The Question That Was Never Asked

It was my goodbye celebration. I was returning to the trenches after too long away.

My best friend took me to lunch.

I complained about packing boxes and layover flights, and then she shared her news; she had had her first colonoscopy last week.

I was shocked. She was only a year younger than me — already five years overdue for her “first screening” colonoscopy. But this wasn’t a screening; now a diagnostic exam to explain her anemia and new, worsening menstrual cramps.

While Black doesn’t crack, time passes. Discussing menstrual cramps with a woman in her mid-fifties felt absurd.

With this setup, the end of this story was not a surprise to me or to any 3rd-year medical student, for that matter.

I wished I were mistaken, that lunch could have remained about me rather than about the possibility of losing my best friend.

I wasn’t mistaken.

They had found a tubulovillous adenoma, which is a type of pre-cancerous polyp, in her cecum (the beginning of the large intestine). The biopsy pathology — the microscopic examination of the tissue — had come back today, and it was high-grade dysplasia, meaning it showed cells that are very abnormal and at high risk of turning into cancer.

It was the size of a golf ball. She told me, “It’s not cancer.”

I almost cried; the finding seemed larger than a golf ball — it felt as if it carried the weight of our years together.

I am a surgeon with years spent in operating rooms and reading medical literature. I know what this diagnosis means now — and what it could have meant if she’d had regular screening and follow-up.

She is right. A tubulovillous adenoma with high-grade dysplasia is not cancer. It is a wolf in sheep’s clothing and needs to be treated with the same respect and aggression.

I share this not for sympathy but to highlight a systemic failure: my friend’s experience is not rare — this is the unacceptable norm that endangers the global majority.

The Numbers We are Not Talking About Enough

Colorectal cancer causes more cancer deaths than any cancer except lung cancer in the United States. Each year, it kills a significant number of Americans.

Colorectal cancer is highly preventable. Early detection means over 90% five-year survival; late detection results in sharply lower survival rates. Early is confined to the bowel wall, often asymptomatic, and found during screening. Anything else is late.

A 2025 UCLA review found that, compared to white Americans, Black Americans are about 20% more likely to develop colorectal cancer. They are also about 40% more likely to die from colorectal cancer than white Americans.

Not because the tumor biology — that is, the structure and behavior of the cancer itself — is different. Not because Black bodies are inherently more susceptible. But because of what happens, and what doesn’t happen, between the first symptom and receiving an official diagnosis.

In 2018, screening guidelines changed: the new recommendation is to begin at age 45 for average-risk individuals — no symptoms, no personal, and no family risk. Previously, the age was 50. The change responded to rising early-onset colorectal cancer in Black patients. In 2021, the US Preventive Services Task Force adopted this update, shortly after Chadwick Boseman’s death at 43 shocked the world.

This was not a quiet recommendation. It was a response to data that showed that people were dying from a cancer we had tools to prevent. Dying, simply because we were not looking soon enough or in the right places or populations.

And yet.

My friend was led to believe that anemia — a lack of healthy red blood cells — at age 55 was not a cause for alarm, and that what seemed like ‘still having menses’ (menstrual periods) need not be distinguished from abnormal uterine bleeding, which can signal a problem.

The question “Does the story fit the diagnosis?” should be automatic. If it doesn’t, investigate. This is basic medicine — pattern recognition taught in the first year. Yet it was missed.

This is Not About One Doctor

I want to be clear: placing blame on one physician is tempting but misses the heart of the issue. These failures reflect ingrained and systematic problems that explain rising colorectal cancer rates in Black patients. This is my central argument.

The harder truth is that this story does not occur in a vacuum. It happened in a system with documented, reproducible, measurable patterns. In this system, symptoms are often investigated and explained away.

Studies have shown that Black patients are:

• Less likely to receive timely follow-up for abnormal test results.
• Less likely to be referred for specialist care.
• Less likely to receive guideline-concordant screening.

Disparities in colorectal cancer screening rates between Black and white Americans persist. This is true even when controlling for income, insurance, and access to care. Access alone is not the explanation. Something else is operating.

That something else is the elephant in the room; it is the accumulated weight of a medical system that was not built with Black patients as its intended beneficiaries. A system in which pain gets explained away rather than taken seriously. Women, especially Black women, are not believed when they communicate their fears and concerns, and their symptoms are investigated the least.

My friend is a Black woman, at least pre-menopausal. Attributing her anemia to menstrual bleeding was wrong. When the guidelines changed in 2021, she was 50 but wasn’t offered a colonoscopy until she was 55.

At some point, this is not a gap in the system. Rather, it is evidence that the system is functioning exactly as it was designed — to exclude and underserve Black patients. This is the main problem the argument addresses.

The Provider in the Room

Here is what the research tells us and what I know from my own career to be true: who is in the room matters.

Patients who are matched with providers who share their cultural background, language, or lived experience notice a difference. It’s not magic — just trust and communication, without translation or extra justification required.

Studies on cultural concordance in care show improved screening rates, better chronic disease management, higher patient satisfaction, and, critically, higher catch rates for symptoms that are attributed rather than investigated.

Would a culturally concordant provider have asked my friend the right questions sooner? I cannot say for certain. I do know what the data says about what happens when the provider-patient match is right. And I know what happened when it wasn’t.

The tragedy is that finding that match — a provider who sees you fully — has historically required luck or connection. The informal networks that communities of color have built fill gaps in a system that excluded them.

That is not enough for my friend or anyone.

What We Are Building

Inclusive Health Match (IHM) was founded to fight this systemic deficiency — the unacceptable but not inevitable gap in care for people of color. This addresses the main argument: the system must change, not just individual actions.

IHM is a center that provides healthcare services to the global majority. It lets patients search for healthcare providers by cultural identity, language, faith traditions, and affirming practices. Not just who is “in-network” or available on Tuesday. It puts you in control when the question that saves your life needs to be asked.

It also includes a Cultural Calendar. This resource helps both patients and providers understand the health implications of different cultural and faith traditions. Context is not a nicety in medicine. Context is clinical information.

If you are a patient: Don’t wait. Access IHM now at www.inclusivehealthmatch.com. Download on iOS TestFlight, Google Play, or use the web app instantly — no download required. Take control. Find a provider who will ask the right questions, believe your answers, and help protect your future.

If you are a provider: Take action. Build your profile today. Go beyond your NPI: list your languages, background, and the communities you understand and serve. Make yourself findable to patients who need you most and be the difference for those seeking care.

If you know a physician who makes a difference: Forward this to them now. Be the connector that could save a life. Remind your network: sometimes asking the right question is everything. Act now — don’t wait.

And While We Are Here — Your Screening

If you are 45 years of age or older and have not had a colorectal screening, I am talking to you directly.

If you are Black, I am speaking to you urgently.

And let me be clear about what screening means, because the barrier for some people is the procedure itself: you have options. A colonoscopy is the gold standard; it can be both diagnostic and therapeutic. It can detect and remove polyps in the same visit. But if the prep or procedure has kept you from demanding health equity, Cologuard is a stool-based DNA test you do at home and mail back, with no bowel prep required. It is not equivalent to a colonoscopy, as a positive Cologuard test mandates a diagnostic colonoscopy, but it is better than nothing. And nothing is what many are choosing, waiting for the perfect option, or accepting the bliss of ignorance. Talk to your provider about which test is right for you. Then just do it.

If you have a sister, mother, friend, or colleague who is overdue, send this to them immediately. Their life could depend on you taking this action — do it today, insistently and without delay.

The Bottom Line

My friend is going to be okay. I have to believe that, and I have reason to because she has me in her medical corner. But she should not have gotten that close to a different outcome. Not at her age. Not with her symptoms. Not in a country with screening tools, the guidelines, and the knowledge to be proactive, not reactive.

The match problem is real. Who treats you and whether they see you fully shapes whether the right question gets asked at the right time. We cannot fix the whole system today. But we can build something inside it that works differently and better for more people.

That is what I am doing, but this only works if we do it together.