Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Arnold Eiser, an internal medicine physician and author, discusses his KevinMD article, “What Chadwick Boseman’s death reveals about cancer prevention and risk factors,” examining how environmental toxins and systemic health inequities shaped the actor’s battle with colorectal cancer. This episode explores the importance of personalized screenings, environmental history-taking in medical care, and actionable steps to address disparities in vulnerable communities. Learn how Boseman’s story can spark change in prevention and public health.

Our presenting sponsor is DAX Copilot by Microsoft.

DAX Copilot, by Microsoft, is your AI assistant for automated clinical documentation and workflows. DAX Copilot allows physicians to do more with less and turn their words into a powerful productivity tool. DAX Copilot automates clinical documentation—making it available in the EHR within minutes—and clinical workflows, including referral letters, after-visit summaries, style and formatting customizations, and more.

70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences.

Discover AI-powered solutions for clinical documentation and workflows. Click here to see a 12-minute DAX Copilot demo.

VISIT SPONSOR → https://aka.ms/kevinmd

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme

I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Arnold Eiser. He’s an internal medicine physician and author. Today’s KevinMD article is “What Chadwick Boseman’s death reveals about cancer prevention and risk factors.” Arnold, welcome back to the show.

Arnold Eiser: Thank you very much, Kevin.

Kevin Pho: So let’s jump straight into this most recent KevinMD article. What’s it about?

Arnold Eiser: It is about environmental risk factors in the development of colorectal cancer.

Kevin Pho: Perfect. And for those who didn’t get a chance to read your article, tell us more about it.

Arnold Eiser: Well, Chadwick Boseman grew up in the rural South, and I identified that, in the water supply where he grew up, there was a chemical that’s a byproduct of the sterilization of water. It’s not a contaminant as much as it is a byproduct of adding chlorine to water sources, but it has been identified in experimental research to promote the development of colorectal cancer. His hometown is hardly the only locale where this has been a problem. Shortly around the time this article was published in KevinMD, it was revealed that James Van Der Beek was also diagnosed with stage three colorectal cancer, which was the same stage that Chadwick Boseman was diagnosed with as well. Mr. Van Der Beek is getting treatment and is alive and well at this point.

The five-year survival for stage three colorectal cancer is about two-thirds will be essentially cured, while one-third will not survive.

Kevin Pho: So tell us specifically which environmental toxins Chadwick Boseman was exposed to in the water supply where he grew up.

Arnold Eiser: The one that I focused on was trichloroethane, which is this byproduct of water treatment. I went to the Environmental Working Group’s water database and found out that the water in that town has over 200 times what the Environmental Working Group considers a safe level. Now, that’s different from the EPA. The EPA permits a much higher level because it has to contend with a variety of inputs. I also identified the same high level—over 200 times—in the town where James Van Der Beek grew up. So there is the potential that the exposure is due not just to where you are at the time you’re diagnosed, but it may be occurring throughout childhood and adolescence.

This is a particular issue because colorectal cancer is now being diagnosed in people under 50 years of age. There are now tens of thousands of Americans under 50—50 used to be the age when colorectal cancer screening began—who are being diagnosed with colorectal cancer. These two gentlemen were diagnosed with stage three, which obviously is involvement of the lymph nodes, and that does carry some risk of death. So I think the awareness of environmental toxins needs to be greater, not only among the public but among physicians as well.

Kevin Pho: Why don’t we take a look at the slides we have?

Arnold Eiser: Sure. So for those who are listening, I provided some slides that we can talk about to show more about the connection between environmental toxins and cancer.

Kevin Pho: Let’s go to this first slide.

Arnold Eiser: Yes. The first slide shows that up to 10 percent of cancers are caused by genetics or genomics, another 20 percent may be caused by viruses, and the most common viruses that cause cancer are HPV (which causes cervical cancer) and Epstein-Barr virus (associated with a number of lymphomas). That leaves up to 70 percent caused by environmental toxins, now including voluntary exposure to toxins such as smoking, as well as dietary toxins.

It’s important to understand that the food we consume may have carcinogens within it. Let’s go to the next slide. A number of chemicals have now been identified as having the potential to contribute to the development of colorectal cancer, which include toxic metals such as lead, cadmium, aluminum, and hexavalent chromium—of “Erin Brockovich” fame—and the trichloroethylenes found in the waters of the two gentlemen I mentioned previously. In addition, organic solvents including benzene and trichloroethylene can be implicated. You may recognize trichloroethylene as one of the contaminants from the burn pits in the military that have been associated with cancer development. Last but not least, pesticides of the organophosphate nature can be avoided by consuming organic fruits and vegetables.

In the foods we eat, one of the most carcinogenic processes involves meats that are smoked, salted, or cured with nitrates, which is common in hot dogs. I actually refer to a particular hot dog delicacy where it comes wrapped in bacon, another source of carcinogenic substances that include acrylamides and other toxins. Now, red meats in general—even if they’re not prepared by curing, smoking, or frying—may still have some of these carcinogens, but if they are grass-fed beef, for example, they probably do not contain as many. Fried foods, like french fries and potato chips, are also high in these acrylamides. Barbecued food, as you can see when it becomes charred on the grill, has additional carcinogens. Another category is sugary drinks that contain a lot of sugar and also the artificially sweetened drinks that may have evidence of being carcinogenic.

So what we eat can have a huge impact on whether a cancer is silently developing. One factor that might help reduce the risk of cancer is exercise. However, if the water you drink after you exercise contains carcinogens like the ones we’ve mentioned, that might defeat the health benefits of exercise. So it’s important to consume filtered water, and if possible, use a whole-house filter so you don’t have exposure through showering or bathing. Another important point is that certain diets are specifically less likely to be carcinogenic. Probably the most familiar is the Mediterranean diet, such as the Greek diet. Again, here you have to be wary that the fruits and vegetables you consume are not laden with toxicants. One way to do that is to get your fruits and vegetables from the organic section. Nuts, beans, fruits, and certain spices can also help. In particular, turmeric—which contains curcumin—appears to have anticancer effects.

As the Surgeon General has recently recommended, alcohol avoidance is also important because alcohol is a known carcinogen, though it has certain other effects that keep it in people’s interest.

Here, I’m encouraging physicians to become more knowledgeable about environmental toxins. In the article published in KevinMD in November, I mentioned the possibility of developing more extensive digital databases of environmental exposure that, with the implementation of an AI component, could help identify the particular risk an individual patient might have. That’s for the future, as further work needs to be done in this area, but some things already exist. The Environmental Working Group water database is readily accessible by anyone, physician or otherwise. The second thing is I urge all physicians to familiarize themselves with the Superfund sites in their vicinity so they have some idea of what may be contributing to illnesses and so they can modify screening interventions. There are some unique features to environmental toxin sampling that are not necessarily taught in medical schools or residencies. This is particularly important with regard to metal toxicity. Metal toxicity is a problem because it can cause a variety of health issues, yet metals often leave the bloodstream and urine within 48 hours. So there’s a recommendation that hair sampling be considered if you really want to determine for certain that there’s no metal toxicity. And, as already discussed, there are a number of toxicants in foods that physicians should be familiar with so they can counsel patients to avoid them.

In the future, we’re going to see more individualized approaches to risk factors. Screening would be initiated in a timely fashion. In the KevinMD article, I mentioned under this scenario, I would have hoped that someone like Chadwick Boseman would have started colorectal cancer screening at age 30. Then, instead of being diagnosed at age 39 with stage three, he might have been picked up at an earlier stage and treated more effectively.

Kevin Pho: So talk to me about the variability when it comes to these toxins, specifically in the water. Have there been any epidemiological studies done that correlate the amount of water toxicity with the incidence of various cancers in the country?

Arnold Eiser: There have been some. I don’t have any to quote at the moment, but there have been studies. Clearly, this is an area where more research is needed. As I indicated, one of the problems is that exposure may occur at a delayed point, so it’s easy to identify highly toxic exposures causing acute illness, but when it causes subtle changes that eventually lead to the development of a cancer, that’s harder to detect. Nevertheless, there is evidence that exposure to these contaminants increases your risk of developing cancers, not only colorectal cancer but other forms as well.

I recently learned that the exposure can be not only from ingesting the water but even from taking a shower in it. There might be aerosolization, and there may be some absorption through mere contact with the skin. So when possible, the consideration of a whole-home filter might be a health benefit.

Kevin Pho: Now, for patients listening to you, is it worthwhile for them to test their water for toxins? How can one even do that, or should you just default to whole-home water filters?

Arnold Eiser: I think it’s impractical for everyone to get a whole-home water filter, but it’s not impractical to get one in your kitchen. You can do it for under 200 dollars. You can get a three-filter system put under the sink in your kitchen, and that is a very reasonable step in that direction.

The other thing that I do personally is I vary my water sources. I don’t know if that helps, but by not always using the same source, I figure it reduces the risk of consistent exposure to a particular toxin. Sometimes I do use bottled water, other times I use my filtered water.

Kevin Pho: How does one go about testing their water for toxins?

Arnold Eiser: The Environmental Working Group has done that for you, so you just have to go on their website, check your water supplier by zip code, and they have that data. You don’t have to do an extensive analysis yourself. However, there’s an exception: if you have well water—if you live in a rural area where you have your own well—that’s been identified as one of the major risk factors. In that case, you do have to test, and yes, there are a number of testing organizations that do that. That’s a good point—you can’t rely on the Environmental Working Group if you’re not connected to one of the main water suppliers.

Kevin Pho: What about those water pitchers that filter water, or those typical water bottles you can buy that have a portable filter in them? Are those good enough to filter out the toxins we’re talking about today?

Arnold Eiser: I do not have any direct knowledge of that, so I really can’t say, but I’m a little skeptical that they can do as much as a more robust under-the-sink three-filter system. That’s probably more effective than the simpler types of filters you mentioned.

Kevin Pho: I’m a primary care physician. If I wanted to take an environmental toxin history of a patient and perhaps personalize their cancer screening based on exposure to toxins—given there are hundreds of possible toxins out there—what are some high-yield areas we should be asking about in primary care?

Arnold Eiser: Well, as I just outlined, you want to know what Superfund sites are closest to where you’re practicing, identify what toxins are there, and identify what type of illnesses they’re associated with. That seems to be an essential component of practicing in today’s environment. In the future, I’m hopeful there will be a readily accessible digital database that can do that for you, with AI assisting in that effort. I think the development of AI is promising for identifying specific risks for an individual based on their exposures, rather than purely relying on population-based screening.

I’ve just finished the period of time where I get colorectal cancer screening, but in my case, perhaps I didn’t really need it in the first place, given various factors. At this point, though, we as physicians still rely on population-based screenings. I look forward to the day when we can individualize them more. But you’re right—there are some things we can do right now, and certainly knowing what’s in the local water is one of them. For example, in southeastern Pennsylvania, we do have arsenic in the water. It’s well known that it’s in Texas and New Mexico, but it’s in other parts of the country as well.

Kevin Pho: We’re talking to Arnold Eiser. He’s an internal medicine physician and author. Today’s KevinMD article is “What Chadwick Boseman’s death reveals about cancer prevention and risk factors.” Arnold, let’s end with some take-home messages you want to leave with the KevinMD audience.

Arnold Eiser: Filtered water, a Mediterranean diet, and severely limiting the amount of smoked meats you consume will help. It’s not possible to manage or eliminate all exposures, but if you eat a healthy diet—something like a Mediterranean diet—you’ll be in a much better circumstance. While exercise is good, exercise alone is not going to be sufficiently protective. The two individuals I cited, Chadwick Boseman and James Van Der Beek, were both in excellent physical fitness from a cardiovascular perspective.

Kevin Pho: Arnold, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Arnold Eiser: Thank you very much, Kevin.