African Americans have a higher rate of colorectal cancer (CRC) mortality than other racial/ethnic groups. This disparity is alarming given that CRC is largely preventable through the use of endoscopy (screening colonoscopy or sigmoidoscopy), yet rates of CRC screening among African Americans is suboptimal. Only 48.9% of African Americans are screened for CRC through endoscopy or fecal occult blood testing. As such, researchers have focused their efforts on the prevention of CRC through patient navigation (PN) services for colonoscopy screening. Although PN has been successful in increasing colonoscopy screening rates, screening rates of navigated participants could still be improved. Thus, the purpose of this exploratory study was to understand why patients, who received PN services, did not complete a colonoscopy. Sixteen participants were interviewed to identify salient themes related to noncompletion of the colonoscopy procedure. Major themes identified included the following: a lack of knowledge about CRC; fear/anxiety about the procedure, including unknown expectations, fear of pain, and fear of cancer diagnosis; inadequate physician communication about CRC and the colonoscopy exam; and believing that cancer leads to death. Participants felt that greater communication and explanation from their physician might help allay their fears. Our findings also suggest that a universal approach to PN, even within culturally targeted interventions, may not be appropriate for all individuals. Future interventions should consider gender-specific navigation and combining PN with nonmedical interventions to address other identified barriers.

Multi-cancer early detection (MCED) tests are blood-based tests designed to screen for signals of multiple cancers. There is growing interest and investment in examining the potential benefits and applications of MCED tests. If MCED tests are shown to have clinical utility, it is important to ensure that all people—regardless of their demographic or socioeconomic background—equitably benefit from these tests. Unfortunately, with health care innovation, such considerations are often ignored until after inequities emerge. We urge for-profit companies, scientists, clinicians, payers, and government agencies to prioritize equity now—when MCEDs are still being developed and researched. In an effort to avoid creating and exacerbating cancer inequities, we propose 9 equity considerations for MCEDs.

A crucial reckoning was initiated when the COVID-19 pandemic began to expose and intensify long-standing racial/ethnic health inequities, all while various sectors of society pursued racial justice reform. As a result, there has been a contextual shift towards broader recognition of systemic racism, and not race, as the shared foundational driver of both societal maladies. This confluence of issues is of particular relevance to Black populations disproportionately affected by the pandemic and racial injustice. In response, institutions have initiated diversity, equity, and inclusion (DEI) efforts as a way forward. This article considers how the dual pandemic climate of COVID-19-related health inequities and the racial justice movement could exacerbate the “time and effort tax” on Black faculty to engage in DEI efforts in academia and biomedicine. We discuss the impact of this “tax” on career advancement and well-being, and introduce an operational framework for considering the interconnected influence of systemic racism, the dual pandemics, and DEI work on the experience of Black faculty. If not meaningfully addressed, the “time and effort tax” could contribute to Black and other underrepresented minority faculty leaving academia and biomedicine – consequently, the very diversity, equity, and inclusion work meant to increase representation could decrease it.