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Colorectal Health

Colorectal Health

What Everyone Should Know

Chadwick Boseman’s death from colorectal cancer at age forty-three was a shock for everyone familiar with the vibrant movie star. His physical and demanding performances in recent films belied the fact that he was undergoing intense treatments for the disease since his diagnosis of stage 3 colon cancer in 2016. Unfortunately, the actor’s death reminds us of two disconcerting facts: that African Americans are at increased risk for colorectal disease, and that the incidence and death rates among younger adults of all races are rising, although incidence is more pronounced and death rates are significantly higher among African Americans.

African Americans are approximately 20 percent more likely than whites to be diagnosed with colorectal cancer and tend to be diagnosed at an earlier age with more aggressive spread of disease. We don’t fully understand the genetic and biological reasons, but we know that this increased risk means it’s critical for African Americans, and all people, to know their family history and follow recommended screening guidelines. When colorectal cancer is discovered early, most people can be cured. 

Who should be screened for colorectal cancer? 

In Virginia, only about 65 percent of eligible adults follow recommended colorectal screening guidelines. While these guidelines vary slightly between different organizations, most people (men and women) with no symptoms should begin regular screenings between the ages of forty-five to fifty. Those at higher risk for colorectal cancer should talk to their primary care doctor about beginning screenings sooner or having them performed more frequently. Factors that increase colorectal cancer risk include:

• A family history of first-degree relatives with colorectal cancer
• A personal or family history of inflammatory bowel conditions or ulcerative colitis
• Prior radiation treatment to the abdomen
• Symptoms such as changes in bowel habits, constipation, abdominal discomfort, blood in the stool, or unexplained weight loss

A colonoscopy continues to be the best screening tool for colorectal cancer because it can not only detect cancer early, but it also allows the doctor to prevent cancer by removing any colon polyps found during the procedure. 

There are less invasive options for colorectal cancer screening, however, suspicious findings will likely require a colonoscopy for an accurate diagnosis. Some of the newer methods detect potential signs of cancer in a person’s stool, such as the presence of blood or specific DNA markers. These tests include the fecal occult blood test (FOBT), the fecal immunochemical test (FIT), and the FIT-DNA test. They are typically administered yearly for screening or every three years in combination with other screening methods. 

Strategies for preventing colorectal cancer

While screening is crucial, healthy lifestyle is also important for reducing cancer risk. Lifestyle factors and changes in dietary habits are thought to be part of the reason for the increase in colorectal cancer diagnoses in young adults. Diet and exercise play a role in preventing most cancers, and that is especially true for colorectal cancer. 

I recommend eating a diet high in fiber and vegetables and limiting consumption of red meat to no more than once a week, if possible. Evidence shows that eating red meat regularly places people at greater risk for colorectal cancer, so I suggest substituting white meat such as chicken or fish. Processed meat, or meat that has gone through a chemical process to increase its shelf life, has been classified as a carcinogen by the World Health Organization. It’s especially important to get children in the habit of healthy eating to set a foundation that can help prevent cancer later in life. 

If you or a loved one have been diagnosed with colorectal cancer

While colorectal cancer can be a complex disease, it is not a death sentence. We do still lose an unfortunate number of people to colorectal cancer and there are worrying trends among younger populations, but, overall, deaths from colorectal cancer have been dropping for several decades. This is due to more people getting screened as well as new and better treatments. There are now more than 1.5 million colorectal cancer survivors in the U.S. 

Most people diagnosed with colorectal cancer will undergo surgery to remove the tumor. They may also receive chemotherapy or radiation therapy before or after surgery. If you are diagnosed, it’s very important to get a second opinion and find someone who specializes in your disease. Studies have shown that hospitals that perform more surgeries and treat more complex cancers have better outcomes as a result. This is often because surgeons at academic medical centers typically specialize in one type of surgery or disease.  

In the past several decades, research at National Cancer Institute (NCI)-designated cancer centers like VCU have led to new types of therapies. One new type is the targeted therapy, sometimes referred to as precision medicine. These are drugs that target mutations specific to certain types of cancer. Additionally, scientists have figured out how to use the body’s own immune system to fight cancer. This is called immunotherapy, and there are several different types that interact with the immune system in different ways. These advancements are offering new hope for patients who previously had none.  

Importance of clinical trials

One way you can access new, cutting-edge therapies is through clinical trials which test promising new drugs or treatment protocols before they become commercially available. Cancer clinical trials are typically only offered through NCI-designated cancer centers, academic medical centers, and high-volume, specialized health care providers. 

In addition to gaining access to new treatments before the general public, clinical trial participants also enjoy a heightened level of care and attention as their health and side effects are closely monitored by the team. Some participants also get free or subsidized care for the duration of the trial. Finally, clinical trials compare new treatments to the best-known standard of care for the disease, so patients receive the best care possible. 

So, while we grieve the death of Chadwick Boseman – a beloved actor who brought historical and fictional heroes to life on the screen – we should be hopeful that we are making advancements against this disease. We should also use his passing as a reminder to take our own health seriously, get regular checkups, and follow cancer screening guidelines.

Khalid Matin, MD
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