“We found a mass.”
The soothing tone and wide smile with which Dr Marie Borum delivered this news was in sharp contrast to the shock and terror racing through my body. Her tranquil voice did help calm me as she explained she’d taken eight biopsies from the grape growing in my colon.
Initially, I couldn’t understand the doctor’s seeming elation at her discovery, but it turns out my tumor was a sneaky bastard, hanging out in my right colon, where waste is still in liquid form. The blob likely would’ve been everywhere by the time I started experiencing common symptoms like pain, a bloody stool, or constipation, which I’d only recalled suffering from once a decade ago on an eight-hour drive from Atlanta to Pensacola.
African Americans are more likely to have these right-sided tumors for which early detection is our greatest weapon, which is why Borum, a black physician, was right to congratulate me for having a routine colonoscopy. Having never smoked or drunk and with no family history of cancer, I had no reason to think I would be at risk of developing colon cancer. At 50, I take no medications, have normal blood pressure, and walk five or more miles a day, so I entered the GW Medical Faculty Associates gastroenterology clinic whistling.
The reason I’d scheduled the screening was rooted in a conversation I had with a college classmate nearly 30 years ago. Kim had shared with me the story of losing her mom to colon cancer in a way that made her mother’s death seem senseless and avoidable. From then on, I considered having a colonoscopy to be like gambling with the house’s money with nothing to lose but a half day of emptying my bowels and my life to gain. So at my annual physical last fall, I asked for my colonoscopy referral.
As a journalist and lawyer, I traffic in information, but I was unaware that as an African American, I should’ve had a colonoscopy at 45, according to guidelines established in 2005 by the committee on minority affairs and cultural diversity for the American College of Gastroenterology. African Americans have the highest rate of death and shortest survival for colon rectal cancer (CRC), and the diagnosis of an advanced tumor is also higher.
When my college classmate died of the disease at 45 and other friends in their 30s were diagnosed with advance-stage CRC, I thought them anomalies rather than what they were: anecdotal evidence of the rising rates of cancer among younger people. Although the overall death rate has continued to drop, deaths from colorectal cancer among people younger than age 55 have increased 1% per year from 2007 and 2016. Last year the American Cancer Society lowered the recommended age for colon cancer screening to 45 for people at average risk and even lower for others.
While African American outcomes are not as good, one study showed with equal access to colon cancer screenings, appropriate surgery, adjuvant chemotherapy and radiation, there were no differences in survival among racial groups. My surgery was performed by Dr Vincent Obias, who actually wrote the book Robotic Colon and Rectal Surgery. Obias was masterful, removing about a foot of my colon through my navel while extracting 38 lymph nodes. Such a high number of sampled lymph nodes has emerged as an independent prognostic factor for improved survival in several studies.
CRC is one of the deadliest, yet most avoidable, cancers. While not exact, colon cancer seems to run on a continuum. Nearly all colon cancer starts out as a non-cancerous polyp, which can be removed before the development of an invasive malignancy. Once cancer is present, the less advanced the cancer, the more likely one is to be cured. My early-stage tumor was removed with a margin of normal cells and only one lymph node was involved, which means I’m cancer-free with little chance of a recurrence. I will live. But life for me now includes a short chemotherapy regimen and a lifetime of regular blood work and CT scans.
Scientists estimate that it takes 10 years for a polyp to become cancerous, so had I been tested at 45, I probably could have avoided a cancer diagnosis altogether. Who knows? Had I not put my colonoscopy off for six months while enjoying the winter holidays and a spring trip to Europe, perhaps there would’ve been no lymph node involvement thus no recommendation for chemotherapy. These things notwithstanding, I am filled with gratitude. Because Kim shared her story, mine continues.
