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The death of “Black Panther” and “42” star Chadwick Boseman recently from colon cancer at age 43 has renewed focus on one of the leading causes of death, and a local specialist said guidelines are now suggesting people get tested earlier for the disease.
Dr. Ralph T. Lyerly Jr., a gastroenterologist at Walker Baptist Medical Center five days a week, said recently he expects now a “flurry of people” who might have put off screenings but now want to be seen
because of this high profile case.
He pointed out the American Cancer Society (ACS) posts the following on its website: “The ACS recommends that people at average risk of colorectal (colon and rectal) cancer start regular screening at age 45. This can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). ... People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75.”
Lyerly said nationwide, particularly for the past decade or more, there has “been an increasing trend to see younger people with colon cancer.”
He said the tests and screenings are made to prevent colon cancer. “Most interestingly, it is the third most common cancer in all parts of the world,” after skin and lung cancer, he said. “It is the second most common death from cancer,” behind lung cancer. “The difference in colon cancer is that it is potentially preventable most of the time. That’s why people get screened.”
The ACS and the Alabama Department of Public Health said in a report in November 2019 that in Alabama, about 2,330 new cases of colon and rectum cancer were expected for 2019, with about 930 deaths from that cancer for that year in the state.
Rates were higher in the state than in the national 38.8 rate of occurrence‑with the rate for black males at 58.8.
Colon cancer always begins as a tiny, benign tissue growth on the surface of the colon, Lyerly said. It takes several years to develop into colon cancer, as there are few fast developing cases ‑ although he classified the ones that are as “very alarming.”
Lyerly said the traditional view of the ACS and insurance companies has been to screen normal risk people ‑ those whose close family members have had no signs of colon cancer ‑ every 10 years, starting at 50. If a benign pre-cancerous polyp is found, it might be lowered to three years. Those with a family history of the disease have been told to start at age 40 and then every five years, and maybe even earlier depending on how early family members had it ‑ usually 10 years before when the family member was diagnosed.
However, he noted the ACS several years ago began advocating 45 as the normal starting age, even before the increase in cases was seen, Lyerly said. Federal mandates for Medicare and insurance companies are now following in that direction.
“Another factor they’ve noticed, and pertinent to the case this weekend, they have recommended for years that African Americans should start screening at age 45, because statistically they have a likelihood of it beginning earlier,” he said. “Now, this will probably progress further in the near future due to the recognition that colon cancer is being seen earlier. We don’t know how far it is going to go.” He said it may be possible in the future that Blacks may be advised to be tested as early as 40.
In fact, researchers haven’t really determined why it is happening earlier, he said.
Asked what to look for, Lyerly suggested specialists look for any unexplained rectal bleeding, any unexplained weight loss, change in your bowel habits and lower abdominal pain.”
The ACS recommends that as part of the regular procedures, a colonoscopy should be scheduled every 10 years. Lyerly said stool specimen tests can also be done annually to look for blood one might not even notice.
He said a full colonoscopy can detect a precancerous polyp earlier than non-evasive tests. However, he also noted the Cologuard TV commercial for the home test, using an animated talking box.
“If people can’t or won’t do a full colonoscopy, it will not statistically detect as many polyps early,” he said. “It can detect a precancerous polyp, butt not as early as a colonoscopy. Of course, sometimes it reflects a hidden colon cancer. We haven’t been unfortunate enough to run into that.” Sometimes, it will get someone who wouldn’t have a full colonoscopy to get that screening.
He noted some cannot do a full colonoscopy, such as women who have had multiple pelvic surgeries like bladder procedures, hysterectomies and C-sections, leading to other methods.
Lyerly said with stage 1 or stage 2 colon cancer, using surgery and chemotherapy, the majority of cases will be curable. Remarkably, several of Boseman’s movies, including “Black Panther,” were filmed between treatments and surgeries after he was diagnosed with stage 3 colon cancer in 2016. At stage 3, one may have positive lymph nodes, he said, and at stage 4 it has spread to distant sites.
“If he had stage 3, I’m sure they gave him an aggressive course of chemotherapy afterward, and it may have delayed it for a long time,” he said, noting sometimes it might not come back but it has to be monitored. “You’re not out of the woods until about five years afterward.”
He noted the polyp that lead to Boseman’s cancer could have start‑ ed as early as his late 20s or early 30s, he said.
Asked if a colonoscopy is strenuous, he said people used to be afraid it would hurt. However, the worst part now probably comes in advance, as one will be on a clear liquid diet for usually 24 hours before a procedure, and one takes laxatives during that time. “You’ll spend the better part of the day in the bathroom,” he said.
“But the test itself, over the past 20 years, it has become increasingly common people get a true, short-acting anesthetic,” he said, saying no one these days should have any discomfort during the procedure. The patient is usually ready to go back to a normal routine the next day.
He noted diet also helps prevent colon cancer. “The same type of diet that we think lowers the risk of heart disease probably also lowers the risk of colon cancer,” he said. That would mean a diet high in fiber and low in fat. And they’ve shown patients on aspirin-like drugs for arthritis or patients who have been put on low dose aspirin to prevent heart attack and strokes because of a risk in their family often have a lower risk of colon cancer.”
The Mayo Clinic also advises of other risk factors, such as a sedentary lifestyle, diabetes, obesity, smoking, alcohol, and radiation therapy directed at the abdomen to treat previous cancers.
Lyerly advised people look at the American Cancer Society’s recommendations online.