Chadwick Boseman’s unexpected death at 43 from colon cancer shocked fans Friday night. He’d battled the disease quietly for four years, continuing to churn out great work despite surgeries and chemotherapy.
While Boseman’s death caught us off guard, cancer advocates aren’t surprised by this young-colon cancer news. Colon cancer deaths have been rising among young people since the 1990s. A report from the American Cancer Society earlier this year found half of all new diagnoses are in people age 66 and younger.
Scientists knew cases of colorectal cancer were going up in younger age groups, but “were surprised by how fast it is happening,” said Rebecca Siegel, study co-author and scientific director of surveillance research at the American Cancer Society.
“This report is very important because it not only provides a snapshot of the current colorectal cancer burden, but also a window to the future,” she said, adding that if the increases in younger adults continue, “doctors should be aware of the unique challenges in this patient population, such as the need for the preservation of fertility and sexual function, as well as the risk of long-term treatment effects because of their extended life expectancy.”
Each year, roughly 140,000 Americans are diagnosed with colon cancer, and more than 50,000 die from it. The numbers for African Americans, however, are more dire. Not only do we have the shortest survival rate of any racial or ethnic group in the United States for most cancers, but we also have the highest incidence of colorectal cancer.
“African-Americans are more likely to get colon cancer, they’re more likely to have an advanced stage of disease when they’re diagnosed with colon cancer, they’re more likely to die from colon cancer and they have shorter survival after diagnosis with colon cancer,” said Fola May, M.D., assistant professor of medicine at UCLA and a researcher at Cedars-Sinai Medical Center.
In fact, nearly 20,000 new cases of colorectal cancer were expected in this country among African Americans in 2019, with incidence rates 24 percent higher in black men and 19 percent higher in black women compared to other races, the ACS reported. Black colorectal cancer patients are also 15 to 20 percent more likely to die from the disease than patients of any other race.
Occurring in the colon, rectum or both, colorectal cancer is the third-most common cancer in all adults in the U.S.—after lung and prostate in men and lung and breast in women. The black community’s heightened risk appears to be due to several contributing factors. “Some biological factors may be at play,” said Inova Schar Cancer Institute oncologist Timothy Cannon, M.D.
African Americans with colorectal cancer are more likely to cope with an aggressive subtype fueled by a mutation in the KRAS gene, which drives cancer growth, he said. This cancer in black people also occurs more often on the right side of the colon, another factor that can lead to poor prognoses.
“But there are also socioeconomic factors that can make it more difficult for people to gain access to screening,” Cannon said. Socioeconomic factors may place some African Americans at a disadvantage by making it harder to seek timely screening or access high-fiber, minimally processed foods, which can lead to lower rates of colorectal cancer.
“Their cancers tend to be harder to treat and grow more quickly, so the prognosis isn’t as good,” he said.
In 2018, the American Cancer Society updated its colorectal cancer screening guidelines, changing the recommended age of initial screening from 50 to 45, due to higher rates of the disease in younger people.
“But even before that, many expert bodies recommended African Americans get screenings at 45,” Cannon said. “Unfortunately, fewer than half of African Americans are screened by 45.”
If there’s a family history of the disease, people should be screened at age 40, said UCLA’s May. If someone has symptoms at any age, she recommends getting a colonoscopy immediately.
Symptoms of this cancer may include changes in bowel habits such as diarrhea or constipation, rectal bleeding with bright red blood, blood in the stool making it look dark, cramps or abdominal pain, and feeling like the bowel isn’t emptying completely after a bowel movement.
The gold standard for colon cancer screening is a colonoscopy because cancer-causing polyps can be removed during the exam. But other screening options exists, and any test is better than not being screened.
Other screening tests include:
- Fecal occult blood test, which can detect blood in a stool sample
- Cologuard, a stool DNA test you can take at home
- Virtual colonoscopy, which requires the same preparation as a colonoscopy, but no sedation, for those who are medically unable to undergo colonoscopy