Chadwick Boseman’s early death shines light on colon cancer in young

We’ve talked a lot about COVID-19, of course, but the death last week of actor Chadwick Boseman at the age of 43 from colon cancer shined a light on an illness usually associated with an older person. Mercer Island MD Dr. Gordon Cohen joined Seattle’s Morning News to discuss colon cancer in the young and why early detection is difficult.

“Colon cancer, for the most part, is really a treatable or curable disease. Part of the reason it’s treatable or curable is because it’s diagnosed early because of the screening. Most people think of it as a disease that typically affects older adults, but really it can happen at any age. The cancer usually begins as a small non-cancerous benign clump of cells called polyps that form on the inside of the colon,” Cohen said.

“But over time, some of these polyps can actually become cancerous. One of the reasons that colon cancer is a problem in terms of diagnosis, and why screening has become so important, is because these polyps that are originally non-cancerous can be very small and produce few, if any, symptoms at all,” he added. “This is where the whole notion of having a colonoscopy starting at age 50 started. It takes a while for a polyp to turn into cancer.”

Are there ways to minimize the risk of colon cancer by being more careful about, for example, what you eat?

“We think that it’s related to diet and obesity, and diabetes, and smoking, and a family history. But there’s also been talk about it being related to the gut microbiome, which is the bacteria that live within our colon,” Cohen said. “And is the gut microbiome changing over time as a result of our changing diet, and is this leading to an increase in cancers?”

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Chadwick Boseman was 43, which is well below the age doctors recommend regular screening for colon cancer. Does that need to be changed?

“Well, it already is being rethought. So the American Cancer Society is now starting to push for people getting screenings as early as age 45, although historically it has been age 50. But people with a family history of colon cancer, they should start getting tested at age 40 … or at 10 years younger than the age at which their family member was first diagnosed, whichever’s sooner,” he said.

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Dr. Cohen says those with a history of inflammatory bowel disease, like ulcerative colitis or Crohn’s disease, and people who have received radiation in their abdomen or pelvis for some other reason should also be tested at an earlier age. The issue, he says, is that the main form of testing is invasive, and the symptoms can be mistaken for others.

“The problem is that the main screening test right now is still a colonoscopy, which is somewhat of an invasive procedure … Now there are some blood tests, but the blood tests aren’t great. The other problem is that because it doesn’t cause very many symptoms, it’s not thought of very often in younger people. I mean the typical signs and symptoms of colon cancer could be just a change in your bowel habits and things like diarrhea or constipation, but a lot of things can cause that,” he said.

“And so one of the things that’s been noted is that in younger people, they are often seen by multiple doctors before they’re actually ever getting diagnosed,” he added. “In fact, one study showed that the average time from symptoms to diagnosis in people under the age of 50 is 271 days, whereas it was only 29 days for people 50 and older. So what does that tell us? That tells us that in people who are under the age of 50, it’s just not the first thing you’re thinking about, or oftentimes, people aren’t even seeking the help of the doctor.”

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