Outline of the body and the colon, showing a tumor highlighted in red.

Boseman Death Highlights Colon Cancer in Young and Black Adults

By on 09/14/2020

Fans were shocked and saddened in late August when actor Chadwick Boseman, 43, succumbed to a private, four-year battle with colon cancer.

But the death of someone so young from colon or rectal cancer is not as unusual as it once was. According to the American Cancer Society, rates in adults under 50 have been increasing for more than 20 years. People under 50 are the only group among whom death rates have been rising.

African Americans have about a 20% higher risk of developing this disease – and a 40% higher chance of dying from it – than the U.S. population as a whole, the cancer society says.

“I hope that this death [of Chadwick Boseman] is going to shed light on this disease and help to increase our colon cancer screening rates, especially in those populations that have lower rates of screening,” says Michael Goldberg, DO, Chair of Gastroenterology for the Einstein Healthcare Network.

Prevention by screening

Colorectal cancer is highly preventable with screening, particularly the most recommended method, colonoscopy. When colon polyps that could turn into cancer are found during a colonoscopy, they can be removed in the same procedure.

Michael Goldberg, DO

Other screening tests include sigmoidoscopy, which is similar to colonoscopy, and tests that look for blood or DNA changes in stool. Find out more about colon cancer screening.

Philadelphia has lower rates of screening than other large U.S. cities, and the neighborhoods around Einstein Medical Center Philadelphia have had rates below the city’s average, Dr. Goldberg says.

In January 2019, he says, only 54% of the Einstein patient population had received recommended colon cancer screening. The hospital then launched a “direct-access” program to urge people eligible for screening to schedule that appointment directly, without a prior office visit.

In the next year, screening rates jumped to 63.5%, Dr. Goldberg says. “We are extremely proud of that.”

Screening colonoscopies were halted during the height of the COVID-19 pandemic, and doctors are working now to reschedule everyone, he says.

When to get screened

About 90% of all colorectal cancer cases are diagnosed in adults 50 and older. Most medical guidelines recommend that people with average risk of colorectal cancer be screened from ages 50 through 75. How often depends on the screening method used.

More recently, some groups said that African American men and women should begin screening at 45 because of their higher risk.

“The screening guidelines had been 45 years for African Americans for several years, while the recommendations only recently changed for other adults,” says Angie Nicholas, MD, a family physician and Chief Medical Officer at Einstein Medical Center Montgomery.

The American Cancer Society in 2018 became the first organization to recommend screening at 45 for everyone at average risk of colorectal cancer. However, specialty physician groups and other organizations so far have not changed their guidelines. 

Dr. Nicholas, whose late husband, John McLeod, already had Stage IV colon cancer by age 45, has advocated for all organizations to recommend screening at 45 so that insurance plans will pay for it. 

Family and personal medical history

Screening is recommended at age 40 or younger for people with greater than average risk of developing colorectal cancer. The high-risk groups include those with inflammatory bowel disease, certain genetic-related conditions or a family history of colorectal cancer or polyps.

“If there’s any family history,” Dr. Goldberg says, “it depends how many family members and what degree of relatives they were. But usually we’re starting at age 40, or 10 years prior to the earliest person in their family that had colon cancer.”

Because more cases are being diagnosed at younger ages, Goldberg says, he recommends that all patients start talking with their primary care doctors about future screening when they are 40.

To prevent colorectal cancer, he says, eat a healthy diet, get regular exercise, don’t smoke or drink excessive amounts of alcohol, and keep weight under control. In addition, Dr. Goldberg says, people should avoid processed meats such as ham and sausage, which have been linked with a higher risk of colorectal cancer.

Most people with colorectal cancer have no symptoms at first. But everyone should pay attention to potential signs of trouble, Dr. Nicholas says.

“The message about symptoms is very important for those under 45,” she says. “Know your family history, and if you have symptoms, see your doctor.”

Symptoms include:

  • Bleeding from the rectum, or blood in stool
  • Significant changes in bowel habits
  • Stool that is black and tarry, clay-colored, red or white
  • Very narrow stools for at least a week
  • Frequent gas pains, bloating or abdominal cramps
  • Unexplained weight loss
  • Feeling very tired or fatigued

If you are 45 to 50 or older, ask your doctor about screening for colorectal cancer. You also may be  able to schedule a colonoscopy without a previous office visit. Find out more about Einstein’s Direct Access Colonoscopy program.

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