By Pam Belluck

In the wake of Chadwick Boseman’s death from colon cancer at age 43, many people have questions about the disease, especially about the risk of colon cancer in younger people. Here’s what is known and what experts recommend:

Q: Doesn’t colon cancer mostly affect older people?

A: Although the majority of cases are found in older people, there has been an increase in cases in younger people in recent years.

Among people over 65, rates of colorectal cancer, which includes tumours in the rectum or the colon, have actually been declining, probably because of more regular screening. Nonetheless, it is the second-leading cause of cancer deaths in the United States for men and women combined, and cases have been rising by about two percent annually in recent years in people under 50, according to a recent report by the American Cancer Society.

Experts aren’t sure exactly why. For some patients, obesity, diabetes, smoking or a family history of cancer may play a role, but not all people who develop colorectal cancer have these risk factors.

“The bottom line is we just don’t know,” said Dr Robin Mendelsohn, co-director of the Center for Young Onset Colorectal Cancer at Memorial Sloan Kettering Cancer Center, which was opened in 2018 to treat younger patients and study the reasons for their diagnoses.

She and her colleagues are exploring whether diet, medications like antibiotics, and the microbiome — which have all changed significantly for generations born in the 1960s and later — might be contributing to the cancer in younger people.

Q: When is screening recommended?

A: Everybody should begin getting screenings at age 45, the American Cancer Society and other expert groups recommend. But people with a family history of colon cancer should start getting tested at age 40, or at 10 years younger than the age at which their family member was diagnosed, whichever is sooner.

Mendelsohn recommends early screening also for people with a history of inflammatory bowel disease, like ulcerative colitis or Crohn’s disease, and for people who have previously received radiation in their abdomen or pelvis.

Screenings can be done with various tests on stool samples or with imaging-based tests like colonoscopies.

The risks from these tests are relatively small.

The prep for a colonoscopy, drinking liquid to cleanse the colon the day before, can be uncomfortable.

But the advantage of a colonoscopy is that if it reveals polyps that might be precancerous, they can be removed during the test, said Dr Mohamed Salem, an associate professor of medicine at the Levine Cancer Institute at Atrium Health in Charlotte, North Carolina.

“It makes a huge difference when you detect cancer early versus late,” he said.

“The five-year survival rate for young people for early-stage disease is 94 percent,” said Rebecca Siegel, the scientific director of surveillance research at the American Cancer Society.

For people with late stages of the disease, the survival rate can be as low as 20 percent, she said.

Early diagnosis, Siegel said, is “the difference between life and death”.

Boseman learned in 2016 that he had Stage 3 colon cancer, according to an Instagram post announcing his death.

Mendelsohn said that patients with Stage 3 “have an approximate 60 percent to 80 percent chance of cure,” depending on a number of factors, including whether the cancer is responsive to chemotherapy.

Q: Are there racial disparities in the risk of colon cancer?

A: Yes. According to the recent American Cancer Society report, rates of colorectal cancer are higher among black people.

From 2012 to 2016, the rate of new cases in non-Hispanic black people was 45.7 per 100 000, about 20 percent higher than the rate among non-Hispanic whites and 50 percent higher than the rate among Asian Americans and Pacific islanders.

Alaska Natives had the highest rate: 89 per 100 000.

Siegel also said that at any age, “African Americans are 40 percent more likely to die from colorectal cancer. It’s because of later-stage diagnosis, it’s because of systemic racism and all that this population has been dealing with for hundreds of years.”

Q: What symptoms should prompt someone to see a doctor for possible colon cancer?

A: Common symptoms include bloody stool or bleeding from the rectum, doctors say. Other symptoms can include constipation or diarrhoea, a change in bowel habits, dark sticky faeces, a feeling of anaemia, abdominal pain or cramps, nausea, vomiting or unexplained weight loss.

“If you feel something, you have to say something,” Salem said. “Don’t put it off because you’re busy or because you’re a young person or because you have too much on your plate.”

Q: Are younger people less likely to receive a diagnosis early, and are they less likely to discuss their disease?

A: Unfortunately, yes. The average time from symptoms to diagnosis for people under 50 is 271 days, Siegel said, compared with 29 days for people 50 and older.

“Both doctors and these young folks are not thinking they have cancer,” she said.

“Part of that is screening, but it’s not all screening. Young patients have symptoms, sometimes for years. For one thing, they’re much less likely to have health insurance than older people, and so they have less money. And they’re thinking, ‘I’m a 30-year-old, what could be wrong with me — it’s going to go away.’”

Also, she said, “There’s the embarrassment factor. ‘I’m bleeding from the rectum.’”

Salem said “there is a lot of shame somehow. Nobody likes to have bleeding, especially from their butt. Especially young people; they don’t like to discuss this or disclose this information. That’s understandable. But it’s our obligation to change that culture. It’s OK to talk about your pain in that area, or your bleeding, or your constipation, or your diarrhoea.”

Doctors also need to get better at flagging a younger person’s symptoms as possible colorectal cancer, experts said.

“Anytime patients are 75 years old and have rectal bleeding, we say ‘Make sure and get checked out for colon cancer,’” Salem said.

“When younger people have rectal bleeding, sometimes we say ‘Oh, that’s haemorrhoids or stress from working too much.’ Those symptoms go on for many, many months or years, and now it’s not Stage 1 anymore, it’s Stage 3 or 4.”

Once they receive a diagnosis, doctors said, younger people should not feel ashamed.

“Increasing awareness and reducing stigma, all of this information could be saving lives now,” Siegel said.

“Keeping a secret is not the way to go.” – The New York Times

Staff Reporter

The Supreme Court of Appeal (SCA) has dismissed a bid by a medical aid scheme established over 40 years ago to change its name.

Compcare Wellness Medical Scheme, set up in June 1978, has been trying to change its name to Universal Medical Scheme.

The scheme is administered by Universal Health Care Administrators, a part of the Universal group of companies, and wanted to take advantage of the Universal brand which it considered to be stronger than its own.

The Council for Medical Schemes (CMS), through its registrar, however turned down Compcare’s name-change application after concluding the new name was likely to mislead the public.

The medical aid provider successfully appealed to the CMS Appeal Board which ordered the registrar to accept the name change, subject to conditions it imposed to mitigate the misleading effect.

The registrar and the CMS then took this decision on review, resulting in the Judge J Fabricius, in the Gauteng High Court in Pretoria, upholding their application and setting aside the Appeal Board’s order.

This prompted Compcare to approach the SCA in Bloemfontein.

On Monday this week, Judge C Plasket dismissed the appeal with costs.

The judge concluded that the Appeal Board’s decision could not stand and that the court below was correct to set it aside.

“The registrar had no lawful power to approve Compcare’s proposed change of name once he had concluded that it was a name that was likely to mislead the public,” Judge Plasket said.

“He also had no lawful power to approve such a change of name subject to conditions . . .

“As a result, the Appeal Board exceeded its powers by purporting to order the registrar to approve a name that was likely to mislead the public, subject to conditions.”

Staff Reporter

Dozens of graves containing bodies of people with albinism have either been robbed or violated over the past five years in different parts of Africa – including South Africa – by people targeting their body parts and other personal effects, a new book on African skin conditions says.

The African Atlas, Synopsis and Practical Guide to Clinical Dermatology by Bloemfontein dermatologist Dr Lehlohonolo Makhakhe states that at least 28 graves were robbed and a further 22 violated.

The book says a shocking 207 people living albinism were killed from a reported 507 attacks in which they were targeted for their body parts and ritual purposes.

“Albinism is a genetic condition that affects melanocytes, which are pigment-containing cells in the skin,” Makhakhe told The Free Stater as he dismissed the superstitious beliefs.

“People living with albinism need skin care, eye care and support from society,” he explained.

“They are born with normal intelligence and full capacity that is mostly not fully realised due to societal stigma and faulty beliefs that their skin or body parts have some supernatural powers.”

According to the book — which is the first comprehensive full-colour volume in southern Africa featuring visuals of mostly black people with different skin conditions — those attacked risked being mutilated, treated violently, raped or abducted, forcing those who survived to seek refuge elsewhere.

The book says the attacks and killings could be much higher as many other cases are never reported to the authorities or documented.

“These ritual attacks frequently find their roots in ancient ancestral beliefs and have been going on . . .” Makhakhe says in the book which he describes as a life-time goal.

The African Skin Atlas further states about nine cases of violations against people with albinism were reported in South Africa in early 2018.

It says four people with albinism were killed, two went missing, two survived attacks and there was one grave robbery.

The book says it is believed there is a thriving cross-border trade of people with albinism and their body parts.

According to the book, other countries known to be involved in the trading include Tanzania, Burundi, Kenya, the Democratic Republic of the Congo, Mozambique and Swaziland.

Free State police say they have not handled any case involving attacks on people with albinism in recent years.

The book has 36 chapters and it explores a variety of other topics.

Makhakhe, who wrote the book with the support of about 20 black medical practitioners from different disciplines, described it as a practical approach and insight to common dermatoses in the southern African setting.

“The book is of vital importance in many ways including, unifying medical specialists, demonstrating that even though we all work in different fields in medicine, some skin conditions can play a unifying role,” he told The Free Stater.

“An HIV specialist will see some skin conditions, diabetic specialists will also encounter diabetic related skin conditions, same with psychiatrists, child specialists and even skin signs of child abuse.”

The book has been accepted as part of the curriculum for third to final-year medical students at the University of the Free State and will also be offered as a supplementary book for nursing students.

“About 80-90 percent of our referrals from primary healthcare are basic skin conditions with treatment readily available at the same referring facilities,” said Makhakhe who is also a lecturer at the University of the Free State.

“This book seeks to give doctors and nurses access to basic knowledge of diagnosis, principles of treatment as well as when to refer in order to prevent late referrals and accompanying complications.”

He believes the book will help unleash other academic writers to offer “decolonised” and “recommodified” learning material.

GAME CHANGER . . . African Atlas, Synopsis and Practical Guide to Clinical Dermatology