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Colorectal Cancer Does Not Only Strike Older People.


Chadwick Boseman as King T’Challa in Black Panther #Wakanda forever

Image from The Times


Sadly, the recent demise of the Hollywood celebrity, Mr Chadwick Boseman brings to light a new and uncomfortable truth that is still an emerging reality for many. Cancers related to the digestive system are one of main cancers that younger adults are increasingly being diagnosed with. Anecdotally, these cancers tend to be more aggressive, but this can also be attributed to the fact that they are often diagnosed at a later stage.

Lifestyle

Though evidence suggests that an increasing number of younger adults are being diagnosed with colorectal cancer, most individuals in their 30s to 40s would still brush this away as a little more than a whisper of a warning. Understandably, this is because they tend to think that time and age are two factors that reduce their risk. While it is generally true, there are some vital mitigating factors that do add to the risk of colorectal cancer. While we cannot say what these were for Mr Boseman, as we did not know him personally, other considerations such as lifestyle, eating habits, how much stress one is experiencing on a daily basis, and the history of family members who suffer from cancer are vital for a doctor to compose a more personalized risk profile.

Symptoms

It also does not help that on many occasions, patients who have colorectal cancer do not experience severe or violent symptoms and signs till it is too late. The generic bloating, nausea, constipation or diarrhoea may often also be written off as bowel changes not to be too worried about. Even blood in the stool is often attributed to non-cancerous conditions such a as piles or haemorrhoids in the young. And as we live in an aesthetical climate of fitter and slimmer physiques, the weight loss and appetite changes may no longer signify the traditional red-flag symptoms that doctors look out for.

Older versus younger

There is a growing body of evidence which shows a decrease in older adults suffering from colorectal cancer, likely due to screening practices, but the numbers continue to rise for young adults. Currently, most countries with screening programmes recommend adults to undergo screening for colorectal cancer from age 50. However, in May 2019 the American Cancer Society (ACS) became the first national organization to recommend that adults of average risk for colorectal cancer begin routine screening at age 45 instead of 50. The revised guidelines was a result of an increasing rate of colorectal cancer among younger adults, coupled with the fact that for both older and younger adults, the early detection of colorectal cancer will significantly improve the chances of survival and cure.

The recent event involving the Black Panther star should be a wakeup call to reconsider reducing the screening thresholds, and start the process at a much younger age. Till then, we should all be mindful of our intestinal health, and keep the #WakandaForever star in our thoughts.


By Dr Grace Tan and Adj Prof Melissa Teo

The Surgical Oncology Clinic

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