Is Colorectal Cancer an Epidemic?
Actor Chadwick Boseman's death from colon cancer is putting the spotlight on some alarming statistics.
The shock of Chadwick Boseman’s passing reverberated around the world. The 43-year-old actor was renowned for his starring role in Marvel’s Black Panther, as well as portrayals of Jackie Robinson, James Brown, and Thurgood Marshall on the big screen. On August 28, Boseman died after a four-year battle with colon cancer he never spoke publicly about, leaving his fans and colleagues reeling at the unexpected loss of a man whose career was just beginning.
Boseman’s family shared in a statement that he was diagnosed with stage III colon cancer in 2016, and it progressed to metastatic disease before he passed. He had been working “during and between countless surgeries and chemotherapy,” they said, filming some of his most iconic work as he underwent treatment.
Unfortunately, his story is not entirely unique–it highlights the alarming fact that young-onset colorectal cancer is on the rise. “We’re seeing about a 2% rise in rates of colorectal cancer for those under the age of 50,” says Michael Sapienza, CEO of the Colorectal Cancer Alliance in Washington, D.C. Eleven percent of colon cancer diagnoses and 18% of rectal cancer diagnoses occur in patients under 50 years old, the vast majority of which are preventable with regular screenings.
Colon Cancer in People Under 50
This spike in young-onset cases is somewhat of a medical mystery. “We don’t really know why we’re seeing this increase,” Sapienza says, and not even folks in their 20s are immune.
“Patients or individuals born after 1990 are twice as likely to get colon cancer, and four times as likely to get rectal cancer, as those people born before 1990,” he explains. “It is definitely an epidemic.” Colorectal cancer is the second deadliest cancer in the U.S. when men and women are combined.
Sapienza notes that there are many known risk factors for colorectal cancer, including family history, obesity, diabetes, and tobacco smoking. The American Cancer Society also lists red and processed meat consumption and heavy alcohol use as potential risk factors, as well as a personal history of Crohn’s disease or ulcerative colitis.
While both sexes are affected at similar rates, certain populations are at higher risk–notably the African American community. According to the Colorectal Cancer Alliance, 1 in 41 Black males will get colorectal cancer in their lifetime.
“Blacks in general are at 20% higher risk of getting the disease, and unfortunately about 40% more likely to die from this disease than their non-Hispanic white counterparts,” Sapienza explains–a statistic confirmed by the American Cancer Society’s 2020-2022 fact sheet on colorectal cancer. Again, the cause is not totally clear, but it likely has something to do with access to medical care. “We do know that health inequity is a huge issue here, whether that’s around screening or care,” he says. “Certainly, pre-existing conditions and/or lifestyles play a part as well.”
Fighting Stigma Around Colon Cancer
Another significant barrier to fighting this disease is the stigma attached, often more so than other forms of cancer and chronic disease. “When we’re sitting around the dinner table at Thanksgiving, people are talking about their mammograms,” Sapienza says. “No one wants to sit around the dinner table talking about prepping for a colonoscopy.”
Boseman himself decided to keep his diagnosis private–a personal decision each patient must make for themselves. But Sapienza notes that public education is a huge part of lowering disease prevalence. “We have to keep talking about it,” he urges. Though it may feel like TMI to talk about colorectal cancer with your loved ones, the statistics really speak for themselves. The Colorectal Cancer Alliance estimates that 19,740 cases of colorectal cancer occurred in 2019, and this number could be even higher in the next few years.
“Patients have to be their own advocates, whether they’re under 50 or over 50,” Sapienza says. “It is one of those cancers that is almost completely preventable with screening.”
Knowledge Is Power
Luckily, colorectal cancer is one of the most preventable of all cancers. Proof: Rates among older adults have been decreasing for years, likely due to an increase in screening rates. “We’ve been making progress, Sapienza notes, but there’s a long way to go. “We’re still not catching some of these colorectal cancer diagnoses early enough.”
Do your research and know your family history, suggests Zuri Murrell, M.D., a colorectal surgeon and cancer specialist at Cedars-Sinai Medical Center in Los Angeles. "Not just if there is a history of colon cancer, but if a family member has a history of colonic polyps," that means you need to start getting screened sooner rather than later, he says. Talk to your doctor for questions about the best plan for you.
Even if you're not at heightened risk for colorectal cancer, simple lifestyle changes can lower your chances of developing it. "Decrease intake of processed food and red meat, [and] increase intake of fiber," Dr. Murrell says. "We need 25-30 grams of fiber daily." You can get this by eating more fruits, vegetables, and whole grains. He also suggests staying hydrated to keep your digestive system healthy and moving.
When you do go in for colorectal cancer screening, your doctor will be looking out for polyps in your intestinal tract. “Those polyps are what potentially turn into colorectal cancer,” Sapienza says. During a colonoscopy, any pre-cancerous or cancerous polyps can be snipped out, which prevents the cancer from growing. Ninety percent of patients with localized colon cancer (detected early) have at least a five-year survival rate, but often many decades longer.
Here’s what you should know about getting screened.
Regular colorectal cancer screenings should begin at age 45 for anyone at average risk. (We bolded this for a reason!)
If you have a family history of colorectal cancer, you should begin screenings 10 years prior to the age at which your first degree relative was diagnosed. (If your father was diagnosed at 42, you’d want to start screening at 32.)
If you have Crohn’s or ulcerative colitis, you may need to start screenings even earlier, depending on the level of existing damage to your bowel. A report in World Journal of Gastroenterology suggested that IBD patients begin colorectal cancer screenings as soon as the presence of abnormal tissues is detected.
If you see blood in your stool, you should see a doctor, full stop. "Blood mixed with stool is an indication of needing a colonoscopy, no matter the age of a patient," Dr. Murrell says. "It can be an indication of cancer, polyps, Crohn's disease and other issues."
How often you need screening depends on which test you choose to get. Sapienza notes that there are multiple options out there, from a colonoscopy to a fecal immunochemical test (FIT) (a blood test and bowel-movement swab) to a CT colonography (a.k.a. virtual colonoscopy that takes x-ray images of the colon). Each test has a different recommended interval of use, which may also vary depending on your medical history. “Talk to your primary care physician or GI doctor about which test is right for you, and which intervals make sense,” he suggests. You can also visit the Colorectal Cancer Alliance website for more details on your options.
Taking action now can literally save your life or the life of a loved one. This message is personal for Sapienza–his mother died of colorectal cancer in 2009. “I wish my mom had gotten screenings,” he says. “She died when she was 59 because she didn’t, and unfortunately, this is happening to way too many people.”
The actor’s heartbreaking death–and the publicity around it–may help spur more people to conversations about this disease. “Chad Boseman’s passing will hopefully open the eyes, not just of young people, but people of color as well,” Sapienza says. There is no shame in being proactive, and no shame in looking out for the people you love. As Sapienza said in a statement following Boseman’s death, “Even superheroes can develop colorectal cancer.”
Rest in peace, Chadwick.
CCA Statement on Chadwick Boseman: Colorectal Cancer Alliance. (2020.) “CEO Statement on Chadwick Boseman’s Death.” ccalliance.org/news/press-releases/chadwick-boseman-alliance-ceo-statement
Risk Factors: American Cancer Society. (n.d.) “Colorectal Cancer Causes, Risk Factors, and Prevention.” cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention.html
Facts & Figures: American Cancer Society. (2020.) “Colorectal Cancer Facts & Figures, 2020-2022.” cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf
Prevention: Colorectal Cancer Alliance. (2019.) “Is colorectal cancer preventable with screening?” ccalliance.org/blog/prevention/is-colorectal-cancer-preventable-with-screening
Screening Rates: Cancer. (2014.) “The Impact of Colorectal Cancer Screening on the United States Population: is it time to celebrate?” ncbi.nlm.nih.gov/pmc/articles/PMC4378239/
IBD & Colorectal Cancer: World Journal of Gastroenterology. (2019.) “Colorectal cancer surveillance in inflammatory bowel disease: Practice guidelines and recent developments.” ncbi.nlm.nih.gov/pmc/articles/PMC6700690/