Sep 2, 2020 5 min read

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News that actor Chadwick Boseman passed away over the weekend after a four-year battle with colon cancer stunned his fans.

Boseman is best known for his roles in “Black Panther” and his portrayal of Jackie Robinson in the movie “42.”

The actor had kept his cancer battle private and, at age 43, his diagnosis was surprising to many since colon cancer is often associated with patients over the age of 65.

Now, the American Cancer Society (ACS) is sounding the alarm about increasing numbers of colorectal cancer cases in much younger patients.

According to the ACS, colorectal cancer is the third most common cancer diagnosed in both American men and women, excluding skin cancers, and the organization is estimating more than 104,000 new cases of colon cancer in the United States in 2020. Since the mid-1980s, the overall rate of people being diagnosed has dropped mainly because of better screening and changing lifestyles.

However, there’s an alarming trend among younger adults with cases rising 2% each year from 2007-2016 in people under age 55. The ACS said 12% of cases in 2020 will be diagnosed in people under age 50.

“Unfortunately, this is becoming more common and it is particularly distressing when the patient has no known risk factors,” said Dr. James McCormick, chairman of the Colon and Rectal Cancer Center of Excellence at Allegheny Health Network Cancer Institute.

McCormick said the mean age for diagnosis has been steadily decreasing over the past several decades.

“Historically we had placed the age group for individuals with colon cancer starting in the sixth decade and increasing from there,” he said. “But more and more we are seeing younger and younger individuals with colon and rectal cancer. This seems to disproportionately affect young black males seen for colon cancer, while rectal cancer has been increasingly affecting young females.”

In the past year, McCormick said he has seen colon cancer in college age males with no known risk factors and rectal cancer in women in their childbearing years.

“These patients will present with symptoms which unfortunately may indicate more advanced disease at presentation,” he said.

Younger cases on the rise

With the rise in cases among younger patients, changes in screening recommendations have already taken place.

Doctors used to recommend a routine colonoscopy starting at age 50, but that age has now been lowered to 45.

McCormick said a screening recommendation can only be successful if members of the population participate.

“Only about 75% of individuals who are eligible for colorectal cancer screening are actually receiving it,” McCormick said. “It is also important to point out that screening recommendations are for individuals with no risk factors and no symptoms. Once risk factors are identified or symptoms develop, then testing is indicated regardless of age or eligibility.”

Common symptoms of colorectal cancer include abdominal discomfort and bloating, bleeding or anemia, pain or change in bowel habits. Anyone with these symptoms should have colon cancer ruled out regardless of age.

As for the rise in cases among younger age groups, McCormick said it’s a very disturbing development.

“We do not have a specific understanding as to why this is the case,” he said. “If we understand that cancer is most likely an interaction between an individual’s immune system with our environment as we age, colon cells are exposed to factors that alter the cells and the accumulation of these alterations ultimately lead to the development of colon cancer.”

Genetics certainly plays a role but McCormick said other factors like diet, microbiome, environment, exposure to carcinogens, physical fitness and activity and obesity also contribute.

Who should get screened?

Dr. McCormick said it’s possible screening recommendations will change even further with changing demographics among colon cancer patients. He said they always lag behind the need.

“Age has been the historical go-to criteria but obviously fails to capture some of the most at risk individuals,” he said. “Rather, I would look forward to alternative methods of screening and alternative and more sensitive and specific methods of identifying at risk individuals at any age.”

So how do we do that and who should get screened when? Currently, all individuals age 45 and over should have a screening colonoscopy. This test is required every 10 years if negative and more frequently if there is a finding. If a colonoscopy cannot be performed, alternative tests include stool studies such as Cologuard, which can detect DNA and blood cells from altered cells, and the FIT test, which can detect blood in the stool.

Those with a family history of colon cancer, should be screened at age 40 or 10 years prior to the age at which a family member was diagnosed.

How do we cut risk?

Proper screening and follow up with a doctor can go a long way in lowering the risk of colon cancer.

McCormick said the best step to take is a lifestyle change including diet, exercise and weight management. He said the best known diet regarding avoidance of cancer is the pesco-vegetarian diet, which consists of fish and vegetables, and he also recommends the specific colon cancer diet, which high in fiber and low in red meat.

“It is felt to be a promoter of a healthy microbiome within the colon and this may decrease stress on the colon cells and help to decrease the risk of colon cancer,” McCormick said.

Active individuals have a lower risk of all types of cancers and colon cancer is no exception.

“Exercise is felt to increase levels of certain immune factors that help to slow the cellular changes that lead to cancer,” McCormick said. “Obesity on the other hand is a pro-inflammatory condition which accelerates cellular changes that lead to cancer.”