March is National Colorectal Cancer Awareness Month. I write this in honor of my husband, John, whom I miss intensely every day. Hopefully our story can help someone else.
John Anderson, my husband of fifteen years, died in September after a fierce five month battle with colon cancer. He leaves behind our two children ages five and nine, and a 32-year old daughter from his first marriage. John was 59, and no, he never had a colonoscopy.
Why, despite knowing the facts about colorectal cancer screening didn’t he? That question will plague me for the rest of my life. And it tortured John from the moment he was diagnosed until the day he died.
The good news: colorectal cancer screening rates have increased since 2002, perhaps due in large part to significant resources the federal government and others have put into effective awareness campaigns. Yet despite this, and a documented increase in knowledge about colorectal cancer, approximately one-third of people age 50 or older have not been screened.
The disconnect between knowledge and certain behaviors is one that challenges social marketers every day. And while we’ve made tremendous strides in creating evidence-based programs that yield positive results, there are still (and will always be?) people whom we can’t reach. John was one of them.
Behaviors can be so illogical and complex, and John, a PhD level behavioral scientist, is the perfect example of how that plays out in real life.
When John turned 50 I reminded him to get a physical and colonoscopy. He got his physical but no colonoscopy. We had the same conversation half a dozen times over the years. He had physicals. Each time he came home with a fecal occult blood test kit and colonoscopy prescription. But he never followed through with either.
To encourage him, I would invoke our family (“Do it for the kids…they need you.”), my own screening habits (“How would you feel if I didn’t get my annual mammogram?”), the data (he was a scientist after all), the Katie Couric effect (a celebrity whom he liked and respected), and his risk factors (age, weight, diet). In the end was my nagging just noise?
Typical screening barriers (not knowing risk, no physician reminder, no health insurance, or fear of the test) didn’t really apply to John. So what was his barrier(s), and could addressing it have made a difference?
One month shy of his 59th birthday, John finally got that colonoscopy. It was after side pain led to a sonogram, which revealed tumors on his liver. His diagnosis: stage 4 colon cancer with inoperable liver tumors. Unless he responded to treatment, there wasn’t much hope. He didn’t respond, and died five months to the day that he began chemotherapy.
I knew it was like salt in a wound. And I knew there would be no answer that would ever heal a thing or make a difference. But still, I had to ask.
“Why didn’t you get a colonoscopy?”
I desperately wanted an answer that would make sense of this awful truth that in many ways would define the rest of our lives.
He didn’t have a definitive answer. And said that he didn’t think it was that complicated. Said he felt invincible, didn’t have the time, didn’t have cancer in his family…
None of it really made sense, he admitted. And our hearts broke with the reality that there really was no answer that mattered because, in the end, there was no excuse.
His oncologist kindly waived it away and said not to go there. We’d never know. John’s cancer was very aggressive. It’s possible that a colonoscopy or other test wouldn’t have made a difference.
But we knew the truth. Colorectal cancer screening saves lives. And it might have saved John’s.
I also asked John if I could have done anything that might have made a difference. After a pause, he half-jokingly said “well, maybe if you withheld sex”. As quickly as we laughed it off, it occurred to me that maybe he really was on to something. But what, I’m not quite sure.
Withholding sex is not the answer, but maybe it begs a bigger question…what are we competing against with people who, despite having the knowledge, still don’t get screened? What’s so important that if they were confronted with it, they might change their behavior? If we figured that out, could we use it successfully to reach them?
So I’ll leave you with this…in the end, for John, it was all about his family. That’s what devastated him the most. Not being there for or with us. Not watching his children grow. That’s what mattered.
So what do you suggest I do with that?