Actor Chadwick Boseman, 43, died Friday from colon cancer – a leading cause of cancer-related deaths in the U.S. and one that is increasingly affecting young Americans.
While deaths from colon and rectal cancers have been declining for several decades due to improved screening and treatment measures, deaths among young people have been increasing slightly in recent years, according to researchers.
"We are seeing more people in their 30s and 40s who are developing colorectal cancers – often because they’re having symptoms that aren’t thought to be cancers," said Dr. Nilofer Azad, an associate professor of oncology at Johns Hopkins Medicine.
About 30% of colorectal cancer diagnosed today is in people under the age of 55, she said. Symptoms of colorectal cancer include a change in bowel movements, rectal bleeding, blood in stool, abdominal pain and more.
Boseman, who made a global impact bringing "Black Panther" to life in the Marvel Cinematic Universe along with playing Black icons on the silver screen, was diagnosed with stage III colon cancer in 2016 and battled with it as it progressed to stage IV, his family said in a statement Friday.
Colorectal cancer – which includes colon and rectal cancer – is expected to cause more than 50,000 deaths in 2020 – including 3,640 deaths in people younger than 50 years.
The lifetime risk of developing colorectal cancer is about 1 in 23 for men and 1 in 25 for women, the American Cancer Society says. This year, more than 100,000 people will be diagnosed with colon cancer and more than 40,000 with rectal cancer, including 18,000 colorectal cancer cases in people younger than 50, the group estimates.
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More young people are being affected
For younger people, those numbers are rising. Deaths from colorectal cancer among people younger than age 55 have increased 1% per year from 2008 and 2017, according to the American Cancer Society.
In 2017, about 130 people in their 20s died from colorectal cancer, 720 in their 30s and 2,700 in their 40s, with older age groups accounting for higher and higher death tolls, according to the Centers for Disease Control and Prevention.
During the late 1970s and early 1980s, colon cancer diagnoses were declining in age groups younger than age 50 years and increasing in those age 50 years and older, according to a 2017 study in the Journal of the National Cancer Institute.
But that trend flipped in the mid-1980s, when rates declined in adults age 55 years and older, while increasing by 2.4% per year in adults age 20-29 years and by 1% per year in adults age 30-39 years, the study found.
Rectal cancer rates saw an even more extreme version of this trend.
"If you were born in 1990 or afterward, you were two times more likely to get colon cancer or four times more likely to get rectal cancer than those born before 1990," said Michael Sapienza, CEO of the Colorectal Cancer Alliance. "It is, unfortunately, becoming a bigger and bigger epidemic."
Sapienza, whose mother died of colon cancer at age 56, said oncologists are seeing more late-stage diagnoses of colorectal cancers, which are often mistaken for other illnesses.
"What’s happening is, young people are going into the doctor having symptoms, and it’s usually taking them to see three or four doctors until they’re getting a diagnosis," he said. "Especially now, in the telemedicine world, people are going to be afraid to recommend a colonoscopy. If you're having rectal bleeding, night sweats, cramping – especially dark blood – you really to emphasize that with your physician."
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Baltimore Orioles outfielder Trey Mancini was diagnosed in March, days before his 28th birthday. He was at spring training when a pair of blood tests revealed low iron levels. What he initially thought may have been a stomach ulcer or celiac disease turned out to be stage III colon cancer. Manci had a malignant tumor removed a week later and began chemotherapy in April.
"If you’re young like me, you don’t think you're getting colon cancer," Manci told USA TODAY. His father was diagnosed with stage II cancer at 58. "I was shocked."
Oncologists don't yet know what's causing the rising number of cases among young people, but there are several theories.
"We really can’t hone in on one cause," Azad said. "There could be diet changes, obesity, increasing prevalence of diabetes. All of these things are also associated with colorectal cancer."
High consumption of processed meat and alcohol, low levels of physical activity and fiber consumption, and cigarette smoking are also known risk factors, researchers said.
"It is not surprising that the timing of the obesity epidemic parallels the rise in colorectal cancer because many behaviors thought to drive weight gain, such as unhealthy dietary patterns and sedentary lifestyles, independently increase colorectal cancer risk," researchers said in the 2017 study.
Black Americans disproportionately affected
Overall, colorectal cancer disproportionately affects Black Americans. The cancer incidence is about 20% higher in Black men and women compared to their Caucasian counterparts, and Black patients are about 40% more likely to die of colorectal cancer, said Rebecca Siegel, a cancer epidemiologist and scientific director of surveillance research at the American Cancer Society.
"The mortality difference is what’s striking," Siegel said. "It’s also the elephant in the room of systemic racism that has been going on for decades and affects everyone in the Black community, regardless of their wealth status."
Among young people, the difference in the rate of cases between Black and white Americans narrows, Siegel said. White Americans under 50 account for a large portion of the increase in cases in the younger age group, she said.
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When should people get a colonoscopy?
To combat the rising prevalence of colorectal cancer among young people, researchers suggest educating clinicians and the public about symptoms and screenings, and expanding health care access to young people, who are less likely to have access to a primary care physician and more likely to declare bankruptcy from their cancer treatments, Siegel said.
Researchers also suggest developing new strategies to curb the obesity epidemic and shift Americans toward healthier eating and more active lifestyles.
It's also important to end the stigma around colorectal cancer, experts say.
"A very common symptom is bleeding in the stool, and that’s embarrassing. Young people are not accustomed to talking about these symptoms with their friends," Siegel said.
Reducing the stigma and increasing awareness both of the symptoms and the increasing risk in young people directly translates to saving lives, she said.
"It might be tough for some people to talk about their colon and bowel movements, but it’s the third most common cancer and we need to talk about it more," Manci said.
In 2018, the American Cancer Society updated its guidelines to recommend that people at average risk for colorectal cancer start regular screening at age 45, or at 40 for people with a personal or family history of colorectal cancer, a history of inflammatory bowel disease and more.
"Everybody’s always told that you don’t need colonoscopies until you’re 50 years old, and that’s clearly not the case," Manci said. "In hindsight, I wish I would have gotten screened at 25 or so."
More groups are planning to revisit their guidelines in the next year or two, Azad said.
"I wouldn't be surprised if we started to see screenings moving earlier across other guideline committees as well," Azad said. "This is a very treatable cancer, and it’s a fully preventable cancer if people get their screening."
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