The recent death of rising star Chadwick Boseman has put a new face on a disturbing trend in colorectal cancer, the disease that took the young actor’s life. While the rate of new colorectal cancer diagnoses among older adults has dropped dramatically since 2000, the rate of new cases in young adults has risen sharply over the past several decades. Boseman was 43 when he passed away on Aug. 28, four years after he was diagnosed with stage 3 colon cancer.
Now Boseman’s battle with cancer and his death may serve as a wake-up call to young men and women who may think colorectal cancer is an old-person’s disease.
Recent studies have concluded that the rates of colorectal cancer among younger adults are taking an alarming turn.
An American Cancer Society (ACS) study released in March, for example, indicates there are “rapid declines” in new cases of colorectal cancer in those 65 and older between 2011-2016. But that trend was “reversed in those aged 50 to 64 years.”
“Trends in young people are a bellwether for the future disease burden,” says Rebecca Siegel, MPH, Strategic Director of Surveillance Information Services at the ACS. “Our finding that colorectal cancer risk for millennials has escalated back to the level of those born in the late 1800s is very sobering.”
A 2013 study published in the Journal of the National Cancer Institute, found a sharp rise in colorectal cancers in adults in their 20s and 30s. Compared to people born around 1950 and earlier, millennials and Generation Xers have double the incidence rates of colon cancer and quadruple the rate of rectal cancer, according to the new findings.
Many risk factors
How or why Boseman developed colorectal cancer will likely never be known. And the reasons for the spike in cases among young people have not been pinpointed.
Colorectal cancer may be linked to inherited gene mutations. For instance, about 15 percent of all colorectal cancers are linked to Lynch Syndrome, one of many so-called cancer syndromes in which mutated genes that increase cancer risk are passed from generation to generation. Colorectal cancer diagnoses and deaths are also higher among African Americans and Alaska Natives.
Colorectal cancer also has many lifestyle risk factors, including:
- Obesity
- Smoking
- Poor diet
- Sedentary living
- Alcohol consumption
“I do believe lifestyle and diet are contributing to the higher rates of colorectal cancer among young people,” says Eyal Meiri, MD, Medical Oncologist at CTCA® Atlanta. “I term this generation as the fast food generation. This is an international phenomenon.”
New screening guidelines
To address the increase in colorectal cancer cases among younger Americans, the ACS in 2018 changed the recommended screening guidelines for adults at average or low risk, saying people should get screened for the disease at the age of 45, instead of 50, the previous recommendation. Adults in good health at average risk and a life expectancy of more than 10 years should continue screening through the age of 75. Those older than 76 should and at high risk may require a more aggressive screening program.
The ACS also is recommending that doctors give patients a wider range of colorectal cancer screening tests to choose from, in hopes that more choices will result in more screenings. Recommendations for screening test options include:
- Fecal immunochemical test every year
- High‐sensitivity, guaiac‐based fecal occult blood test every year
- Multi-target stool DNA test, such as Cologuard®, every three years
- Endoscopic or imaging examinations
- Colonoscopy every 10 years
- CT colonography every five years
- Flexible sigmoidoscopy every five years
Trends clearly indicate that colorectal cancer is no longer a disease of concern for senior citizens. The average age of a patient diagnosed with colorectal cancer dropped from 72 in 2001 to 66 this year, with trends indicating that it may continue to decrease.
A rising star
In his too-short, but remarkable career in Hollywood, Boseman played heroes real and imagined, including baseball legend Jackie Robinson in the film 42 (2013), music icon James Brown in Get on Up (2014) and pioneering Supreme Court Justice Thurgood Marshall in Marshall (2017).
In 2016, Boseman made his first appearance in his most popular role, as T’Challa, the superhero Black Panther, in the Marvel action movie Captain America: Civil War. That was the same year that Boseman was diagnosed with the disease that would too soon claim his life, according to news reports. Over the next several years, Boseman continued to take on demanding movie roles “during and between countless surgeries and chemotherapy,” his family said in a statement on Twitter announcing his death.
Boseman kept his cancer battle so private that unknowing fans were alarmed to see his dramatic weight loss in a video he released in April. The actor did not address concerns about his appearance in the video, but announced later that his cancer had progressed to stage 4.
To many, Boseman was not only a great actor, but an inspiration and role model on and off the screen. In 2018, he paid an emotional visit to St. Jude Children’s Research Hospital to connect with young patients battling the disease. In his last video, he discussed an initiative to provide personal protective equipment and other supplies for hospitals that serve African-American communities.
Know the signs, and your risk
Maurie Markman, MD, President of Medicine & Science for Cancer Treatment Centers of America® (CTCA) urges younger Americans to be aware of common symptoms of colorectal cancer. “There is solid evidence of an increasing risk of colon and rectal cancer in younger individuals,” he says. “Any young adult who experiences possible signs or symptoms of colon or rectal cancer should see their health care provider for an evaluation,” he says.
Signs and symptoms of colorectal cancer include:
- Rectal bleeding or blood in your stool
- Diarrhea
- Constipation
- Changes in your bowel habits
- Alternating diarrhea and constipation
- Abdominal bloating, cramps or discomfort
- Stools that are thinner than normal
- Unexplained weight loss
- Unexplained loss of appetite
"Know your risk for the disease,” says Dr. Meiri. “Making lifestyle changes to help prevent it can help, too—by eating a healthy diet and staying physically active. It’s important to remember that colorectal cancer, when diagnosed early, is typically very treatable.”
Learn how cancer cells use supervillain traits to evade detection and treatment.
