts with just a very small abnormal growth in the lining of
12:47the colon that if we were to do a colonoscopy we could see and then remove but if it's allowed to grow
12:53over time it grows and grows can grow into the inside of the colon to for example cause a blockage
12:59and it can grow outside of the colon it can invade lymph nodes and then it can ultimately spread to
13:05other organs such as the liver such as the lungs and such as even the brain and that's what we talk
13:11about with stage four once it is traveled out to other organs we consider that to be stage four colon
13:18cancer and that's what we try to prevent with screening okay and for both of you i mean again you
13:24you know i asked you dr winfield if there are younger patients that you see and you said yes
13:29you're seeing it more and more i mean what type of support as doctors do you often have to give to
13:36these patients you know particularly for younger individuals a cancer diagnosis can be quite devastating
13:44um we always think of young people as as individuals who are starting something new in their life whether they be
13:49starting a new job starting a new marriage um becoming parents for the first time and so you
13:54can imagine if you're 30 years old or you're even in your early 40s and you're getting a cancer
13:59diagnosis the cancer diagnosis that can disrupt things but there are amazing organizations that
14:04are there to support individuals with cancer um the american cancer society is one um but we have lots of
14:11ways that we can support our patients i must say that as a clinician one of the things that i
14:15oftentimes will do is try to make sure i'm listening to the patient and hearing them and
14:20making sure i understand what their goals of treatment are now i must say when i have a 28
14:25year old with breast cancer and i've had that before who says i don't want chemotherapy because
14:29i don't want to lose my hair i sometimes have to put my mama hat on and say you know what sweetheart
14:34you're going to get some chemotherapy because you have triple negative breast cancer and you're a black
14:37woman and we die and we don't have to so i think again it's really important to meet people where they
14:43are and have those important conversations and for young people to know again cancer is not a death
14:49sentence there is going to be some interruption in their life but whatever we can do as clinicians as
14:55cancer centers as communities to support individuals we try to do the best we can to put the wraparounds
15:02around individuals and make sure they have the education they need and their families and friends
15:06have the education they need to help support them through the journey yeah and dr you bring up a good
15:12point about the support like i mentioned i've had um a couple people in my family uh die from cancer
15:20and you know nobody young though and so i think that um not that it makes a difference but i do think
15:28there's there's a certain level of hurt that comes when young people are plucked so early in life
15:34um so dr gray for you uh what are some of this what what kind of support can someone offer
15:41um let's say a young person who has been diagnosed with cancer yeah thank you for that and and similar
15:49to what dr wingfield was saying you know people don't care how much you know until they know how much
15:54you care and so that's where relationships come into play and so we have to be sure that you have a
16:00great relationship with the provider um and it's also important that this be a team effort and so as we are
16:08supporting young people we want to know that for example as a gastroenterologist and i'm diagnosing
16:13a colon cancer maybe that's the first time i met that individual because they were referred by their
16:17primary doctor straight to my endoscopy suite where i do the colonoscopy and so i have to meet them
16:23where they are like dr wingfield say said to empathize with them and their family in that moment
16:28and also bring in their health care provider and bring in other teammates to ensure that we have those
16:33wraparound services for them but also connect them to advocacy groups to let them know that they are
16:38not alone and i think of groups such as the blue hats foundation i think about fight crc i think about
16:44colorectal cancer alliance that really helps to support people where they are and it's so important
16:50that i think as we you know like dr wingfield said you know that diagnosis when you say the c word it's
16:57it can be very very alarming and sometimes in the moment of that diagnosis when you are telling
17:03someone you just have to give them a little moment because it's hard for them to hear anything after
17:08you have said the c word and so making sure that we offer that follow-up that we offer that support
17:14that we let them know that we are there with them to ensure that they get the treatment
17:19and this the support they need to be survivors of this yeah thank you for that um we do have a couple
17:26questions from our audience so um chanel asked why are younger people being diagnosed with colon cancer
17:36so chanel thank you so much for your question thank you for being here and engaging it's a very good
17:41question and i think we're still trying to figure it out there is likely to be some um interaction with
17:47diet and obesity and i must say in the black community obesity is a huge huge problem we know
17:55that obesity is the number two modifiable risk factor for cancer after smoking right and smoking
18:02in and of itself actually can cause colorectal cancer believe it or not so there are lifestyle
18:08choices that people are making whether it be tobacco use or eating you know fat fatty foods or
18:14really just inactivity that can be killing us silently and so when we look at the black community
18:21in particular where seventy seven zero percent of african americans in the united states are overweight
18:27or obese that has to play in to some of the risks that we're seeing particularly since we're seeing
18:33more obesity in teens which gives that environment that inflammatory environment of obesity more time to
18:41cause cancers yeah and dr gray did you have a take on that yeah i would just agree i think that the real
18:48answer is we don't have a complete answer yet and there's a lot of research that's going into this
18:53this topic to try to figure out why this increase is happening i agree that some of it definitely has
18:58to we think do with the obesity epidemic when you know two-thirds of america are overweight or obese
19:05and we and that trend has been increasing over time so we think that's associated we also think it may
19:10be associated with some environmental or social determinants of health so in the environments in which
19:16people will live and that uh the kind of social structures that inform things even such as simple
19:22as their neighborhood and their access to playgrounds to exercise because like dr winkfield pointed out
19:27risk factors include things such as our lifestyle physical inactivity is is another risk factor for
19:34development of colon cancer and so all of these things kind of intertwine but we have a lot to learn in
19:40this space now dr you actually mentioned earlier that you had a 28 year old patient who who didn't
19:47want to go to chemotherapy because she worried about her hair but i think you know for women especially
19:52someone like me i'm in my 30s and you know having children is also something that's really top of mind
20:00um does a colon cancer diagnosis uh prevent pregnancy is that a myth that you know having a cancer
20:09diagnosis will prevent women uh of a young age to be able to do things that they really want to do
20:17yeah that is man that is such an important question and i think it really depends on the type
20:22of cancer that you're diagnosed with and what the treatments are for that so what is important is for
20:30anyone who does have a cancer diagnosis to have those discussions up front and as i mentioned our job
20:36as providers as cancer doctors is to have that conversation and say what are your goals are you
20:42do you have children are you interested in having more children because frankly you know i do know
20:47that if i have to give radiation therapy to the pelvis for a woman who has colorectal cancer
20:52the likelihood is is that i am going to render her menopausal meaning i will impact her ovaries and then
21:00she may not be able to have children after that so there are things that can be done beforehand to do
21:05fertility preservation that really can help to make sure that if a woman who is diagnosed with
21:11colorectal cancer wants to have children later on that she will be able to do that now again this is
21:17where early detection is key stage one colorectal cancer could just be managed with surgery right so
21:23you don't need the radiation you won't need the chemotherapy so again it's related to the type of
21:27cancer that someone has and what the treatments are going to be for that cancer depending on the stage
21:33that really predicate the side effects the long-term side effects and the challenges or the
21:39lack thereof that someone may experience with respect to their cancer treatments so it's really
21:44important though and i must say for anyone who has a diagnosis a friend family member please ask those
21:50questions ask the questions about what the long-term side effects are going to be and if you're a young
21:55woman ask about your body ask about what the potential long-term side effects may be that may prevent
22:01you from doing some of the things that you'd like to do yeah now dr greg do you have people who come
22:07in with that that long list of questions that they want to ask i mean because i'm thinking if somebody
22:13refers me to a doctor there are a million questions that i have would you suggest that hey i'm excited
22:20when that happens because that means that that person is activated um all too often though i see people
22:25on the other end of the spectrum who come in and don't have any questions for me so whether i'm seeing
22:30them in the clinic or the first time i'm seeing them when i'm doing a procedure um and they don't
22:35have questions i love it when i see patients with a list of questions or even a family member to assist
22:40them in asking those questions because you know sometimes when you're in the moment maybe the if
22:45the person's wearing a white coat it can be a little intimidating you forget it's kind of like you
22:49you know you go to the car shop you may forget you know what kind of things were happening with the car
22:53and how to describe it um so the same thing it's important to have a companion potentially with you
22:58um or just writing it down before you go to the doctor's office to be able to ask those informed
23:04questions yeah so um we have another question from our audience essence asked what if your insurance
23:11company won't pay because you are too young yeah i'm actually going to defer this to dr gray because i
23:17know he deals with this more than i do on the on the diagnostic end so dr gray yeah it you know it
23:23depends on a couple of factors so for example if someone is age eligible meaning if there's an
23:30african-american who is 45 years of age um who is average risk for screening they should they're sure
23:37it should be paying for it if there is pushback usually i encourage the patient as well as the
23:42provider the healthcare provider to you know have have a discussion with the the claim folks and and say
23:49look we have the american college of gastroenterology guidelines here in one hand we have the united
23:54states multi-society task force guidelines in another hand and really just really share that
23:58with them sometimes the person processing the claim or the agency may have some language that's confusing
24:04and so just providing them with the data that's important now however if you are going and you're
24:11let's say 30 years old no family history no symptoms um and you're not age eligible within
24:18that criteria yeah it's likely that your insurance will deny the claim um but if you're someone who's
24:24having symptoms you know that would be a diagnostic procedure or if you're someone who has a strong
24:30family history when i talk about family history let's let's clarify that for a second particularly
24:34those who are at highest risk or those who have a first degree relative mom dad brother sister
24:40who have been diagnosed with colon or rectal cancer at age 60 or below and so for those people they
24:46should start screening either at age 40 or 10 years younger than the age at which that relative
24:54was diagnosed so let's give an example let's um suppose um using the unfortunate example of mr chadwick
25:02bozeman that he was diagnosed when he was 39 let's just say 39 or 38 then his first degree relative
25:10would need to be screened 10 years earlier than that okay because that is before that kind
25:17of 40 cutoff um and so it's really important that people have that in mind but again if you are age
25:23eligible if you have a particularly if you have a family history it's important the under the affordable
25:29care act preventative screenings are covered um some of the gray area can be with the age 45 for
25:36screening and that's where you need to present the data um or the health care provider can present
25:40the data to the insurance company to advocate on your behalf i i do want to point out though that
25:45there is a difference between screening and diagnostic procedures and so some of the work that
25:50unfortunately i've had to deal with is patients go in for a colonoscopy they get a polyp removed
25:55and then that becomes a diagnostic test and they're surprised because there may be additional fees
25:59associated with that test so it's really important up front to talk with your doctor about what the
26:04options could be and to make sure that you have the appropriate insurance coverage absolutely now i
26:10know both of you guys do quite a bit of work with health equity and uh dr winkville you work with stand
26:16up to cancer to address health disparities in cancer care such as colon cancer can you tell me a little
26:22bit more about your work with the organization yeah sure um stand up to cancer has been as you know
26:29a very huge proponent of making sure that we are moving the needle with respect to cancer therapies
26:36and more recently they've taken it upon themselves to say how can we make sure that every community
26:41whether any person regardless of their race or ethnicity has the capacity to take advantage of the
26:48new techniques and technologies that are coming out just to treat cancer as we mentioned you know
26:52cancer has we're doing better we are curing cancers now but not everyone has access and that's the reason
26:59why we know that blacks are dying of cancer so the stand up to cancer has a new breakthrough initiative
27:04where what they are doing is asking their researchers anyone that they're giving money to
27:09to do some cancer research that they have a strategy around making sure that they are being inclusive
27:15of communities of color particularly blacks but also other communities hispanic communities even
27:20adolescent young adult we're talking about this young adult population rural communities how can
27:24we make sure that everyone has access to the amazing cancer therapies that are coming out and so that
27:29breakthrough initiative is is up and coming and we're hopeful that that will really move the needle in
27:34terms of ensuring access to cancer clinical trials okay um we have a few minutes left so i want to make
27:40sure that i get in this last question my temple wellness asked what about treatment with
27:45plant-based diets dr gray i'll ask you first well we don't know much about treatment for colon cancer
27:52with plant-based diet but we do know a little bit more about risk prevention with plant-based diet
27:58so going back to some some of the uh words that dr wingfield shared really there's things that we can
28:03do in trying to reduce our risk for colon cancer she said uh avoid smoking and exercise it's also important
28:12to reduce consumption of red meats limit alcohol and yes increase plant-based diet consumption so
28:18increasing the fiber fruits and veggies that you're consuming we know that a high fiber diet decreases
28:24your risk for developing colon cancer and that's so important but what's even more important is that
28:29people like um just what you just who asked the question get out there and really educate people so
28:35we've had this session today and now everybody who watched needs to be a champion and turning this pain
28:40we're experiencing from a recent passing of chadwick boseman into purpose so we need to engage our
28:45communities in talking in a manner in which they can understand and they can relate and talking about
28:50what we just discussed today yeah and before we wrap i want to make sure that i ask this question
28:56um because you know if we were to have a diagnosis i mean really of anything right of any sickness we want
29:03to make sure that we're seeing the right doctor that we're selecting the right physician so um what
29:09would you recommend as far as when people are considering doctors and treatment so the the first
29:17thing that i have to say is that you have to feel comfortable with your provider and a lot of times
29:22people when they hear the c where they hear cancer they get nervous um and so they feel like they have to
29:26go to the first person no you don't it's okay to get a second opinion and i think it's really important
29:31since this is a journey it's this is not a sprint cancer is not a sprint any of your diagnoses whether
29:37it be hypertension diabetes etc you must trust the person who is caring for you so take your time
29:44get a second opinion look for someone who is really going to sit there and listen to you
29:49and is going to be eager to understand what your goals of care are great now for both of you are there
29:55any parting words juan and then also where we can find you dr win for ladies first oh thank you so
30:02much so um you know i just want to say i'm so grateful again to essence for really highlighting
30:08this and i know it's sometimes hard when there are tragedies in our community but hopefully we can
30:13all leverage this as an opportunity to really educate ourselves educate our families i always say
30:18it's important to become advocates once you're aware then please become an advocate in your community
30:23in your families and so i'm dr karen winkfield i can certainly be found on twitter instagram facebook
30:28at dr winkfield w-i-n-k-f-i-e-l-d and also at our podcast which is at three black docs and we are
30:36on whatever wherever you find your podcast we're there so hopefully you guys will join us in some of our
30:41discussions and please uh follow me and and i'll be sure to post more information on my social media
30:48channels it's twitter and instagram at dmgray md and also follow organizations such such as blue hat
30:58foundation fight colorectal cancer colorectal cancer alliance and also know we at the ohio state
31:03university wexner medical center and the comprehensive cancer center we're putting out a lot of content
31:07about this as well particularly how we can continue to engage our communities in this such important
31:12dialogue so now i expect everyone who heard us to be champions in their families and in their
31:18communities and to use this information we've shared on essence uh broadly so dr winfield dr gray thank
31:25you so much for being here with us today and answering our questions uh to our facebook and twitter
31:31viewers thank you so much for joining us we'll see you next week at another wellness check bye
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