Vital Facts on Colon Cancer: Know Your Family History, Get Screened Early

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September 2, 2020

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When should I get screened for colon cancer? What is my risk if a relative was diagnosed at an age younger than 50? How can such a young and physically fit person like actor Chadwick Boseman die from this disease at the age of 43?

Sarah Joseph, M.D., medical oncologist at Miami Cancer Institute

These are some of the common questions being raised worldwide with the shocking death of Black Panther star, Mr. Boseman. Primary care physicians and cancer specialists are fielding more questions than ever about colon cancer risk factors, symptoms and screening guidelines since the news broke of the actor’s death.

“The passing of this Hollywood star, Chadwick Boseman, has left me looking at him as a role model for our youth today, a role model to bring awareness to colorectal cancer,” says Sarah Joseph, M.D., medical oncologist at Miami Cancer Institute, with a focus on gastrointestinal cancers. 

What happened is a tragedy, but she said there is a “positive light” that can emerge from his death, as colon cancer rates among younger adults, and especially African Americans and Hispanics, continue to rise.

(Watch video now: The Baptist Health Resource team hears from Sarah Joseph, M.D., medical oncologist at Miami Cancer Institute about colon cancer — who’s at risk, screenings and increasing rates among younger adults. Video by George Carvalho.) 

Knowing your family history is crucial, she adds. If you have an immediate relative who was diagnosed with colon cancer, it’s vital to get screened 10 years earlier than the diagnosis age of the relative, she says. (For “average risk adults, the American Cancer Society recommends starting regular screenings for colorectal cancer at age 45, while other guidance has kept the general average-risk recommendation at age 50.)

“This tragedy made me more aware of how we can bring forward awareness to our society — awareness to be screened earlier and to catch this disease in the early curable stages,” said Dr. Joseph.

Learn more about colon cancer’s genetic and non-genetic risk factors, when to get screened and the importance of knowing your family history from Dr. Joseph in the following Q&A:

What can you tell us about rates of colorectal cancer in adults under 50?

Dr. Joseph: “At Miami Cancer Institute, I treat colorectal cancer and many of my patients are under the age of 50 at time of diagnosis. The American Cancer Society in 2020 has average new diagnoses in the U.S. of colorectal cancer to be about 150,000 cases. Of those, about 10 percent are diagnosed before the age of 50. So, that’s about a 1-in-10 rate in patients younger than 50. Over the last decade, this trend has been steadily increasing among younger adults.”

What are the most common risk factors for colon cancers?

Dr. Joseph: “Risk factors can be divided into in genetic and non-genetic predisposing risk factors/ The non-genetics would be obesity, smoking, unhealthy diet — a lot of processed red meats, for example. Smoking plays a huge risk factor in developing colorectal cancer. If we look at the genetic components of increased risk of colorectal cancer, we have genetic predisposing conditions. The biggest ones are called Lynch Syndrome and Familial Adenomatous Polyposis.

Why is knowing your medical family history so important when it comes to getting screened for colon cancer, especially for younger adults?

Dr. Joseph: “If we look at the incidence of these (genetic-predisposing conditions) in a younger age group, the biggest telltale sign is speaking to your family and getting that medical history. For example, in the case of Chadwick Boseman, he was diagnosed in 2016 around the age of 39. So, I would tell his family members in the future to be screened at the age of 29 — that’s 10 years earlier than 39. So, it’s always 10 years earlier than at the age of (colon cancer) diagnosis of your first-degree relative.”

How about higher risks of colorectal cancer among African-Americans and Hispanics?

Dr. Joseph: “Partly because of the higher colon cancer rates in the African American and Hispanic populations, compared to the general population, our screening guidelines have moved down from the age of 50 to 45 for colonoscopies. For those with a family history, get screened 10 years earlier than the diagnosis age of the immediate relative.”

What message would you have for adults 50 or older, or those who are younger and at risk, who have postponed colorectal cancer screenings because of the pandemic?

Dr. Joseph: “In terms of delaying screenings, that can adversely affect patient care. For example, at the time of a diagnosis with a colonoscopy, we found a pre-cancerous polyp and that was removed. Patients do well. They go ahead and have another screening colonoscopy in five to ten years. If, because of the pandemic, that is delayed by a couple of months to a year, that pre-cancerous polyp now becomes cancerous due to the delay. That puts the patient at a higher risk of developing cancer.”

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