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Chadwick Boseman

The news media are filled with obituaries and tributes to this leading actor and action hero who died from metastatic colon cancer contracted in his early 40’s. When a public personality falls to an illness it becomes big news. But to those of us following the medical literature it is not news.

Colon cancer is one of the most common malignancies. It can be fatal because all too often it is not diagnosed until it already has advanced.  Colon cancer can be prevented significantly by colonoscopy, which can detect and remove polyps, small growths, that if left undetected could go on to become cancers.

Most national guidelines have been recommending that colonoscopy screening start by the age of 50. For many years this has been the suggestion for the general public who have no symptoms and no concerning family history. Initial colonoscopy has been recommended ten years earlier (by age 40) for those with a close family member (parent or sibling) who has had colon polyps or cancer or when there are worrisome symptoms like rectal bleeding, iron deficiency anemia, change in bowel habits, or abdominal pain. Adherence to these guidelines by the public has been relatively poor (about 40% at best). We still see patients presenting with colon cancer in their seventies or older but never had undergone colonoscopy.

But in the past few years there have been a number of disturbing reports of colon cancer occurring in patients who, like Mr. Boseman, were younger than the general guideline age for first colonoscopy. In fact, because of these reports and larger surveys nationally the American Cancer Society in 2019 recommended that the age for first colonoscopy be lowered from 50 to 45.  While this suggestion has not been embraced yet by all medical organizations it is likely to become adopted more widely.

So this is an appropriate time to suggest that you discuss colonoscopy with us. Are you in your forties or older? Do you have a family history of colon polyps or cancer? Have you noticed blood in your bowel movements that you are presuming is due to hemorrhoids? Have you experienced a change either toward constipation or diarrhea? Have you been found to be anemic? Have you had abdominal pain or distension, nausea or vomiting? Have you experienced involuntary weight loss? Even without any of these symptoms colon polyps and cancer can be growing and spreading silently.  If your initial colonoscopy is normal you may be able to wait as long as 10 years before being advised to repeat the examination.

In the past six months, compounding poor adherence to national guidelines, there has been a general reluctance of patients to reach out to physicians during this Covid pandemic. Please do not neglect the rest of your health and potential life-threatening conditions like colon cancer because of your understandable fear of Covid.

We wish you continued good health and are here to help you achieve that.

Dr. Peter Rubin

Author
Peter H. Rubin, MD

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