Q&A with Dr. Sophie M. Balzora, Member of Fight CRC’s Health Equity Committee

Sophie M. Balzora, M.D., FACG, is a Clinical Associate Professor of Medicine in the Division of Gastroenterology and Hepatology at the NYU Grossman School of Medicine. Her interests include inflammatory bowel diseases and enhancing physician engagement and the patient experience through objective structured clinical exams (OSCEs).

Dr. Balzora is Vice-Chair of the American College of Gastroenterology (ACG) Diversity, Equity, and Inclusion Committee and co-founder of ACG’s #DiversityinGI Social Media Campaign. She is a Senior Associate Editor of the American Journal of Gastroenterology and on the social media team for the Inflammatory Bowel Diseases Journal. She is a member of the Patient Education Sub-Committee of the Crohn’s and Colitis Foundation (CCF)’s National Scientific Advisory Committee and Fight CRC’s Health Equity Committee. In 2020, Dr. Balzora was in the inaugural cohort of the Office of Diversity Affairs’ Faculty Leadership Development Program through the NYU Langone Academy, and a recipient of the 2020 ACG President’s Special Recognition Award for efforts in leadership and exemplary service in promoting diversity, equity, and inclusion. Dr. Balzora is also President and Co-founder of the Association of Black Gastroenterologists and Hepatologists (ABGH), founded in 2021.

Why did you go into medicine?

I come from a family of medicine, my mom is a nurse and my dad and sister are physicians. It’s not uncommon in Caribbean families to instill in the kids the idea that there are three options for your future — becoming a doctor, lawyer, or maybe both! In college I was an anthro major and I loved medical anthro, understanding how the language of medicine came to be and how everybody thought it was so objective. When I really looked at it, I found so much subjectivity in medicine, so many opinions. It was very interesting to me and it became the foundation for what my interests are today, especially when we’re talking about racism in medicine and implicit bias. What attracted me to GI was the people. There weren’t many women in the field and definitely not Black women. I thought, “Wow, what an opportunity.”

What does an average day look like for you?

It depends on the day. Some days, I am with patients all day. Other days, I am doing procedures. Then other days, I am doing interviews or tasks that are not directly related to patient care. I like that variety and it’s one of the reasons I chose to be in academic medicine.

Are there any stories that jump out at you that exemplify the urgency of having health equity conversations?

Two come to mind.

The first is a patient I met two or three years after I began practicing. She presented with symptoms, she was around 55, and she was Black. She was super savvy and worked as a police officer, and she told me her husband, who was around her age, had actually passed away from colon cancer. She tries her best to stay on top of her health but caring for her husband caused her to fall behind on her own screening. By the time I did her procedure, she had colon cancer. She had surgery and thankfully is doing well. She’s on a surveillance regimen now.

Her story resonates with me because it takes into account so many different factors. We know there are stark racial and ethnic disparities in colorectal cancer. The fact that it affected two Black people in the same family, obviously not bloodline, is incredibly sad. And then there’s the female caregiver aspect and how she neglected her health while she took care of her husband. I see that a lot.

The second patient that comes to mind is a Black female patient who was around age 25. She told me that when she was in her final years of college, she tended to drink quite heavily. After she graduated, she wanted to become healthier and lose some weight. She started to lose some weight, but it was a little bit more dramatic than the effort she was putting into it. Mind you, when I saw her in the office, if I hadn’t read her chart, I wouldn’t have guessed that any of this had happened to this patient in front of me. I was floored by what I read in her chart. She then begins to tell me her story – she had sudden, severe abdominal pain while at home, called 911, and by the time 911 came, she had seized and was found down. In the ER, they found she had a perforated sigmoid cancer. She had no family history. If she wasn’t young and otherwise healthy, she would’ve never made it to my office in the condition she was in, if at all. Fortunately, she did amazingly well and to see her now, and in the shape that she is in, is a gift.

These two stories made me think, “Wow, we really need to let people know the danger in ignoring symptoms.” In medically underserved communities and communities of color, we need to pay particular attention to this idea of rationalizing symptoms or not having the opportunity to prioritize one’s health as a few of many contributing factors to being diagnosed with later-stage disease. These two patient stories are real reminders of why this is important.

What are you hoping the Fight CRC Health Equity Committee can accomplish?

This committee is providing a unique opportunity to bring people together across the country in a new and much-needed way. The first time I went to Call-on Congress, I couldn’t believe it, it was so cool to see everybody so pumped and energized; and there was so much blue. I loved it. If physicians can take some of the tools Fight CRC utilizes to advocate for the things that matter and for the patients we see, that could be very empowering. It’s also key to have Black and Brown faces as trusted messengers who are saying, hey, this is important; and why it’s important, and to emphasize that this really needs to be at the forefront of people’s priorities, and also, how health equity will ultimately benefit everybody.

What are some of the messages you hope reach underserved communities?

It’s much harder to focus on your health when you have other very real, immediately pressing issues in front of you, like food insecurity, paying the rent, or being unemployed. You’re not thinking about getting your FIT testing. I think that preventive aspect is something a lot of people don’t know about—you can actually prevent cancer if you have timely screening.

We need to consider the stigma of having a colonoscopy and people’s assumptions that it has something to do with homosexuality in Black communities. Knowing more about the entire process from start to finish is helpful.

A lot of people think colorectal cancer only afflicts men. I see that a lot, especially given the very sad and most recent celebrity example of Chadwick Boseman. I think there’s a false sense that it’s a “man’s disease.” It’s important for people to know this affects men and women the same, at the same rates.

Information needs to get not just to the patients, but also to the providers, because one of the main predictors of getting screened is a doctor’s recommendation to actually get screened in the first place. Sometimes physicians may subconsciously assume certain patients will not get screened, or they may prioritize other things, and so, these physicians may not mention it or prioritize it during their visits. But just like smoking cessation, it has to be mentioned at every visit. Physicians need to implant the thought. I like to implant the idea of getting screened five years before the patient is of age to start screening.

There’s a stigma of discussing medical problems at the dinner table or talking about them openly, even with physicians. Sometimes, when I ask about people’s medical history, they’re like, “Oh we don’t talk about that.” This has got to change. There’s so many cultural and societal things that will take time and dedicated effort to break through, but if people see Black and Brown faces telling them the importance of talking about and knowing family health history, not fearing colon cancer screening or what may be found, this will help.

What fuels your passion to fight racism in medicine?

My personal experience during fellowship is what fueled me to do objective structured clinical exams, or OSCEs, that were geared toward cultural competency—how to speak to patients, how to speak to colleagues, how to speak to fellows, all the trainees who are watching, etc. Microaggressions happen all the time and a lot of times people don’t realize what they’re doing and when. Bringing that awareness has always been important to me.

When you look across all GI cancers, there are racial and ethnic disparities. That’s not a coincidence and it’s obviously not biological. This is a societal issue that has a lot to do with socioeconomic status and where somebody lives, access to care, and many other things. People are moving away from the false interpretation that someone’s DNA is the cause, which is an astronomical step in thinking, because it’s easy to fall back on blaming biology. It’s hard to see and admit the societal factors at play because it makes you rethink everything about medicine, which is scary— but we have to.

What unfair assumptions do you see being made when it comes to health disparities?

“People don’t care about their health and that’s why they don’t take their medication, get screened, or go to the doctor.”

Part of the reason people aren’t coming is mistrust. And, a history of mistrust will be confirmed during medical visits if someone’s talking and they feel ignored or if they feel unheard or don’t feel understood. Disparities in maternity deaths and infant deaths of Black mothers is the quintessential example — think Serena Williams. If you’re of that stature and your doctor won’t believe you, how can you expect a poor, Black woman to be believed or listened to?

It’s not that people don’t want to be healthy. The institution people look to to get healthy has not always treated them with the best intentions.

You never know what people are really dealing with and going through, and we must think about the whole person. People do have other priorities, but it doesn’t mean they don’t care about their health. There may be a lot of obstacles in their way that we don’t realize are preventing them from getting to the office to see their doctor or getting them to that screening. And historically, they’ve not been believed.

Why have you chosen to team up with Fight CRC and support our health equity work?

This is what you guys do, this is what you fight for: You fight for patients and you fight for families. We need to fight for those families who have historically not been at the forefront. That’s why I think this is so important.