The gravitas of actor Chadwick Boseman's death at age 43 has been felt around the world. For "Black Panther" fans and the Black community, his greatness was only in midstride, which makes his death even harder. But amid the tweets, TV specials and reruns of "Black Panther" in homage to his body of work, the medical community is speaking up about the rise in colorectal cancer rates among young Black adults and the need for more screenings.
"We know that the incidence of colorectal cancer is higher in African Americans than in all other races and ethnicities, so there are clearly disparities," said Dr. Dana Hayden, a colorectal surgeon at Rush University Medical Center. Among those disparities are chronic diseases such as obesity, poor access to care, socioeconomic needs, underinsured, incarceration, systemic structural racism and food deserts. "There's nothing surprising about the disparities when it comes to colorectal cancer," she said. If people are struggling with maintaining a job, it's hard to tell them to be proactive in preventive health and pay attention to these symptoms. It just might not be people's priority. So that's why education about symptom awareness is so important."
According to a recent article in a Cancer Journal for Clinicians, colorectal cancer is the third most common cause of cancer death in men and women in the United States. In 2020, approximately 147,950 people will be diagnosed with CRC and 53,200 will die from the disease, including 17,930 cases and 3,640 deaths in individuals younger than 50. Hayden says the numbers have improved for those over 55. From 2007 to 2016, the incidence rate dropped by 3.6% each year for that age group, but it increased by 2% each year for those younger than 55, according to the American Cancer Society.
"We know that the numbers are going up in younger people, but it's still much more common to get colorectal cancer over 50," said Hayden. "We don't know why it is. Epidemiologists have looked at this and are guessing that it may be more sedentary lifestyle or dietary factors. But that doesn't really clearly explain it either. My guess is a combination of tumor biology, and something about the environment that is happening in regards to risk factors for this, but it's likely multi-factorial."
Symptoms of colorectal cancer include weight loss, rectal bleeding and blood in the stool. Another common sign is a change in bowel habits, such as new bouts of constipation or diarrhea. The caliber of the stool should also be noted. Bowel movements that suddenly are much thinner than normal and/or if you are feeling extremely fatigued and weak could be a signs of cancer, Hayden said.
"The issue is, all the things I mentioned are associated with a bunch of different diseases that are mostly benign," she said. "Rectal bleeding can generally be hemorrhoids or a fissure (a tear in the lining of the anus) and doesn't mean a cancer, but at the same time, we have to be sure that that's the case."
Organizations such as the United States Preventive Services Task Force recommend that colonoscopies begin at age 50, while the American Cancer Society and the American College of Gastroenterology suggest that screening for colorectal cancer begin at 45. (The American College of Physicians advises Black men and women to begin getting screened at age 40.) The numbers differ, but Hayden emphasizes that age shouldn't be the reason you don't get a work-up if you're concerned or experiencing pain.
"I think where we've gotten into trouble with a lot of patients if physicians or patients themselves might blow off symptoms like bleeding because 'of course, hemorrhoids or, of course, I'm too young and there's no one in the family who has colorectal cancer,' " she said. "Those are myths we have to disprove and make people aware that if you're having any of those things that are not normal, it doesn't equal cancer, but we have to be sure that it doesn't. If you're having any symptoms, it doesn't matter what the recommendations are, you should go get a work-up."
Hayden is concerned that the pandemic may have postponed preventive measures such as colonoscopies. People afraid of being exposed to COVID-19 might have decided a preventive health check is not a necessity, or essential workers might not have been able to take time off to get one done. But she advises against that way of thinking.
"What colonoscopies do is diagnose a polyp," Hayden said. "We can remove it before it turns into a cancer. If we do a colonoscopy early or when symptoms first begin, then you can diagnose colorectal cancers when they can be treated very easily with an excellent cure rate."
Hayden hopes Boseman's passing translates into more physician visits at the first sign of symptoms. She said not to let fear of a colostomy bag or fear of knowing the truth scare you into not getting a colonoscopy. The sooner the truth is known, the better, she says.
"Whatever point we know, even if we diagnose you at a stage 4, stage 4 colorectal cancer can still be cured. We have a really aggressive approach at Rush for stage 4 colorectal cancers," Hayden said. "We just have to know, so we can move as efficiently and aggressively as we can."
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