Actor Will Smith says that he was convinced by his physician , that the time had come for the 51-year-old actor to undergo his first screening colonoscopy: "I'm 50, so people need to look up my stuff," quipped the "Men in Black" star.
But then Smith decided that he needed to do this Hollywood style and he recorded a 17-minute (which has now been seen over 2.5 million times). It starts in silent movie mode, complete with ragtime music and intertitles (the text frames between the movie action sequences), during which Stanford explains the procedure and the preparation for it.
The video then cuts to Smith arriving at the hospital at 5:30 a.m. where he undergoes the procedure. Fortunately, the camera cuts away as he's wheeled into the colonoscopy suite and picks up in the recovery room where Smith is still feeling giddy from his sedation.
Days later, Smith is seen FaceTiming with Stanford about the results of his colonoscopy. A polyp was found in his cecum, which was removed. Pathology came back as a tubular adenoma, a precancerous condition. She praised Smith for agreeing to get the test done as he was able to have the polyp removed before it became a problem. The only thing Smith needs to do differently is that he should have another colonoscopy every 2-3 years.
Smith now hopes to spread the word that preventive screening is important: "Gotta get our health right. There's a certain amount of commitment and embarrassment involved with being healthy. You just gotta do it."
Colon Cancer
Cancer of the colon is a highly treatable and often curable disease when localized to the bowel. Surgery is the primary form of treatment and results in cure in approximately 50% of patients. Recurrence following surgery is a major problem and is often the ultimate cause of death.
Estimated new cases and deaths from colon and rectal cancer in the U.S. in 2019:
- New cases: 101,420 (colon cancer only)
- New cases of rectal cancer: 44,180
- Deaths: 51,020 (colon and rectal cancers combined)
Risk Factors
Increasing age is the most important risk factor for most cancers. Other risk factors for colorectal cancer include the following:
- Family history of colorectal cancer in a first-degree relative
- Personal history of colorectal adenomas, colorectal cancer, or ovarian cancer
- Hereditary conditions, including familial adenomatous polyposis and Lynch syndrome (hereditary nonpolyposis colorectal cancer)
- Personal history of long-standing chronic ulcerative colitis or Crohn's disease colitis
- Excessive alcohol use
- Cigarette smoking
- Race/ethnicity: African American
- Obesity
Colonic polyps
The main types of colonic polyps are classified as hyperplastic and adenomatous. Hyperplastic polyps are the most common of the two and are considered benign. They are typically small (<0.5 cm) and are located in the sigmoid colon and rectum. As they are difficult to visually distinguish hyperplastic polyps from adenomatous polyps, they are usually removed at colonoscopy and sent to the lab for pathologic confirmation.
Although adenomatous polyps (adenomas) of the colon and rectum are benign growths, they may be precursor lesions to colorectal cancer. Polyps >1 cm in diameter are associated with a greater risk of cancer. Unremoved, they can continue to grow and may become cancerous.
Adenomatous polyps have three histologic variants: tubular, tubulovillous, and villous. Found throughout the colon, tubular polyps tend to be small, and are the most common type of adenoma. Villous adenomas tend to be bigger and occur in the rectal area. They have a velvety, cauliflower-like appearance and are nonpedunculated (i.e., they do not have a stalk). Tubulovillous adenomas have a mixture of both types of adenoma.
Tubular adenomas represent ~75% to 85% of adenomatous polyps and have <5% chance of harboring a malignancy. Tubulovillous adenomas represent 10% to 15% of polyps and usually 20% to 25% harbor a malignancy. Villous adenomas constitute 5% to 10% of the remaining polyps and 35% to 40% of the polyps are malignant, according to a .
Colon Cancer: Racial Disparities
Several studies have demonstrated a discrepancy in the survival rates between African Americans and other ethnic groups when it comes to colon cancer. According to the SEER (the Surveillance Epidemiology End Results) program of the National Cancer Institute, the incidence of colon cancer in Caucasian men and women declined after 1985. By 2000, the incidence of 20%-25% is lower than it was in 1985. However, the incidence in African Americans increased over the same time period and was 12.3% higher than in Caucasian men, and 17.5% higher than in Caucasian women. What's more, the 5-year survival rate was 90% for Caucasians compared with 83% for African Americans with stages 1 and 2 colorectal cancers. For patients with stage 3 or 4 cancers, African Americans had a significantly decreased survival rate compare to Caucasians (64% vs 53%).
The reason for this disparity has been suggested to be a difference in access to healthcare coverage. Authors of the 2005 review stated, "Studies have shown that there are statistically significant differences in the rates at which physicians performed screening tests in African Americans, with physicians performing less digital rectal examinations, fecal occult blood testing, and colonoscopy. The decreased survival rate could also be attributed to the fact that a greater proportion of African Americans present with more advanced disease, which has also been ascribed to lower screening rates, less access to healthcare, and differences in treatment options."
Given these discouraging facts, it's fortunate that well-known celebrities, such as Will Smith, can play a vital role in raising awareness for healthcare screening in minority populations.
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.