AUSTIN, Texas — Amid the loss of Chadwick Boseman, University of Texas at Austin medical officials suggested his death "prompts a closer look at early-onset colorectal cancer."
Livestrong Cancer Institutes medical oncologist Anna Capasso at UT's Dell Medical School said early-onset colorectal cancer has been increasing over the past few decades, according to recent research.
To address the ongoing situation of colon cancer and the importance of early screenings, KVUE spoke with Dr. Thiru Lakshman, a colorectal surgeon at St. David's North Austin Medical Center.
Terri Gruca: It is interesting. I lost a friend this same age, 43 ... so young. It seems like this is not something we talk about in younger people. Why is that?
Dr. Lakshman: Yes, it's not commonly considered a disease of younger people. Historically, colon and rectal cancer has been known to affect the older generation. It's one of the reasons why the screening age for colonoscopy initially was put at age 50 because it was known that science has shown us that you have a greater risk of developing colon polyps, and therefore cancers, as you get older, particularly after the age of 50. And because of this sort of nature of colon cancer and rectal cancer, rectal bleeding, changes in bowel habits, it's not something that people are very readily willing to talk about. Well, what we found now recently – which the unfortunate story of Chadwick Boseman has highlighted – is that we're clearly seeing this more and more in younger patients, for sure.
Gruca: It is also disproportionately more common in African Americans. Do we know why that is?
Dr. Lakshman: I think there's a number of factors. I think just in a couple of things, one is, is the sort of normal, what we call major modifiable risk factors such as diet, access to exercise, and then probably most importantly, is access to health care that's been seen in the Black American population to be lacking. And therefore, they've had, you know, a greater incidence of both cancers. And also their response to the treatments and to the cancers is not as good as well either, meaning that the mortality rates, particularly for Black males that have colon cancer, is significantly higher. And, you know, one of the things that we've seen is, you know, the American Cancer Society has done a lot of data and research into this ... and that over 50% of the reasons for the increased rates, the discrepancies in the rates can be attributed to racial and socio-economic disparities. And that's why we're seeing that here.
Gruca: You have mentioned these screenings. I know a lot has changed over the years. People hear horror stories, I think, about colon cancer screenings. Can you talk a little bit about how a person can be screened, how that's changed recently?
Dr. Lakshman: Absolutely. So there's many different screening methodologies out there that we can do. The gold standard is the colonoscopy. That's a flexible, lighted scope that the gastroenterologist or a colorectal surgeon like myself will use to evaluate the entire colon. And what we're looking for is inside the lumen of the colon is for these polyps or precancerous polyps or tumors, God forbid. In addition to that, there are other less-invasive screening methods. You can get X-ray studies. You can do X-ray enema studies. There's actually, recently, there's been an increase in the number of what we call sort of DNA testing where we can actually look at the DNA within a stool sample. All of those tests are good, but generally, if they find any positive findings, it requires a full colonoscopy to check and make sure. In terms of screening ages, historically, it's always been thought to be 50 years unless there's a family history. Just recently, the American Cancer Society lowered their recommendation to 45 years of age, which I think is appropriate, particularly given this, new increasing incidence of younger patients getting it. What they found is that the overall total number of cases is still greater in older populations, but the incidents among patients under the age of 50 is increasing significantly year-over-year compared to the other ones as well, too. So, 45 is the current American Cancer Society guidelines. We'll see if all of the other societies sort of jump on board because that will help facilitate in terms of insurance approvals and things like that. As far as a colonoscopy, you know, it is unpleasant. You know, you have to drink a prep to clean the colon out. It's important to do that. But with new prep available now, it's pretty tolerable. It's really just one afternoon of and one evening of discomfort. The scope itself is really well up, relatively well-tolerated. And most people are back to normal by that evening and back to work the next day.
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