Last November 6, Will Smith announced on his vlog that he had his first colonoscopy and it revealed precancerous lesions (polyps) which were successfully removed. I was so happy to hear that these polyps had been detected early but then, as I read the details, I became somewhat concerned. Why was he, an African American Male, only now having a colonoscopy at 50 when the guidelines have long recommended screening at age 45

His story highlighted an unsettling truth that we have in healthcare: many minority patients still end up with more advanced diseases because guidelines are applied to them, incorrectly/inadequately. This extends from pre-pregnancy genetic carrier screening for diseases such as sickle cell disease to diabetes education and especially, colon cancer screening.

Did You Know that African Americans are Considered a High Risk Group for Colon Cancer? 

Though there may be unpleasant anecdotes aplenty, the state of your colon is something you should not take lightly. According to the United State’s Centers for Disease Control and Prevention, colon cancer, also known as colorectal cancer, is the third leading cause of cancer-related deaths in the United States, for both men and women. Specific to Black Americans, according to Cancer.net, a doctor-approved patient information site from the American Society of Clinical Oncology (ASCO), Black people have the highest rates of colorectal cancer (sporadic or non-hereditary) in the United States! In fact, the condition is also the leading cause of cancer-related death in the Black community. In particular, Black men are more at risk of death from colon cancer than Black women. 

The U.S Preventive Services Task Force encourages screening for colon cancer beginning at age 50, for all Americans, while more specialized health advocacy and professional groups, like the American Cancer Society, recommend starting earlier, at age 45, if you have gastrointestinal issues or a strong family history of colorectal polyps. Though risks for colorectal (colon) cancer are varied, common factors include age, gender, family history, inflammatory bowel disease, nutrition and race genetics.

The Truth About Colonoscopy and Why it is Important

While the reasons for the increased rates of colon cancer deaths in Black Americans remains somewhat unclear, given the reality, the American College of Gastroenterology (ACG) recommends that Black people begin colon cancer screening with colonoscopies at age 45, if there is no family history, since diagnosis of this cancer amongst Black Americans often occurs at a younger age, sometimes before age 50. Additionally, if you are Black and have a first degree family member (sibling or parent) who was diagnosed with colon cancer, it is further recommended that you have your first colonoscopy at 10 years before the age of the youngest colon cancer diagnosis in that family member or age 45, whichever comes first. As an example, this means that if your mom was diagnosed with colon cancer at age 40, you should have your first colonoscopy at age 30.

While Will Smith’s own personal family history is not known to me, you can now appreciate why I was shocked that he was getting his first colonoscopy at age 50! One would probably think that a celebrity of his renown has access to the Cadillac of healthcare systems but what we also saw is that he seems to have had a delay in obtaining a procedure that guidelines recommend should have occurred five years earlier than it ultimately did. Whether Mr. Smith’s apparent five year delay in getting his first colonoscopy was due to him first being told about it at age 50 or whether he was told at age 45 and he simply chose to delay, is unknown. 

However, if we assume that he was not previously recommended for it before age 50, it highlights a healthcare disparity and a big problem that needs to be fixed. More of our healthcare providers and patients need to be versed and aware in race based risk stratification for specific disease screening … failures to stay aware and implement these guidelines can often lead to delayed diagnosis and more advanced disease, at time of diagnosis, for patients of color.

Although Smith’s precancerous polyp was removed during the colonoscopy, he will need to get surveyed for a second colonoscopy in a few years. Dr. Darell Gray, M.D., M.P.H., a deputy director at the Center for Cancer Health Equity, explained that depending on the number and size of polyps, your next colonoscopy will likely need to be in three or five years, if polyps were in fact found and removed, according to evidence-based guidelines.

The whole premise behind the recommendation for colonoscopy is that earlier colonoscopy screening may find abnormalities in the colon at a point when they are more easily treated and before they are actual cancer lesions which can spread (metastasize) to other parts of the body. Colon cancer usually does not cause symptoms until the disease is advanced. Therefore, it is crucial for people, especially those of a certain age and certain high risk ethnic backgrounds, to talk with their doctor about colonoscopy and what they should expect during the screening.

If you’re living a bustling life and swamped from your prime endeavors, getting a colonoscopy may not hold a top spot on your list of priorities. Perhaps the drudgery of waiting in a hospital lobby for your turn doesn’t sound appealing for a workaholic person like you. Or, maybe you’ve convinced yourself that getting a colonoscopy is going to be painful and embarrassing but it is important to ignore any colonoscopy jokes and puns and just do it!

In relation to this, Will Smith, the Philadelphia-born Actor and Rapper, uploaded a lighthearted vlog on his YouTube channel, chronicling his first colon cancer screening — and it is my hope that the results will change your mind about colonoscopy.

“There’s a certain level of commitment and embarrassment to getting healthy. You ‘gotta do it, man,” Smith exclaimed on the video.

What is Colonoscopy, Really – What Can You Expect?

A colonoscopy is an integral medical procedure that is done to screen for colon cancer. The exam is used to detect abnormalities in the large intestine (colon) and rectum. With its proven method and practice, colonoscopy is the most accurate and direct screening and diagnostic test for colon cancer which is able to identify possible disease at an early stage. Thus, this method should come as a necessity for nearly everyone, at some point in their life.

During the screening procedure, the doctor will sedate you (put you in a sleep state such that you will not remember the procedure) and then look inside your rectum and colon with a specialized camera – a long, thin, and flexible lighted tube which is placed via the anus, into the rectum and the entire colon to look for polyps or cancer. Colonoscopy allows your doctor to remove polyps or any other concerning tissue, for pathological examination and diagnosis. The removal of these polyps can also prevent colon cancer.

In Smith’s video, the Actor learned that a precancerous polyp was found and removed during his colonoscopy. The polyp that was discovered could have grown larger, if left untreated, and could eventually spread to other areas of his body. He said he was not expecting the results, but it was important for him to share the experience with the world. It is also important to note that Smith did not experience any signs of colon cancer — thus, the polyp could have become malignant and his condition would have progressed unnoticed, if he had not done the colonoscopy. Now, that is horrifying!

Dr. Peter Oshin, a gastroenterologist at Advocate Trinity Hospital in Chicago said that timely colonoscopy screenings save lives. Timely colonoscopy can prevent colon cancer or detect the condition at an early enough stage to make a difference in the aggressiveness of cancer treatment options needed — as well as cancer survival outcomes.

Setting Your Health Foot Forward for a Meaningful Future

“Health is our greatest health,” Smith said with a smile as he concluded his vlog. 

We see these public figures and folks from our communities, in their 50s, enjoying their long-enduring successes without missing a beat and we all assume, based on their timeless presence that none of us is aging! Afterall, it is great to witness them thriving in their careers and enjoying what they really love, day in and day out. However, as a Physician and a Black Woman Physician at that, it is alarming to see a number of people overlooking their health by skipping timely check-ups such as colonoscopy. If you continue to neglect your health, how can you fulfill your future when a “condition” that could have been caught early starts deteriorating your well-being, simply because you screened too late?

Nowadays, everyone says that turning 50 is the new 40! Indeed, I too am inclined to believe it because despite turning 40 a couple years ago, I still do not feel a day older than 30. Yet, I must admit that while it feels great to prepare for that golden stage in my life, with so much youthful energy and exuberance, I am allowing my knowledge to guide me. Although we feel unstoppable and invincible, while living our busy lives with family, friends, amidst exciting endeavors, I am imploring that this is no excuse to stop caring about causes that are important for us to keep going — our health! Before turning 50, it is normal to look forward and believe the majority of your years still lie ahead but when it comes to colon health, 45 or younger is critically important for those of us who identify as Black.

Now is the time to be a person of action! Talk to your family members. Find out if there is any history of colon cancer or colon polyps in members of your family and ask the ages at which people in your family were diagnosed, if they had any of these. In addition, schedule a visit with your Primary Care Doctor to discuss your colon cancer risk and to determine if it is time to get your colonoscopy! Do not delay. 

Remember, time is health, and your health is your wealth! Embrace your age as you put your health at the forefront. Do not worry about running out of time; you can still hug your inner kid and kick off your life adventures after you secure your overall well-being.