When her doctor finally clarified what he was saying, Kim Hall Jackson was shocked.
The 45-year-old mother of six had just woken up after having a colonoscopy that she had scheduled as a precautionary measure several months earlier. Given her lifestyle and age, Jackson had no reason to expect anything other than a clean bill of health. Still, she listened intently when the doctor returned to her room after the examination.
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"You're very lucky," Jackson recalled the doctor saying. "We found this early, so you should be OK."
During the colonoscopy, the doctors found a tumor growing inside her rectum, which they then biopsied and discovered was something Jackson never expected at her age: Stage one colorectal cancer.
Colorectal cancer is one of the deadliest and most common cancers in the world. According to the World Heath Organization, it's the third-most common type of cancer worldwide and the second-leading cause of cancer-related deaths in the United States. This year, colorectal cancer has killed more than 52,000 Americans, according to the National Cancer Institute. Another 153,020 cases have been diagnosed.
Overall, about 1 in 23 men and 1 in 26 women are diagnosed with colorectal cancer during their lifetimes.
For African Americans like Jackson, the statistics are even more alarming. According to the American Cancer Society, Black Americans are 20% more likely to get colorectal cancer than other racial groups, and 40% more likely to die from it once diagnosed.
To help address this racial disparity, Independence Blue Cross and the Colorectal Cancer Alliance recently launched a public awareness campaign, called 45+ Reasons, with the goal of getting at least 5,000 Black Philadelphians screened for cancer.
The campaign raises awareness that the recommended age for one's first colorectal cancer screen was recently reduced to 45. After years of encouraging everyone to get screened starting at 50, the U.S. Preventive Services Task Force revised its recommendation in 2021 due to an increase in colorectal cancer cases among people under 50.
Not only are more people under 50 getting diagnosed with colorectal cancer these days, but colorectal cancer deaths within that age group increased as much as 3% annually from 2011 to 2020, according to statistics from the American Cancer Society – even as the overall death rate from colorectal cancer decreased by 2% each year.
But back in 2008, when Jackson had her colonoscopy, the notion of a 45-year-old woman being diagnosed with colorectal cancer was much more unusual. Given her age, relatively good health and lack of a family history, Jackson figured she was fine. She certainly never imagined hearing the words her doctor uttered that day as her husband Jeffrey held her hand in the examination room.
"I stopped him and said, 'Wait a minute. Are you saying that I have cancer?'" Jackson recalled. "I just started to cry. I was blown away."
After undergoing a temporary ileostomy – a reversible procedure commonly used to treat early stage cancers in the colon – Jackson's shock was compounded even further by a new discovery: The cancer had spread to her lymph nodes. Instead of being cancer-free, she was restaged to stage 3 colorectal cancer and needed to begin chemotherapy and radiation immediately.
The deadly myth of 'fitting the profile' for colorectal cancer
A cancer diagnosis is seldom anything less than shocking for most people, but for Jackson it was especially surreal. That's because even though the Philadelphia-based event planner had noticed a small amount of blood in her stool while getting ready for work a few months earlier, she otherwise felt fine and said she "did not fit the profile" of a colorectal cancer patient at the time.
Jackson's diagnosis was so seemingly unlikely that her primary care doctor did not initially recommend a colonoscopy, even after he ruled out other potential causes of her bleeding, like hemorrhoids or a tissue tear. It was only after she repeatedly asked for a colorectal cancer screening that she finally got one.
"If I had been a different gender and a different race, I believe, I probably would have been offered the colonoscopy much sooner," Jackson said. "I had to advocate for it."
Jackson's proactivity ultimately saved her life. After talking with several oncologists at different hospitals in Philadelphia, she settled on Penn's Abramson Cancer Center, where she underwent an eight-month-long chemotherapy and radiation treatment from May to December 2009. By the end of it, her cancer was in remission. Five years later, her doctors officially declared her cancer-free.
From patient to advocate: Encouraging everyone to get screened
Of course, not everyone is as assertive about pursuing an invasive medical exam as Jackson was back then. For a variety of reasons, many people do not get screened for colorectal cancer, despite the consensus among public health experts that everyone should do so.
"There are actually very effective ways to not only identify early stages of the disease, but also prevent it," said Dr. Shivan Mehta, an associate professor of medicine and health policy at the University of Pennsylvania. "We can remove polyps before they become cancerous. If we find it early enough, patients have better outcomes."
One of the reasons people avoid getting screened is the anxiety they have about an invasive procedure in a sensitive part of the body. Fortunately, Mehta said, there are now less intrusive ways to screen for the disease, like submitting a stool sample.
Other factors that often inhibit people from getting screened are unequal access to health care, fear about getting cancer in general, distrust in the medical system and misconceptions about the procedure and what it entails.
"One of the biggest misconceptions is that if you don't have symptoms or family history, you are therefore not at risk," Mehta said. "That's why colorectal cancer screenings are recommended for everyone."
For Jackson, who has spent several years advocating for colorectal cancer awareness and screenings, some of the myths and misconceptions she's heard are downright outlandish. A surprising number of people she's met falsely believe that a colonoscopy can cause erectile dysfunction, damage the inner lining of one's bowels or even alter their sexual orientation.
"There are a lot of crazy stories," Jackson said. "Some people were just uncomfortable with the thought that somebody was doing something to your rear-end while you were asleep."
Whatever their rationale may be, Jackson knows that failing to get screened for colorectal cancer is a potentially deadly mistake that she was fortunate to avoid – and she implores just about everyone she meets to do the same and schedule a screening if they're 45 or older or have experienced symptoms like she did.
"It's not the easiest test, but it's one that can actually save your life," Jackson said. "It's one of the only tests that can prevent those polyps from turning into cancerous cells. You can get in front of it."