He was only 43.
Last week, the world learned that Chadwick Boseman—the actor and budding icon best-known for his leading performance in Black Panther—had died of colon cancer. He was diagnosed in 2016, and within four short years, during which he made his most-celebrated films, Boseman was killed by the disease. And he was only 43.
Colon cancer is the third most commonly diagnosed cancer in men, behind cancers of the lungs and prostate. In 2020 alone, the American Cancer Society estimates that more than 147,000 cases of colon and rectal cancer will be diagnosed. Among men, the lifetime risk of developing colorectal cancer is one in 23.
But Boseman’s cancer death at a young age is yet another statistic in two worrying trends that doctors have observed over the last several years: First, data collected by the Colorectal Cancer Alliance show that the colorectal cancer incidence in Black people is about 20 percent higher than that of white people, a troubling fact that dovetails with the ongoing and long-overdue conversation about race and health prompted by the racial inequities of the coronavirus crisis.
Second, while the overall rate of colon and rectal cancers is decreasing, the number of men being diagnosed with colorectal cancers under age 55 is going up. An ACS-funded study in 2017 discovered that people born around 1990 are twice as likely to develop colon cancer and four times as likely to develop rectal cancer compared to people born 40 years earlier.
“The risk of colorectal cancer in young people, meaning people in their 20s, 30s, and 40s, is increasing,” says Teresa Fung, nutrition professor at Simmons University in Boston. “And we really don’t know why.”
Still, we do have some idea as to what younger men can do to keep healthy and decrease their colorectal risk. It begins with plenty of exercise and a good diet. As Fung points out, obesity increases a person’s risk of developing colorectal cancer, while physical activity lowers a person’s risk. A diet rich in whole grains, fruits, and vegetables—fiber, in other words—can also reduce a person’s risk. Red meats, particularly processed meats, are associated with higher rates of colorectal cancer. So are processed foods, and their increasing dominance of the grocery-store shelves may explain some of the increasing risk among colorectal cancer in men born in 1990 and after.
Yet colorectal cancer can strike even fit young men like Boseman. That’s why it’s important that men pay attention to their bodies, monitor any changes, and report them swiftly to their doctors. Obvious clues are blood in the stool or on toilet paper, but other symptoms of colorectal changes can mask themselves as common issues: constipation, bloating, and nausea. Any gut or bowel symptom that’s new to you and lasts more than a couple of weeks should be a red flag—it might mean nothing, but pushing your doctor about screening is one of the best ways to catch early-onset colorectal cancer.
As is so often the case with cancers, catching it earlier results in dramatically higher survival rates: In its earliest stages, the five-year survival rate for colorectal cancer is 90 percent. The five-year survival rate for stage IV colorectal cancer is just 14 percent. (Boseman was initially diagnosed with stage III, which progressed to stage IV.)
In light of the disease’s increased prevalence among younger people, the ACS recently lowered its recommendations for routine screenings to begin at 45, down from 50. But right now, routine screenings aren’t recommended for younger people. These recommendations are based on a delicate balancing of very real cons of testing: the risks of false positives, unnecessary biopsies, and strain on the healthcare system. People with a family history of colorectal cancer, or anyone with an inflammatory bowel disease like Crohn’s or ulcerative colitis, should talk to their doctor about beginning screenings earlier. But for most younger men, being aware of the risk is one of the best preventative measures you can take.
And as to why colorectal cancer is hitting people at younger ages, an answer is hopefully forthcoming: At the Dana-Farber Cancer Institute in Boston, researchers at the Young-Onset Colorectal Cancer Center are spearheading a five-year, $25 million study to figure it out.
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