Abstract
“I don't trust the box,” a focus group participant told Charles R. Rogers, PhD, MPH, at an Ohio barbership in 2019. Rogers was initially confused about what the man was talking about, he recalls. “Then, the guy said, ‘You know, this little man on TV with little blue hands and a box that can help me?”
That's when it struck Rogers that the participant was talking about Cologuard, a device used in colorectal cancer (CRC) screening. “It just blew me away because when I think about Cologuard and other stool-based exams, they're less invasive, can be done in the comfort of your own home, and are usually cheaper than a colonoscopy.”
Rogers is on a mission to find and implement translational solutions that address inequities in men's health, with a focus on colorectal cancer disparities among African-American men and other underrepresented populations—a journey that had Rogers recognized as a C2 Catalyst for Change Award winner last year.
Raised in rural North Carolina, Rogers grew up embedded in disparities—a theme that has been at the heart of his career. “Do you know what a chicken house is?” Rogers asked. “A chicken house looks like a green house, but it's very, very long and full of chickens eating, pooping, and standing in their poop until they're taken away to be killed and provided at your local grocery store. I grew up in places where they have chicken houses.”
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After getting a bachelor's degree in applied mathematics and a master's degree in applied statistics, Rogers jumped into public health at the suggestion of a mentor and got a doctorate in just three years. During his postdoc in Minnesota, Rogers gained additional expertise in community-engaged research, cancer, and health disparities, but felt that his message fell on deaf ears. “I knew I was doing good work, but I felt like people weren't listening,” said Rogers.
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“It isn't where you come from; it's where you're going that counts.”
So, once more, Rogers jumped back into higher education to pick up a master's focused on public health administration and policy. “That taught me how to write policy briefs and newspaper articles, on how to talk to individuals in layman's terms on television or radio,” says Rogers. “What I do doesn't matter if I can't connect to people to get the word out…. You'll see me in the barbershop, at churches, or even at a house party on Super Bowl Sunday, right before the game starts, so I can talk to men about colorectal cancer.”
For more than 30 years, Black men have been the group with the highest odds of developing CRC. “Even today, I have a 47% higher chance of dying from colon cancer than White men,” says Rogers. “And when I first started this work over 10 years ago, I had a 52% higher chance.”
And the number of young people being diagnosed with CRC and dying from it has been on the rise at rates of about 2–3% every year since the mid-'90s. “A lot of people don't know that by 2030, CRC is projected to be the leading cancer killer among people ages 20 to 49, and that's unacceptable,” says Rogers.
When he saw these disturbing statistics, Rogers jumped in. Rogers said he picked up on the problem in 2011, a few years after the 2008 recommendation that the screening age for colorectal cancer be lowered to 45 for Black people because they were, as a group, diagnosed with CRC younger and at a more advanced stage. But he didn't see anybody really looking into it or talking about it.
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“We are the change that we seek.”
Rogers has found that there are many barriers for Black men seeking CRC screening. One is a lack of trust in the medical system. The man from the Ohio barbershop didn't trust the Cologuard box because, in light of precedents like the Tuskegee syphilis study, he was concerned about what the medical community was going to do with his DNA.
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A second factor, Rogers says, is that some men see themselves as being the provider for their home, so they won't see a doctor because they need to work. Then there's the question of whether their sexuality will be questioned if they get screened. Some men fear exams below their waist—not just CRC screening, but also prostate cancer screening exams.
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“Today's mighty oak is yesterday's nut that held its ground”
Another potential contributing factor is a lack of knowledge. “Just because you have a college degree, or even a PhD, doesn't necessarily mean that you have an idea about CRC and related early detection screening options,” says Rogers. “I found out about it myself in 2009, and I already had my bachelor's and master's and was just about to start my PhD. I had never heard about CRC in the black community. Back then, you only heard about prostate cancer for Black men and breast cancer for Black women.”
And some people just fear dying, so they won't go to the doctor because they don't want to know if they have CRC. They think that if they have CRC, they may die immediately.
Rogers has also seen faith act as a barrier to seeking CRC screening and other medical exams in the Black community.
“One scripture in Proverbs says that ‘life and death are in the power of the tongue,' and so when I first started out in this space and did some work looking at cancer prevention through churches and family reunions, I remember people saying, ‘I won't even say cancer.' They believe that if they say it, they may develop it.”
When he worked in Minnesota, Rogers looked at barriers and enablers to CRC screening among Somali men. Some of the men felt that cancer resulted from being disobedient to Allah. Rogers also learned that they couldn't distinguish different cancers. They didn't know the difference between colorectal cancer and prostate cancer.
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“My humanity is bound up in yours, for we can only be human together.”
Digging deeper, Rogers learned that prevention wasn't a big deal in the Somali community. “Going to the doctor for some preventive measure is not really common in that community—they'll go to a doctor when their eyeball falls out,” says Rogers.
He also learned that he would need to be respectful of prayer time because many Somalis pray several times a day. Rogers made sure that the food he provided was free of pork because Muslims don't eat it. He thought he was prepared to connect with the men. Yet, to his surprise, he had to have his research lab interpreters walk the men through the consent forms because they couldn't read in English or Somali.
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When asked where he would like to see changes in the medical system, Rogers jumped right to healthcare access. “With me being a professor, I have some satisfactory insurance, and if my insurance is even just tolerable and I have some expenses that come with it, I can probably afford that,” said Rogers. “But for a lot of people, that may be an issue in multiple ways. Some people don't feel like they can get time off work to be able to go get a colonoscopy, for instance, or they don't have insurance. They can't afford this $2,750 (on average) exam.”
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“Never be limited by other people's limited imaginations.”
Addressing colorectal cancer-related disparities also requires taking on social determinants of health. Social determinants of health are the conditions and environments in which people live. It's where they're born and grow up, where they learn and work, and where they play and worship.
Rogers paints a picture of a person who lives in a place without access to green spaces where he could walk around, or even safe places to play basketball. This person may not have access to grocery stores that have healthy foods, and there may be a lot of convenience stores that promote things that increase their cancer risk. They may just have processed foods and alcohol. “It's a snowball effect that just keeps adding up, depending on where you live and how much money you make,” says Rogers. “Plenty of research shows that if you have a poor smoker and a rich smoker, the rich smoker will survive longer than the poor smoker any day.”
To Rogers, some of those social determinants are changeable, but a lot of them are structural. “But I don't think it's okay for us to continue to lose people to a preventable, beatable, and treatable disease,” said Rogers. “I'm in a place where I can partner with others to really influence policy change and help people potentially change their lifestyle and screening behaviors to save their lives. I don't take that for granted at all.”