This transcript has been edited for clarity.
Hello. This is Dr. Mark Lewis. March is Colorectal Cancer Awareness Month, so I’m wearing blue today to stay on topic with that campaign. We know when October comes around, everything turns pink in recognition of breast cancer awareness. We are indebted to our women ‘s health advocates for showing us how to raise the profile of disease in public awareness and how to promote screening.
When screening large populations, it is incumbent on us as the doctors and organizations who recommend the screening intervention that we do no more harm than good and that we properly deliver the benefit. half of which is similar to a specific screening intervention. I would argue that colonoscopy is very powerful in the sense that it can prevent the adenoma-to-carcinoma sequence through which a polyp shrinks into malignancy. I want to talk about that especially because of Chadwick Boseman, who later won an award for his acting at the Golden Globes.
Boseman has opposed early colorectal cancer. I will never forget sitting with my son and watching Black panther. My phone started ringing because all my friends, many of them non-medical, asked me, a GI oncologist, if I knew Chadwick Boseman had just died of colon cancer. Chadwick Boseman is a positive proof that a lifestyle alone cannot reverse the risk of malignancy. I do not know all the details of his case, and I do not want to admit a subsequent death, but working backwards, we can assume that his diagnosed at age 39 with locally advanced colon cancer and was eventually diagnosed with metastases 4 years later. In the meantime, it was the picture of health, literally featuring a superhero. He had an amazing fitness regiment. Maybe he had access to a wonderful diet and maybe even formal support there.
One thing that really bothers me is this idea that a lifestyle alone is enough. Back in January, the CEO of Whole Foods said Americans needed less or no health care if they were just eating right. I was preparing to file a statement about that, but then January 6 happened and understandably, America ‘s attention was diverted to the government in the hope of a peaceful power shift. But now, 2 months later, I’d like to take another look at those comments.
Let’s be honest: I was previously honored to be among the people who can afford to buy at Whole Foods. However, you cannot take out the place in society that allows you to comfortably buy at Whole Foods from all the variables that affect your environment and access to the quality of food that the Whole Foods CEO attacking. Socioeconomic status also influences other ways in which people can influence their risk factors for disease. This is not to stop worrying about healthy living. Where I see the disconnect is the passionate loneliness with which people properly control their own bodies to the extent that they have autonomy. Some people are very proud of their exercise habits and their commitment to a healthy diet. But that should not be overlooked sympathy. You should still be able to see that it is not a foolproof shield against “grooves and arrows of sad fortune.”
When you look at people with cancer, you should understand that there but by the grace of God go I. That’s where I have a problem. Whole groups and hashtags on Twitter are designed to promote healthy lifestyles. I am all for it. But it is not a perfect antidote against cancer. I see that all the time in my clinic.
Recently, a 40-something-year-old professional triathlete died in my clinic with metastatic esophageal cancer. You could hardly fail this person for his commitment to fitness. I mentioned this on Twitter as an almost astronomical question: How can you explain the death of such a physical person? Someone responded that this is because exercise was destroying their immune system ergo they got cancer. I believe that that is a stretch. I came back with a counterargument, that is, how do you define the 4-year-old child with medulloblastoma? What did that child do to pull cancer? And I didn’t get a response at all, which is exactly what I was expecting.
Our ability to define one’s oncogenesis is limited. Therefore, screening is extremely important. We owe it to ourselves to protect when and where we can; however, we should not blame others for getting cancer. It cannot be completely prevented. I actually see some patients pushing back on the word “prevention” and describing it more as risk mitigation. I believe that that is right; risk mitigation is the name of the game. The formula is, and I am referring to Dr. Siddhartha Mukherjee, an oncology speaker poet: cancer is synonymous with heredity as well as environment as well as motivators as well as opportunity. I advise all of us to be both compassionate and careful before we judge others who have been sorely embraced by this terrible, horrible disease.
Mark A. Lewis, MD, is the director of gastrointestinal oncology at Intermountain Healthcare in Salt Lake City, Utah. He is interested in neuroendocrine tumors, hereditary cancer syndromes, and physician-physician communication.
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