We lost a very talented actor and director, Chadwick Boseman, way too early to colorectal cancer in 2023. When I recently became aware of his enormous talent, I resolved to examine his premature death as best I could with the hope of sparing others such a life snuffed out in the midst of a highly successful career.
Although I usually work in the sphere of neurodegenerative disorders, a curious phenomenon links my work to oncology: environmental toxins that promote neurodegeneration are also carcinogenic in other subsets of people at different stages of life with differing genomics and other factors.
Mr. Boseman was an African American man born and raised in the rural South, Anderson, SC, to be precise, graduating from TL Hanna High School there. This original environment could have a significant bearing on the development of fatal colorectal cancer at an age well before screening recommendations. In 2021, screening recommendations to start colorectal cancer screening were lowered to 45 years of age. Chadwick Boseman died at 43 years of age, having been diagnosed with an advanced stage (IIIC) at 39 years.
African American male colorectal cancer hotspots
Charles R. Rogers, PhD, is a public health researcher whose team has identified that colorectal cancer hotspots for African American males are predominantly (92 percent) in the rural South. The hotspots include South Carolina, Appalachia, and the Mississippi Delta.
Environmental carcinogens in the rural South
What carcinogenic factors in the rural South, and specifically near Anderson, SC, may lurk in such a bucolic setting? It did not take long to uncover the practice of using sludge from factories and sewage plants to fertilize crops and cattle grazing fields. The sludge contains PFAS, the endocrine-disrupting chemical, and related compounds. Pesticides and herbicides, as well as mine pollution, add other potentially carcinogenic chemicals in the runoff that impact the water supply.
The Environmental Working Group website provides the following information on the water consumed in Anderson, SC: total trihalomethanes are 205 times the safe limit. This category of chemicals has been associated with the development of colorectal cancer in humans. So, the cancer prognosis may be affected by such water exposure at an early part of life, and this is not part of the usual medical history-taking.
Toxin synergy
Environmental toxicology research suggests that disease expression often follows multiple overlapping toxic exposures. So, what else may Chadwick Boseman have encountered as a young man, first in the rural South and then as an actor in New York and Los Angeles?
The South Carolinian tradition of grilling pork over hardwood coals of hickory or oak comes to mind. What young man of the South could resist such a flavorful tradition? Yet grilled meats of various kinds can increase one’s risk of developing colorectal cancer. Of course, we do not know that Chadwick consumed such delicacies.
Air pollutants such as PM 2.5 and nitrogen dioxide increase the risk of colorectal cancer if the exposure is long-term. Although New York City has made strides to improve air quality, it still has elevated PM 2.5 and nitrogen dioxide levels, especially in neighborhoods with many restaurants and high population density.
As for Los Angeles, it is the home of a street delicacy known as the danger dog, a hot dog wrapped in bacon—two foods associated with an increased risk of colorectal cancer. A dangerous food to consume, indeed. We do not know whether Chadwick ever consumed one, but actors often eat fast food when on set.
Oncology avoids discussing toxins
Oncologists often fail to note the role of environmental toxins in cancer. Close to two million Americans have been diagnosed with cancer each year in the past decade, and approximately 600,000 succumb to it annually. Yet, do any of their oncologists mention environmental toxicants at all? Not often. Colorectal cancer is one of many cancers related to environmental toxins: the National Cancer Institute observes that such carcinogenic compounds range from vinyl chloride (which was involved in the Ohio train derailment) to hexavalent chromium (of Erin Brockovich fame in California). Trichlorethylene was one of the carcinogens involved in the military burn pit cases, while mesothelioma is well known to be caused by asbestos exposure, as the lawyers’ ads have reminded us. Artificial turfs are implicated when athletes experience a cluster of cancers, such as the dreaded brain cancer: glioblastoma. Environmental toxins likely have a role in the spike in cancer cases among younger generations today. Oncologists avoid addressing the role of environmental toxins in cancer causation and, hence, prevention. Perhaps it is because pharmaceutical companies are also chemical companies and may contribute to environmental pollution while being major sponsors of clinical research, including oncology studies.
More likely, physicians of all varieties are not accustomed to taking an environmental history that often reaches back to the patient’s distant past, as Mr. Boseman’s case suggests. But given the pervasiveness of environmental toxins today, the time has come to train physicians to do so.
Environmental history taking and individualized health risk screenings
So, let Chadwick Boseman’s case be the turning point for environmental history being part of the medical evaluation of patients.
And that is not the only part of medical practice that should change: screening procedures should be individualized for patients’ actual risks. This would include the usage of artificial intelligence (AI) to craft a truly meaningful set of health screenings based on individualized risk factors that include diet, lifestyle, genomics, and environmental history. A database of environmental toxins could be developed, and AI will assist substantially in its usage.
A promising future of prevention
Perhaps we will look back someday on population-based screening studies as a relic of an earlier era of disease prevention and surveillance.
In this reimagined medical world of individualized health risk screenings, Chadwick Boseman would have begun colorectal cancer screening at age 30, and we would still be graced with his creative presence today.
Arnold R. Eiser is an internal medicine physician and author of Preserving Brain Health in a Toxic Age: New Insights from Neuroscience, Integrative Medicine, and Public Health.
