Chadwick Boseman death and colon cancer in younger adults, Black Americans

Chadwick Boseman’s death from colorectal cancer at age 43 highlights two troubling trends, RCCA oncologists say

Last month’s tragic news that Black Panther star Chadwick Boseman had died from colorectal cancer (CRC) at age 43 underscores two troubling trends in the fight against the disease, say physicians with Regional Cancer Care Associates, LLC (RCCA), one of the nation’s largest networks of oncology specialists.

“First, while the overall occurrence of colorectal cancer has been declining since the mid-1980s, that favorable trend has been offset in recent years by an increased incidence in younger and middle-aged adults,” explains Iuliana Shapira, MD, a board-certified medical oncologist and hematologist who serves as RCCA’s Chief Medical Officer. “While recent years have seen new cases of colorectal cancer fall by 3.3% annually in people age 65 and older, diagnoses in adults aged 50 years or younger have been going up by an average of 2.2% each year,” Dr. Shapira says in citing data from the American Cancer Society (ACS).

“Second, there is an increasing gap between Black people and white people in the rate of new diagnoses of colorectal cancer and in deaths from the disease,” Dr. Shapira notes. The oncologist explains that while incidence and mortality rates for the two groups were similar in the 1970s and early 1980s, and have been declining in both groups since that time, the rates of decrease have been much greater among whites, leading to a growing disparity. Referencing statistics from the ACS, Dr. Shapira notes that while the CRC death rate for Blacks was 10% lower than that for whites in the early 1970s, it was roughly 50% higher three decades later. “Access to care – specifically to screenings such as colonoscopy — is one factor contributing to this disparity and must be addressed,” says Dr. Shapira. She adds, however, that with guidelines recommending that most people begin CRC screening at age 45 or 50, it is also important for younger adults to know the potential indicators of colorectal cancer, and to consult their physician promptly if they experience symptoms.

“Those symptoms include blood in or on the surface of bowel movements; significant and lasting changes in bowel habits; persistent stomach pain, aches, or cramps; and unexplained weight loss,” the cancer specialist explains. She adds that while the great majority of people with, for example, frequent stomach cramps will not have colorectal cancer, the symptoms nonetheless warrant investigation to address any issues that might exist and to provide peace of mind.

“It also is very important to tell your physician about any close relatives who have had colorectal cancer or other cancer, particularly if those people developed cancer before they were senior citizens, because this may make it advisable to start CRC screening before the age recommended for most people,” notes Dr. Shapira, adding that this advice pertains to all people, regardless of whether they are experiencing gastrointestinal symptoms.

Advances in treating colorectal cancer

Screening and early detection have helped drive down CRC mortality in recent years, as has the availability of innovative new therapies, says Andrew M. Bernstein, DO, a board-certified medical oncologist and hematologist who practices with RCCA in Pompton Plains, N.J. “We’re now able to employ targeted therapies that interfere with specific steps in the development and spread of cancer,” says Dr. Bernstein. These targeted therapies generally have milder side effects than chemotherapy, the oncologist adds. While roughly one-third of patients with advanced colorectal cancer are candidates for targeted therapies, the medications are not effective in patients whose cancer is driven by certain genetic mutations. “We employ sophisticated genetic analysis of colorectal tumors to identify their mutation profiles and match the patient with the treatment strategy that will be most effective for him or her,” says Dr. Bernstein. The cancer specialist adds that immunotherapies — drugs that enhance the cancer-fighting abilities of the body’s immune system – are beginning to play a larger role in CRC following their initial use in lung cancer, melanoma, Hodgkin lymphoma, and other cancers.

Mohammad Pazooki, MD, notes that new evidence and strategies are also enabling cancer specialists to make more-effective use of three types of therapy that long have been the foundation of CRC treatment. “Surgery, chemotherapy, and radiation continue to play important roles in our management of the disease, and in recent years we have made great strides in identifying which combinations of those treatments — and which sequences of their use — best serve a patient given the stage and nature of the cancer,” says Dr. Pazooki, who practices with RCCA in West Hartford, Conn., and Manchester, Conn.

“Compared to just a few years ago, we have a greatly expanded ability to draw on different therapies, and various combinations and sequences of therapies, to create truly individualized treatment plans,” says Dr. Pazooki. He adds that this personalized medicine approach is enhanced by growing knowledge of the genetic basis of colorectal cancer. “For example, we now know that in roughly 15% of cases of colorectal cancer – or 1 in 7 patients – the DNA has an impaired ability to repair mismatches in the genetic code, resulting in a condition called microsatellite instability, or MSI. In MSI, there is genetic hypermutability, or a very strong predisposition to mutation, which in turn causes cancer. Immunotherapy can be very effective in the setting of microsatellite instability.”

While close attention to developments at the molecular level help shape treatment decisions, Dr. Pazooki adds that at RCCA, the primary focus remains on the patient’s overall well-being. “Beyond seeing increased survival with colorectal cancer in recent years, we’re also seeing a better quality of life in most patients,” he says.

Julianne W. Childs, DO, a medical oncologist and hematologist practicing with RCCA in Cape May Courthouse, N.J. and Marmora, N.J., says a reduction in treatment side effects plays a big role in this improved quality of life. “Some of the newer therapies we use are better tolerated than chemotherapy. Meanwhile, we have many more resources in our toolbox to prevent the nausea, treat the diarrhea, and manage the blood-count side effects that can accompany chemo,” Dr. Childs notes.

Another factor contributing to improved quality of life, she adds, is that patients with colorectal cancer have more cause for hope today than ever before. Dr. Childs explains that in addition to an expanded array of medications and evolving approaches to using long-standing therapies, promising new strategies are being employed in advanced CRC. “When colon cancer spreads, the liver is one of the most common – and concerning – sites of metastasis. Now, recent research supports a more-aggressive approach to surgical resection – or removal – of multiple metastasis to the liver. Additionally, approaches such as transarterial radioembolization (TARE), which can utilize localized radiation, and transarterial chemoembolization (TACE), which uses chemotherapy in a localized fashion to specific affected areas of the liver, have been shown to increase survival,” notes Dr. Childs.

While the cancer specialist says that the advances of recent years are likely to be exceeded by the progress to be seen in the years just ahead, she stresses that preventing colon cancer needs to remain the primary focus of patient and physician alike.

Dr. Childs notes that obesity, lack of physical exercise, reduced fiber intake, and consumption of red meat all are believed to play a role in the increased CRC rate in younger adults. In addition to changing their lifestyle and dietary habits to address those risk factors, Dr. Childs stressed that most people should have a first colonoscopy at age 45, while those with a family history of colon cancer should have a colonoscopy 10 years before the age at which their relative was diagnosed.

“The progress we’ve made against CRC in recent years has been significant, but as Mr. Boseman’s death reminds us, we still have a long way to go, including in terms of promptly diagnosing and effectively treating younger and middle-aged adults, as well as in eliminating disparities in care and outcomes,” notes Dr. Shapira.

With more than 80-plus cancer specialists practicing at more than 20 care centers located throughout Connecticut, Maryland, New Jersey and the Washington, DC area, RCCA provides care to roughly 22,000 new cancer patients and 225,000 established patients each year. RCCA offers those patients immunotherapy, targeted treatment, cell-based therapy and other cutting-edge treatments and diagnostic modalities, as well as access to clinical trials.

To learn more about RCCA or to schedule an appointment, call (844) 928-0089 or visit www.RCCA.com.

Colorectal Cancer by the Numbers:

• 104,610 — estimated number of new cases of colon cancer in the U.S. in 2020
• 43,340 — estimated number of new cases of rectal cancer in the U.S. in 2020
• 53,200 — estimated number of deaths from colorectal cancer in U.S. in 2020
• 4% — percentage of men in U.S. who will develop colorectal cancer in their lifetime
• 2% — percentage of women in U.S. who will develop colorectal cancer in their lifetime

Source: American Cancer Society. Colorectal Cancer Facts & Figures 2020-2022. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf. Accessed Sept. 3, 2020.