Doctors are encouraging people to honor the life of the actor Chadwick Boseman, who died Friday of colon cancer at age 43, by learning more about the disease and getting their routine screening — especially if they have put off the procedure because of the coronavirus pandemic.
Colon cancer is often associated with older age, in part because routine screening isn’t recommended until ages 45 or 50. But the Black Panther star’s death is a reminder that colon cancer diagnosis rates among people under age 50 have been rising steadily since the 1980s. What’s more, the disease disproportionately affects Black individuals, who are 40% more likely to die of colon cancer than white patients.
Doctors and researchers are not entirely sure what’s driving this trend, though they believe a combination of genetic, social, and environmental factors are at play. But they agree that more screening can help detect cancer sooner and reduce death rates.
Boseman was “more than just his diagnosis ... but it’s an opportunity to save lives,” said Austin Chiang, a Philadelphia gastroenterologist. “Maybe Black men and women will be able to go to their doctors and say, ’Should I be screened?’”
Overall, colon cancer rates have been declining, largely due to increased screening among people over age 50. Colonoscopies, the gold standard for colon cancer screening, can detect and remove polyps before they become cancerous.
In response to rising rates of colon cancer among younger patients, the American Cancer Society recommended screening begin at age 45, especially for Black people. Anyone with a family history of colon cancer should get screened sooner.
Screening colonoscopies are covered by Medicare and most private insurance plans for people who meet age requirements, though costs may arise if polyps are found. More widespread insurance coverage has contributed to an increase in screening rates — nearly 70% of age-eligible Pennsylvania residents had a current colon cancer screening in 2016, according to the U.S. Centers for Disease Control and Prevention.
But cases have been rising by about 2% a year among people who are below the screening age.
Doctors are especially concerned about Black adults who are below the standard screening age. Black patients are 20% more likely to develop colon cancer. And Black men have the highest death rate of colon cancer in the country — about 47% higher than white men, said Edith Mitchell, an oncologist and director of the Center to Eliminate Cancer Disparities at Jefferson Health.
“Patients and doctors don’t put colon cancer at the top of the list when young patients come in for abdominal pain and symptoms,” Mitchell said. “Patients should know their family history and provide it to their primary care physician and other clinicians.”
Colon cancer symptoms, such as rectal bleeding and abnormal bowel movements that don’t return to normal after a week or two, can also be symptoms of more common ailments, such as hemorrhoids or gastrointestinal distress. Misdiagnosing symptoms could mean the cancer progresses before it is discovered and treated.
People with a family history of colon cancer are at greater risk of developing it, and doctors believe genetics could partly explain the increase among young people and Black people, she said.
A sedentary lifestyle, poor diet and obesity — all of which are more common among Millennials than older generations — could also be contributing to higher diagnosis rates, Mitchell said.
Higher diagnosis rates among Black patients could be related to access-to-care issues and bias among doctors, Chiang said. Black patients have reported higher rates of doctors not taking their concerns seriously, which could delay diagnosis.
The U.S. history of medical experimentation on Black individuals and racism in medicine has made many distrustful of doctors, which could affect how often people get screened and how soon they seek help for symptoms.
In Pennsylvania, Black patients over age 50 are screened for colon cancer at a slightly higher rate than white patients, but in New Jersey, screening lags for Black and Hispanic patients compared with white patients, according to data from the CDC.
Once diagnosed, standard treatment options may be less effective for some people, said Joshua E. Meyer, vice chair of translational research for the department of radiation oncology at Fox Chase Cancer Center.
“Most of the clinical trials we base our treatments on have enrolled patients, historically, who are more white and more male than the general population,” he said. “All of our evidence is based on a population that is not entirely representative.”
Meyer and other doctors emphasize screening as the most effective way to catch colon cancer early.
Colonoscopies and other routine cancer screenings were among the dozens of procedures put on hold during the coronavirus lockdown, as health systems looked to preserve resources for critical COVID-19 patients.
Preventive screenings for cervical, colon and breast cancer plummeted by 86% to 96% in March, compared with previous years, according to a new report by Epic, an electronic medical records company that analyzed 2.7 million patient records across 23 states.
As a result, cancer diagnoses dropped in March and April, one study found.
Now that hospitals and doctors offices have resumed to regular appointments, they are urging people whose screenings were delayed to come back. Philadelphia gastroenterologists said they are hopeful Boseman’s death will encourage more people to schedule that appointment.
“Increasing screening rates in minority populations certainly can have a substantial effect in terms of improving outcomes,” Meyer said. “It’s not like a mammogram where you find cancer then still have to treat it. This can find and prevent cancer — that’s an important message.”