What Chadwick Boseman's Story Can Help Us Understand About Colorectal Cancer in Younger Adults

What his family said

Chadwick Boseman died on Friday, 28 August 2020, at 43. The statement announcing his death came from his family and was posted to his own account.

It said he had been diagnosed with stage 3 colon cancer in 2016, and that he had never spoken publicly about it. It described "countless surgeries and chemotherapy" carried out while he was making the films people knew him for. His publicist, Nicki Fioravante, told the Associated Press that he died at his home in the Los Angeles area with his wife and family beside him.

That is the public record. This page does not add to it, and it does not describe his treatment choices, because he did not.

What his death did was put a question in front of a lot of people at once: how does a 43-year-old get colon cancer?

The trend behind the question

The answer is that this is happening more, and researchers do not fully know why.

NCI reports that since the 1990s the rate of colorectal cancer has been rising steadily among adults under 50, and that more younger people are dying from it. It calls colorectal cancer a leading cause of cancer death among people under 50 in the United States.

The puzzle is that the rate has fallen sharply in older adults over the same period, largely because of colonoscopy and lower smoking rates.

"We don't understand a lot about the causes, the biology, or how to prevent early onset of the disease," Phil Daschner, a program director in NCI's Division of Cancer Biology, said in an NCI article on the trend.

SEER, the federal cancer surveillance program, puts numbers on the age spread: 2.1% of colorectal cancers occur in people aged 20 to 34, 5.3% in people 35 to 44, and 15.9% in people 45 to 54. The median age at diagnosis is 66.

So it remains uncommon in younger adults. It is not rare.

Why a polyp is different from a lump

Colorectal cancer usually begins as a polyp, a small growth on the bowel lining. Most polyps never become cancer, and the ones that do usually take years.

That slow path is why colorectal screening is unusual among cancer screening programs. NCI's screening summary states, on solid evidence, that screening reduces deaths from colorectal cancer, and that some screening methods also reduce how many cases occur at all.

The second half of that is the important part. A colonoscopy that finds and removes a polyp has prevented a cancer, not just caught one early. Our page on colonoscopy covers what the procedure involves.

What the stage meant

Stage describes how far a cancer has spread when it is found.

Stage III colorectal cancer has reached nearby lymph nodes but not distant organs. It is generally treated with surgery to remove the affected section of bowel and the nodes, followed by chemotherapy.

Stage IV means it has reached distant organs, most often the liver or lungs. Treatment then focuses on control, sometimes for years, and can still include surgery in selected cases.

SEER's five-year relative survival figures track that split: 91.3% for cancer still confined to the bowel wall, 75.2% once nodes are involved, and 16.9% once it has spread to distant sites. Across all stages it is 65.4% for people diagnosed from 2016 through 2022.

Those figures come from tens of thousands of people, most of them much older than Boseman was. They describe a population and forecast nothing for one person.

When to get checked

The story NCI tells about early-onset disease is not really about statistics. It is about delay.

NCI's article opens with a man who noticed blood in his stool in his early thirties, did not mention it to a doctor because it was occasional and painless, was later told it was small tears in the intestine, and decided to live with it. By the time he had pelvic pain and was examined, he was 40 and had stage 3 rectal cancer.

The thresholds worth acting on:

• Blood in the stool, bright red or very dark, even once, at any age.
• A change in bowel habits that persists — diarrhoea, constipation, or going more often.
• A feeling that the bowel does not empty completely.
• Stools that are narrower or a different shape than usual.
• Persistent abdominal discomfort — gas pains, bloating, fullness, cramps.
• Unexplained weight loss, fatigue, or vomiting.

NCI lists all of these. The rule that matters underneath them is simpler: rectal bleeding in a young adult is usually hemorrhoids, and "usually" is not a diagnosis. Ask to have it looked at rather than explained away.

Screening is separate from symptoms. Major U.S. guidance now starts average-risk screening at 45. A family history of colorectal cancer, or an inherited syndrome such as Lynch syndrome, moves that earlier — often to ten years before the youngest relative's diagnosis. Our page on colorectal cancer screening covers the test options.

What being young and fit does not do

Boseman was 43, visibly strong, and working. None of that is protective.

Fitness lowers risk across a population. It does not make anyone immune, and it does not change what a symptom means. A person who runs every day and has blood in their stool needs the same appointment as anyone else.

The same goes in reverse. Nothing in the public record explains why he developed this cancer, and NCI is candid that for early-onset disease the causes are still being worked out.

What to keep in perspective

One death, however public, is not evidence about anyone's individual risk. The rate among adults under 50 is rising and still low in absolute terms.

Nor does his story argue for screening everyone at 25. Screening has costs — preparation, sedation, a small risk of perforation, false positives — and the age thresholds exist because they balance those against benefit.

What it does argue for is narrower and better supported: do not sit on rectal bleeding, do not assume age rules cancer out, and know your family history well enough to say it out loud.

Sources

• PBS NewsHour (AP): 'Black Panther' star Chadwick Boseman dies of cancer at 43
• NPR: 'Black Panther' Star Chadwick Boseman Dies Of Cancer At Age 43
• NCI: Why Is Colorectal Cancer Rising Rapidly among Young Adults?
• NCI PDQ: Colorectal Cancer Screening (Health Professional Version)
• NCI PDQ: Colon Cancer Treatment (Patient Version)
• NCI SEER Cancer Stat Facts: Colorectal Cancer

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

See an error, old source, or unclear wording? Tell us.