Chadwick Boseman: what to know about colon cancer

The death of actor Chadwick Boseman at 43 shines a spotlight on the risk of colorectal cancer, and its rise among people under 50.

The death of actor Chadwick Boseman at age 43 shines a spotlight on the risk of colorectal cancer, especially young-onset colon cancer, which is on the rise among people under the age of 50. Here are a few things to know about the disease.

What is colon cancer and what are the symptoms?

Colon cancer, also called colorectal cancer, starts in the colon in the digestive system and tends to grow slowly over many years. It usually begins as a growth of tissue called a polyp, and removing the polyp early might prevent the cancer.

The cancer might not cause symptoms at the beginning, but symptoms can include a change in bowel movements, bleeding, abdominal pain, fatigue and unintended weight loss.

How common is colorectal cancer? How deadly is it?

Colorectal cancer is the fourth-most-common type of cancer, after breast, lung and prostate cancer, according to the National Cancer Institute. There will be an estimated 147,950 new cases in 2020 and 53,200 estimated deaths, which is 8.8% of all cancer-related deaths.

The cancer is more prevalent in men than women and is more prevalent among Black Americans than other ethnicities, the NCI says.

It is most common among people aged 65 to 74, though more than one-tenth of cases occur in people under the age of 50, said Kimmie Ng, director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute.

How deadly the cancer is largely depends on how far it spreads. But colorectal cancer is the second-most-common cause of cancer death in the U.S., behind lung cancer.

How do you treat it Potential treatments include surgery, especially for an early-stage cancer, as well as chemotherapy, targeted drug therapy, radiation therapy and immunotherapy. The treatment largely depends on the stage of the cancer, or how far it has spread.

What about screening?

Screening for colon cancer in people without symptoms can help doctors find precancerous polyps and remove them before they turn into cancer, or it can identify cancer in its earlier stages, when it is easier to treat.

The United States Preventive Services Task Force recommends regular screening, whether that is stool tests, a colonoscopy or other types of tests, between the ages of 50 to 75, according to its 2016 guidelines. On average, a stool test (which looks for blood in the stool or genetic signs of cancer) should be done every year to three years, while a colonoscopy should be done once every 10 years, according to the Centers for Disease Control and Prevention.

The American Cancer Society updated its guidelines in 2018 to recommend that people get screened for colorectal cancer starting at age 45 because of the rising rates of colorectal cancer among younger adults.

What is ‘young-onset’ colorectal cancer, and how common is it?

Someone with a colorectal cancer diagnosis under the age of 50 is considered to have ‘young-onset’ colorectal cancer.

Rates of new colorectal cancer cases and deaths have decreased overall in recent decades, but among adults under the age of 55, the incidence increased by 51% from 1994 to 2014 in the U.S. and mortality increased 11% from 2005 to 2015, according to the NCI. By 2030, colon cancer incidence is expected to double among those under 50, according to Dana Farber, and rectal cancer incidence is expected to quadruple.

Younger people are often likely to get diagnosed at later stages of the disease, making it more difficult to treat.

What’s causing the increase in that age group?

Oncologists aren’t sure, though changes in diet and exercise, obesity, biological or environmental factors, or a combination of those things, might contribute.

A handful of institutions, including Dana-Farber Cancer Institute in Boston and Memorial Sloan Kettering Cancer Center in New York, have opened centers specifically to research and treat young-onset colorectal cancer in the past few years.

“It is urgent that we understand why colorectal cancer is happening in young people so we can develop new prevention and treatment strategies,” said Dr. Ng in a statement. “The heartbreaking loss of Chadwick Boseman truly amplifies our mission to effectively treat and cure young-onset colorectal cancer.”

The Wall Street Journal