In a year marked by painful losses, movie fans have another reason to grieve: Chadwick Boseman, the star of the popular film "Black Panther," died Aug. 28 at age 43, following a four-year battle with colon cancer.
Boseman was diagnosed with Stage 3 colon cancer in 2016, according to a tribute to the actor in The New York Times. His death stunned fans around the globe, many of whom were unaware he filmed two Marvel movies as fearless superhero T'Challa while undergoing cancer treatment.
Though Boseman, who also portrayed iconic figures such as Jackie Robinson (“42”), James Brown (“Get On Up”), and Thurgood Marshall (“Marshall”), was fit and otherwise healthy, his untimely death shines a spotlight on two major health concerns in the U.S. today:
- Colon cancer rates are increasing among adults younger than 50
- Black patients are much more likely to develop and die from colon cancer than white patients
Boseman was among a growing number of young adults to be diagnosed with colon cancer, a condition once regarded as an older person's disease. Data from the Centers for Disease Control and Prevention show that colon cancer diagnoses increased nearly 2.7% and deaths increased 1.3% from 2012 to 2016, though these rates declined more than 2.5% among patients 65 and older.
This year, the American Cancer Society estimates that 12% of all new colon cancer cases – approximately 18,000 people – will be diagnosed in patients younger than 50. Compared with non-Hispanic whites, Black patients are 20% more likely to develop colon cancer and nearly 40% more likely to die from it.
By 2030, 10% of colon cancers and 22% of rectal cancers diagnosed in the U.S. are expected to be in patients younger than 50. This is an alarming forecast when compared with the rates of 4% and 9% for colon and rectal cancer, respectively, from just 10 years ago.
Unfortunately, there is no single reason why colon cancer diagnoses and deaths are on the rise among young adults. However, there is a chance that earlier screenings and healthier lifestyle choices could help curb this alarming trend.
Issues with diagnosing colon cancer in young adults
As of May 2018, the American Cancer Society’s recommendation was people at average risk start screenings at age 45 – just two years past Boseman's age at the time of his death. Clearly, this is too late for someone who gets cancer in their 30s or early 40s. It is especially important that patients see a doctor if they experience persistent symptoms – even if they are younger than 45.
Colorectal cancer arises from the inner lining of the large intestine, also known as mucosa. It usually begins as an abnormal growth, or polyp, that forms in the colon or rectum. Symptoms might not be readily apparent; rather, they show up as the disease progresses.
Common symptoms can include:
- Abdominal pain
- Blood in the stool
- Decreased appetite
- Weight loss
Studies show that younger people are more likely to be diagnosed with late-stage colorectal cancer because they assume their symptoms are due to something less serious. I’ve seen patients, for example, who experienced blood in their stool and figured it was hemorrhoids or had abdominal pain and thought it was irritable bowel syndrome.
Patients with a family history of colorectal cancer also should talk to their doctor about getting their first colonoscopy 10 years before the earliest onset of anybody in the family. That is, if a patient’s mother was diagnosed at 52, the patient should be getting screened at age 42. To ensure that insurance covers this, patients should speak with their doctor.
Potential factors associated with colorectal cancer
1. Genetic diseases
Up to 35% of people who develop cancer before age 50 have genetic mutations, compared to 3% to 5% of all colorectal cases. These numbers suggest that genetics are affecting younger patients much more than older patients, but we need more research to say for sure.
Two common forms of genetic conditions we see in colorectal cancer patients include familial adenomatous polyposis (FAP), which is when hundreds of polyps cover the inner lining of the colon, and Lynch syndrome, which is a non-polyposis syndrome that increases risk of developing colorectal cancer and other malignancies.
Interesting research is happening now pertaining to genetic mutations that have yet to be identified. While we know many of the genetic mutations that lead to colorectal cancer, we don’t know them all. Screening for possible genetic mutations is extremely important to identify predisposition of the patient and their first relatives, not only for colon cancers but other cancers to organs as well. Moreover, knowing if patients carry a specific genetic mutation might have implications in the type of surgery or chemotherapy needed. As it stands now, new genetic mutations are detected every few years. Therefore, patients who were tested a few years ago and had no genetic mutations could have a different result today. Keeping up with testing could not only help them but their relatives and children, as well. People can do so by scheduling a genetic counseling appointment.
It has been hypothesized for years that a low-fiber diet that’s high in animal protein and red meat can also increase colon cancer risk. We have no definitive evidence to support either of these theories, but patients’ overall health would only benefit from consuming a healthy diet that prioritizes fruits, vegetables, and high-grain fibers. Furthermore, new studies have suggested that certain foods can negatively affect the microbiome, or the bacteria population in the colon, which could result in a higher risk of colorectal cancer.
Heavy alcohol consumption, or more than two drinks per day for men and one drink per day for women, is another important risk factor for colorectal cancer. I suggest patients make their best effort to prevent heavy drinking because it’s been associated with many different health implications.
Smoking cigarettes is a well-known cause of lung cancer, but it's associated with many other cancers, as well. In fact, studies show that individuals who smoke for long periods of time are more likely than non-smokers to develop colorectal cancer.
Obesity and excess body fat have been shown to be associated with increased incidence of colorectal cancer. Moreover, a recent study has shown that excess body fat at an early age might be associated with colon cancer risk later in life.
5. Ulcerative colitis
Ulcerative colitis, or a type of inflammatory bowel disease, is a condition that causes long-lasting inflammation and sores in the innermost lining of the large intestine and rectum. Patients who have ulcerative colitis are at higher risk of colorectal cancer in comparison to the general population. These patients should work with a doctor to plan frequent colorectal cancer screenings to rule out the presence of the disease.
6. Disparities in care
Limited access to care, inadequate insurance coverage, and social and systemic bias have led to disparate outcomes in health care for Black patients over time.
As an academic medical center, UT Southwestern thrives on diversity. Our desire is to reflect the diversity of our community in our team of providers, our staff of employees, and in our patient care.
"By 2030, 10% of colon cancers and 22% of rectal cancers diagnosed in the U.S. are expected to be in patients younger than 50. It’s important that patients be aware of the symptoms and never assume they’re too young to get colorectal cancer."
How colon cancer is diagnosed and treated
As with most cancers, the sooner colorectal cancer is diagnosed, the more likely that treatment will be effective. With a colonoscopy or similar screening, patients can have cancerous tumors detected early and removed, as well as polyps that have the potential to turn into cancer. Polyps are small tissue growths commonly found arising from inner lining of the colon.
Colorectal cancer treatment options vary among patients based on tumor type and location, as well as on a patient’s overall health and lifestyle. Typically, we recommend a combination of surgery (usually a minimally invasive procedure), chemotherapy, and radiation depending on each individual case.
Boseman's premature death is tragic, and one we hope will become increasingly less common over the next five to 10 years. It is important to be aware of potential risks factors and symptoms to detect colon cancer at an early stage.
Please see a doctor at the first sign of symptoms – preferably sooner if you have a family history of the disease. Acting quickly can potentially save your life.
Meet Dr. Polanco
Patricio Polanco, M.D., is a surgical oncologist who focuses on gastrointestinal cancers and has advanced training in minimally invasive techniques and robotic surgery. He also prides himself on bringing warmth and compassion to every patient he treats. "I take their struggles on as my own."