A doctor weighs in on Chadwick Boseman and colon cancer in SA

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Chadwick Boseman
Chadwick Boseman
Photo: Albert L. Ortega/Getty Images

just four days ago, the world woke up to the news of Chadwick Boseman’s passing from colon cancer.

Late last year, veteran broadcaster Xolani Gwala succumbed to the same disease after a lengthy battle, and a specialist colorectal surgeon tells Drum this isn’t a coincidence – it should be a warning to us all.

Tributes flooded in for the fallen actor, who shot to fame in his role of King T’Challa in the Oscar-winning blockbuster Black Panther.

A post on his twitter feed broke the news to his fans. “It is with immeasurable grief that we confirm the passing of Chadwick Boseman,” said the statement, which became one of the most liked posts on the social media platform.

While the world is still mourning the king of the fictional African nation of Wakanda, Dr Brendan Bebington, who heads up the colorectal unit at Wits University, says there are lessons to learn.

The deaths of both Chad and Xolani Gwala have brought the conversation of colon cancer to the table once more. And this conversation is long overdue, as the number of cases is increasing, particularly in developing countries like South Africa.

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Cancer cases on the rise

Mayoclinic describes colon cancer as a type of cancer that begins in the large intestine, or colon, which is the final part of the digestive tract. Colon cancer is sometimes called colorectal cancer, which is a term that combines colon cancer and rectal cancer, which begins in the rectum. Not much is known about the causes of the disease.

“What we do know is that about nine percent of the colon cancer patients we see is because of a genetic abnormality,” Dr Bebington tells Drum. “The rest, the 91%, is environmental – something is happening in the environment that is causing it.”

He says research suggests colon cancer in South Africa may be linked to factors such as a western diet, obesity, sedentary lifestyle and smoking.

Although there is littler data on the disease, Dr Bebington says it’s quite common and “year on year, there appears to be an increase in incidences of colorectal cancer”.

“It is the third most common cancer in women, after breast and cervical cancer, and it is the second most common cancer in men after prostate cancer. Fifty years ago, this disease was almost unknown in the black population but its numbers seem to be increasing in this group. It has been a persistent problem in all other groups as well. Generally, it affects older people but in Africa the patients tend to present a decade younger.”

The increase in cases is coupled with a devastating lack of public awareness, Dr Bebington says. As a result, the majority of patients present with a progressed case of the disease. The lack of public screening in South Africa is one of the major issues behind the delayed response.

He says 55% of SA’s patients are presenting with late stage three and four, which means the cancer has spread to other parts of the body. It also means the chances of successful treatment are very poor. An effective screening programme would increase the chances of picking up the disease at an earlier stage and improve the chances of patient survival.

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From an early stage, patients should look out for:

  • Rectal bleeding
  • Change in your bowels (either harder, softer or more erratic)
  • Bleeding from the anus
  • Unexplained loss of weight
  • Tiredness or lethargy
  • Low haemoglobin or iron levels.

These symptoms are even more worrying if there is a history of colon cancer or other cancers in your family.

Getting tested

In the developed world where there are a large number of cases, screening programmes have been initiated. Every year after the age of 50, your GP asks you to place a stool sample on a special test kit. If this changes colour, you will be sent for a colonoscopy.

A colonoscopy is an examination during which a camera on a flexible tube is inserted through the rectum and advanced to the other end of the large intestine. It allows the doctor to have a good look at the inside of the whole colon, biopsy any growths and remove any polyps that could in the future turn into colorectal cancer.

These screening programmes are not cost effective if the number of cases in a population are small, and they are not considered necessary in South Africa at present. This may change as the condition becomes more common, more research is conducted and more funds are invested to train medical staff how to conduct the screening.

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