Chadwick Boseman Statement

Chadwick Boseman

The Colon Cancer Foundation (CCF) is heartbroken to learn of the passing of a superhero, Chadwick Boseman. Boseman’s life was tragically cut short on August 28 after a four-year battle with colon cancer, the nation’s second deadliest and third most commonly diagnosed cancer. “On behalf of the thousands of patients, caregivers, clinicians, and researchers who we represent, the Colon Cancer Foundation would like to offer our sincerest condolences to the Boseman family and our support to the millions of people who were touched by Chadwick.” said Cindy R. Borassi, Interim President. 

Chadwick Boseman inspired generations through his singular performances in films such as 42, Marshall, and, of course, the Oscar-nominated Black Panther. Only after his death did the world learn that he was diagnosed with colon cancer in 2016, the same year he debuted as King T’Challa in Marvel’s Captain America: Civil War. Everyone who watched him on screen knew that Chadwick Boseman was an outstanding actor. Many people also knew he was a social justice advocate and an amazing role model. Now we realize that he was also a real-life superhero, showing us what we are capable of achieving no matter what the circumstance. 

Chadwick Boseman’s death tragically demonstrates the alarming increase in the rate of young people between the ages of 20-49 being diagnosed with colorectal cancer. Since 2014, CCF has hosted our annual Early-Age Onset Colorectal Cancer (EAO-CRC) Summit, the nation’s only interdisciplinary event that brings together leading clinicians and scientists, as well as EAO-CRC survivors and caregivers from across the globe. The program provides extensive opportunities for participants to advance their understanding of the rapidly increasing incidence of CRC among young adults under 50 years of age in the U.S. and abroad. We encourage you to check out the executive summaries of our past Summits to learn more about EAO-CRC: https:/eaocrc.org 

Boseman said in a 2018 interview, “You should be the hero in your own story.” The Colon Cancer Foundation has been encouraging people to be their own heroes and heroines since 2008 by raising awareness and spreading the word that colorectal cancer is treatable and beatable with early detection and screening.

As we continue to work towards A World Without Colorectal Cancer™, we encourage you to “be the hero in your own story” and #CheckItForChadwick. To donate in Chadwick’s memory using the following link: https://ccfdonations.greatfeats.com/donate 

 

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Colon Cancer Screening Guidelines

When it comes to colon cancer screenings, it pays to be informed. The more information you have on it, the more well prepared you will be. You’ll also have less stress because you will know more about what to expect. Here are some helpful colon cancer screening guidelines to help familiarize yourself with the details so that you can make decisions in confidence.

Understanding Colon Cancer

When considering colon cancer screening guidelines, it’s important to understand how colon cancer works. This disease can develop along any of the 5 sections of the colon which include the transverse colon, ascending colon, descending colon, sigmoid colon, and rectum. That’s a lot of ground to cover, which is why colonoscopies are so popular as a screening method for colon cancer. Colonoscopies are arguably one of the most thorough and effective types of colon cancer screenings available.

What are the Risks?

The risk of forgoing colon cancer screenings goes up over time. By going to your screenings without fail, the risks will be much lower and you will not have to worry as much. It’s important to note that colon cancer screenings should not be looked at as a bad thing. Although it is perfectly natural to be nervous about being screened and hearing the results it’s important to remember that

Early Warning Signs to Watch Out For

In addition to going to your regular screenings, there are some early warning signs to watch out for that can help you detect colon cancer before it has a chance to dig in. One of the most visually apparent of these early warning signs is sudden and unexplained weight loss. This doesn’t mean that you have to worry about colon cancer every time you lose a pound or two. Generally, a loss of 10 pounds over a period of 6 months would warrant a thorough screening like a colonoscopy.

Alternatively, if you know that someone in your family has contracted colon cancer before, you need to tell your Doctor so that they can set up an appropriately aggressive screening schedule. Having a family member with colon cancer is one of the earliest warning signs of all and it’s one that you should take especially seriously. Don’t panic or fret, just be mindful that you’ll have to undergo colon cancer screenings much earlier and more frequently than others.

Typically it is recommended that anyone that has a family member with colon cancer should be screened before the age of 45 rather than after reaching the age of 45. This will give you a much higher chance of catching any signs of colon cancer early and nipping it in the bud before it can do any damage.

Regardless of whether your family has a history of colon cancer or not, if you are diagnosed with having a large polyp or several polyps, you should have a colonoscopy. If adenomatous polyps with a low-grade abnormality are discovered over the course of your colonoscopy it is highly recommended that you have another colonoscopy in 5 years’ time.

Additional Screening Guidelines and Things to Watch Out for

For those of you who have had colorectal surgery, you will need to have a colonoscopy 3 years from the date of your surgery and then another colonoscopy 5 years after that. This will help ensure that you won’t be in for any unwelcome surprises and will catch it early enough to defeat with ease should it ever return.

Generally the very young are not require to be screened for colon cancer unless they have something concerning in their family medical history such as familial adenomatous polyposis. It is recommended that individuals with a family history of familial adenomatous polyposis should have either an annual flexible sigmoidoscopy or a colonoscopy between the ages of 10 and 12. Given the young age of such patients, a full colonoscopy might be more risk than it’s worth in this case as sigmoidoscopies are considerably less invasive.

Finally, anyone with hereditary nonpolyposis colon cancer in their family should be screened for colon cancer by age 20-25 or 2 years before their immediate family member’s colon cancer diagnosis, whichever comes first.

When it Comes to Colon Cancer it Pays to be Aggressive

The single best weapon against colon cancer is to be aggressive about screenings and preventative medicine. Colon cancer has a bad habit of sneaking up on people which is why it’s so important to remain vigilant.

Remember, if you catch it early, you won’t have nearly as hard of a time getting rid of it and won’t have to worry about it as much. You have the power to stop colon cancer in its tracks, as long as you keep getting screened for it.

 

 

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New Screening Strategies From the AGA

A recently published white paper by the American Gastroenterological Association (AGA) titled “Roadmap for the Future of Colorectal Cancer Screening in the United States” states that the development of structured organized screening programs is vital to achieving target colorectal cancer (CRC) screening rates and reductions in CRC morbidity and mortality. The paper includes information shared at the AGA’s Center for GI Innovation and Technology’s consensus conference in December 2018, which outlined the following priorities:

  • Identify barriers to screening uptake
  • Assess the efficacy of available screening diagnostic methods
  • Consider the potential integration of novel diagnostic approaches into screening and surveillance paradigms

 

The paper highlights the following strategies:

Modifications to CRC Screening to Improve Uptake and Outcomes

Although over 1,700 organizations across the 50 states signed onto the “80% by 2018” initiative announced by the National Colorectal Cancer Round Table (NCCRT) in 2014, one-quarter of eligible Americans are yet to undergo CRC screening. Organized screening offers an opportunity for screening improvements by the use of multiple strategies, such as defined target populations, timely access and follow-up, and systematic opportunities for shared decision-making between patients and clinicians. It can also improve efficiency by incorporating noninvasive testing such as annual mailed fecal immunochemical (FIT) tests and colonoscopy alternatives like stool testing. Multiple studies have shown that offering stool testing as an option, in addition to colonoscopy, increases screening uptake, however a diagnostic colonoscopy is still necessary to confirm positive noninvasive test results.

Racial, socioeconomic, and geographic health care disparities also limit screening efficacy. African American and Hispanic American communities and individuals in rural areas in particular face screening barriers, accounting for 42% of the disparity in CRC incidence and 19% of the disparity in CRC mortality between black and white individuals.

The following strategies were discussed to resolve these issues:

  • Incorporate adjunct noninvasive testing to improve screening rates
  • Minimize the ineffective practice of performing re-screening and surveillance colonoscopy sooner than recommended by guidelines
  • Reconsider surveillance strategies for individuals with a history of adenomatous polyps to prevent constraining colonoscopy resources

 

Continued Development of Noninvasive and Minimally Invasive screening Tests

The paper states than an ideal, noninvasive test would “identify lesions with high short-term potential to progress to CRC and should do so with high sensitivity and specificity in a convenient, low-risk, low-cost, and operator-independent manner” that is easy to complete and should achieve high uptake among individuals who are eligible for screening. While an ideal test is yet to be developed, the FIT test and a blood test currently face the least resistance from patients. The researchers propose the development of a noninvasive test that is capable of detecting advanced adenomas and advanced serrated lesions while also being minimally invasive and easy-to-use with a one-time sensitivity and specificity of a minimum of 90%.

 

Improved Personal Risk Assessment for Optimal Programmatic Screening

Current risk assessment guidelines focus on familial and personal colorectal neoplasia risk, but do not acknowledge additional factors such as sex, race, smoking, body mass index, and environmental factors. Family history can be challenging to obtain due to a lack of patient awareness and the health care provider’s limited ability to derive and record the information. The researchers have proposed using patient portals with integrated electronic health record to ensure updated and accurate family health history data and to allow health care providers the ability to accurately assess the patient’s risk by looking at the data in the portal, irrespective of their geographic location. Improved personal risk assessment would help health care professionals select the appropriate CRC screening test method. For example, individuals with a higher risk of advanced adenoma or CRC would be directed to a colonoscopy, while individuals with a lower risk would be directed to a less-invasive screening method.

 

Although initiatives like the 80% by 2018 proposed by the NCCRT are a good step towards increased screening rates, the development of organized screening programs is necessary to further these efforts even more. The desired goal of these screening efforts is testing that is available to at-risk individuals, noninvasive testing methods that are highly accurate and easy to use, increased screening uptake, and reduction in CRC incidence.

 

 

 

 

 

 

 

 

 

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Do Young Diabetes Patients Need Early CRC Screening?

A large cohort study that evaluated Swedish family inpatient and outpatient cancer registries found that those who had diabetes had an increased risk of colorectal cancer (CRC)—the magnitude of risk was similar to having a family history of CRC.

The study had a long timeline and follow-up was conducted between 1964-2015. The 12,614,256 individuals included in the study were born after 1931; 559,375 of them had diabetes and 162,226 had CRC. The authors queried the risk of developing CRC among those who had diabetes and found that:

  • 9-fold greater risk of CRC before 50 years among those diagnosed with diabetes before 50 years (range, 1.6-2.3)
  • 9-fold higher risk of CRC before age 50 years among those diagnosed with diabetes before 50 years who also had a family history of CRC (range, 4.1-12)
  • Lifetime risk of CRC before age 50 years among diabetic patients (0.4%) was similar to those with just a family history of CRC (0.5%). It was double that of the average population (0.2%).

This study confirms the positive association between early-onset diabetes and early-onset CRC and makes a case for earlier CRC screening among young adults with diabetes.

Results from the South Australian Young Onset (SAYO) CRC study identified a similar correlation between personal and family history of diabetes and CRC risk. The study cohort included 50 unrelated young adults up to age 55 years diagnosed with CRC (23-54 years), and 253 controls without CRC (18-54 years). Personal and family history of diabetes was documented in this entire population. The study found:

  • 24% of CRC patients also suffered from type II diabetes compared with 5% of the control group
  • 51% of young adults with CRC had at least one first-degree relative with type II diabetes
  • All patients with a personal history of type II diabetes also had first-degree relatives with type II diabetes
  • 44% of CRC patients under 45 years and 60% of CRC patients 45-54 years had a first-degree relative with type II diabetes

These findings create a very strong case for raising awareness among young adults with diabetes of their increased risk of early-onset CRC, especially if there is a family history of diabetes, so they can initiate CRC screening earlier than the USPSTF recommendation of 50 years.

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2020 Global Challenge Winners

2020 has been a challenging year in so many ways, but especially for the cancer community. However, colon cancer does not stop for Covid-19 and neither do we! We were extremely excited to continue the legacy of the physical Colon Cancer Challenge by going virtual this year. 2020 also marked the 17th year of the Challenge, where teams of families, friends, co-workers, local and national corporations come together to raise awareness of colorectal cancer, support those battling the disease and raise funds for the Colon Cancer Challenge Foundation’s strategic initiatives of Public Awareness, Prevention, and Research. 

We were blown away by the support of our community during this unprecedented time, and are happy to recognize Maya Degnemark and Darryl Gross for their efforts and support during the Challenge. They ran over 1,200 miles collectively during our virtual event, each for their own reasons which you can learn more about below:

 

Maya Degnemark, top female winner of the Global Colon Cancer Challenge

My name is Maya Degnemark, I am 16 years old and I live in Brooklyn, New York. I have watched my uncle, Sanjay Bery, battle colon cancer for many years and now I proudly stand beside him fighting for this cause. Though I have been on my school’s running team since I began high school and have participated in many local races (including the physical race for colon cancer the last couple of years), I have never been so serious about running or about staying healthy. Things changed, however, in mid- March when my packed everyday life quickly changed (and ultimately became more relaxed), and I saw the opportunity to set both a weight loss and general health goal for myself (and compete in this virtual challenge, which I did not know was this great when I started!) Since then, I have been staying very active – even reaching my 100th day of running (between 3 and 6.5 miles) on July 26th. Now looking back on the past few months and this challenge, I am proud of myself for achieving my personal goals but for also using my own determination to fight for a much greater cause. I thank everyone who participated in this challenge, donated to this organization, or just helped raise awareness for this cause. I am dedicated to continue working with this organization in the years to come and continuing to commend them for their fantastic fight.

Darryl Gross, top male winner of the Global Colon Cancer Challenge

I became involved with CCF after my wife, Jessica, was diagnosed with colon cancer back in April. It’s been a whirlwind since then with surgeries and having to then start chemotherapy.  The experience has been very hard especially during these times. The positive is that her cancer was caught relatively early due to her proactivity.  She knew her body and she felt something was not right and pressed the issue of getting a colonoscopy with her gastroenterologist even as the world was shutting down in March due to Covid-19.   Knowing her body, her intuition was right as she had a cancerous polyp that was removed during her colonoscopy.  She then had to have an additional colorectal surgery before starting chemo.  Chemotherapy will be done in November just in time for the holiday season! She’s 36 and her prognosis is great because she was proactive in getting a colonoscopy even during these uncertain times. It’s been an extra challenging time with everything else going on but we are pushing through. I know both my wife and our world will be better soon! Through this whole situation we have realized how important friends and family are and the power of positive thinking! We are very grateful for everyone in our lives!

As far our involvement with the foundation, it’s new but will be a cause we will support for the rest of our lives.  I saw the notification of the activity challenge and as a family who supports physical activity (we are both runners), I thought it was something great to get involved with.  I plan on participating for many years to come!

 

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H.R. 1570/S. 668: ACS CAN Supports Bill on Eliminating Financial Barriers to CRC Screening Among Medicare Enrollees

First introduced in February 2017, the Removing Barriers to Colorectal Cancer Screening Act of 2019 (H.R. 1570/S. 668) aims to waive Medicare coinsurance for colorectal cancer (CRC) screening tests, regardless of the code billed for a resulting diagnosis or procedure. The bill sponsors are: Representatives Donald Payne, Jr. (D-NJ), Rodney Davis (R-IL), Donald McEachin (D-VA), and David McKinley (R-WV) in the House and Senators Sherrod Brown (D-OH), Roger Wicker (R-MS), Ben Cardin (D-MD) and Susan Collins (R-ME) in the Senate.

The bill acknowledges that CRC is largely preventable if polyps are detected early and removed before they become cancerous. But there is a large gap in CRC screening rates in the country, with 60% of CRC cases and 70% of deaths occurring in those 65 and over. In order to improve colonoscopy rates, the bill, if passed, will eliminate any unexpected costs, and remove financial barriers that prevent seniors from being screened.

In a statement supporting H.R. 1570 and S. 668, the American Cancer Society Cancer Action Network (ACS CAN) explains that seniors who set up a screening colonoscopy visit do so assuming there is no cost sharing since it’s a screening procedure. However, detection and removal of a polyp during the screening can result in the enrollee facing a surprise medical bill because removing the polyp changes the colonoscopy to a diagnostic process. Medicare enrollees are responsible for a 20% copay on diagnostic procedures, and this amount may vary based on the procedure and the facility where it was conducted. ACS CAN says that Medicare beneficiaries may be sensitive to such out-of-pocket (OOP) costs, and it may deter them from undergoing screening colonoscopy.

ACS CAN is hopeful that removal of this OOP cost loophole can not only save lives by catching CRC at an earlier stage, but it will also result in savings for Medicare, which is expected to spend $20 billion on CRC treatment in 2020 alone.

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New Indiana Law Requires Insurance to Cover Colon Cancer Screenings at the Age of 45

A new law passed during the Indiana General Assembly’s 2020 session now requires insurance companies to cover colonoscopies at age 45 instead of the previously recommended 50. The law comes two years after the American Cancer Society modified their guidelines for colon cancer screenings.

In a study published in 2017 by the Journal of the National Cancer Institute, researchers found that from the mid-1980s through 2013, colorectal cancer incidence rates in adults age 55 years and older were declining while incidence rates for adults between the ages of 20 and 49 were increasing. It is speculated that the increase in colorectal cancer incidents in young adults is attributed to the fact that screenings were previously not recommended for those under 50.

Implications

It is estimated that there will be around 104,000 newly diagnosed cases of colon cancer and around 43,000 new cases of rectal cancer in the United States in 2020. Almost 18,000 of these cases are estimated to be diagnosed in adults younger than 50. The American Cancer Society estimates that among these numbers, 3,410 will be Indiana residents. Inspired by these statistics, the new Indiana law allows for cases to be diagnosed at an earlier age since screenings are now covered for those 45 years and older. Rep. Brad Barrett, who drafted the law, emphasized its benefits by explaining that insurance costs could potentially decrease if people are diagnosed at an early stage since “the cost of treatment will be less than if it had been caught at a later stage.” The five-year survival rate for colorectal cancer that has been detected early is 90%.

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Pembrolizumab Approved as First-Line for MSI-H/dMMR Metastatic CRC

At the virtual American Society of Clinical Oncology (ASCO) annual meeting in May/June 2020, promising results from the interim analysis of phase 3 data from the KEYNOTE-177 trial were presented during the plenary session. First-line treatment of a subset of patients with metastatic colorectal cancer (mCRC) with the immunotherapy drug pembrolizumab doubled the median progression-free survival (PFS) compared to patients treated with standard-of-care chemotherapy. This has now led to an FDA approval for the drug.

Trial Results

KEYNOTE-177 was designed as a global, multicenter, open-label, active-controlled, randomized trial that compared treatment of 307 previously untreated patients with microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) mCRC. Mismatch repair is an inherent property of cells that allows them to correct DNA replication errors, and dMMR cell lack this process, resulting in mutations in the DNA. dMMR cells with alterations in short, repetitive DNA sequences are called MSI-H.  Patients were randomized to receive first-line pembrolizumab alone at 200 mg every 3 weeks for up to 2 years or investigator’s choice chemotherapy: FOLFOX (fluorouracil [5-FU], leucovorin, and oxaliplatin) or FOLFIRI (5-FU, leucovorin, and irinotecan) every 2 weeks, with or without bevacizumab or cetuximab.

This was a crossover trial, meaning patients on chemotherapy could cross over to receive pembrolizumab for up to 35 cycles if their disease had progressed. Primary end points were PFS and overall survival (OS); objective response rate (ORR) was the secondary endpoint.

Median PFS was 16.5 months in the pembrolizumab group and 8.2 months in the chemotherapy group. Pembrolizumab showed a 40% reduction in the risk of disease progression (P=0.0002); PFS rates were 55% vs 37% for pembrolizumab vs chemotherapy, respectively, at 12 months, and 48% vs 19%, respectively, at 24 months. ORR were 43.8% and 33.1%, respectively. While the median duration of response was 10.6 months for chemotherapy (2.8-37.5 months), it had not been reached with pembrolizumab (2.3-41.4 months). Complete responses were achieved in 11.1% and 3.9% patients receiving pembrolizumab vs chemotherapy, partial responses were achieved in 32.7% vs 29.2%, respectively.

Only 22% of patients in the pembrolizumab arm had treatment-related adverse events (TRAEs) compared to 66% in the chemotherapy arm. One TRAE death was reported in the chemotherapy arm.

The study is ongoing and OS data are expected to be presented at a later time.

FDA Approval

The above results have led to the FDA approval of pembrolizumab in previously untreated patients with MSI-H/dMMR mCRC. Importantly, this is the first immunotherapy to receive FDA-approval as first line of care in this patient population.

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Colon Cancer Immunotherapy

Many therapies have been proposed in the continuous fight against colon cancer. Some of these therapies have proven to be more effective than others. One of the more promising therapies for treating colon cancer is immunotherapy. It is a much more holistic approach than many other treatment methods and helps the patient’s body fight cancer on its own. Here is what you should know about the benefits and challenges of treating colon cancer with immunotherapy.

In 2019, an estimated 100,000 of new cases of colon cancer emerged. Numbers like that might not seem like a lot, but when you start looking at the big picture, say, 100,000 cases of colon cancer per year, you can see a trend of 1,000,000 cases in ten years. One hundred thousand might seem trivial, but a million people is like the population of a small country, and when you look at the mortality rates, the picture gets even more interesting.

This is why colon cancer awareness is so important. Do yourself and your loved ones a favor and start talking about your family history and get screened. Prevention is crucial, and being proactive is the key to prevention. One of the best things you can do for yourself aside from committing to regular screenings is to learn more about the most effective treatments. One of the most intriguing treatment methodologies to date is immunotherapy.

What to Know About colon Cancer Prevention and Immunotherapy

Most immunotherapy methodologies focus on leveraging the patient’s own body to actively seek out, identify, and destroy cancer cells. It works by empowering your own immune system and helping it root out any cancer cells before they cause you any more trouble.

Immunotherapy has displayed impressive success rates when used to treat certain types of cancer including a type of lung cancer and skin cancer. Less is known about immunotherapy’s potential to combat colon cancer.

For those who are afflicted with colon cancer, immunotherapy shows the most promise to patients who exhibit something called mismatch repair deficiency. Patients with mismatch repair deficiency are prone to abnormal rates of mutations including the types of cells that contribute to colon cancer.

This serves to highlight the importance of knowing more about your genetics. Some people are afraid to investigate their genetic predisposition because of the fear of actually being predisposed. No one wants to hear that they are genetically susceptible to contracting colon cancer. As difficult to hear as it may be, information is your best friend in these situations. If you’re genetically predisposed to getting colon cancer, you can focus on prevention to decrease your chances of contracting the disease.

Is Immunotherapy Right for You?

One thing that you should know about immunotherapy is that it’s widely considered to be the last line of defense, or offense, depending on how you look at it. Chemotherapy and surgery are the two most commonly used treatment options. They are used at both to combat colon cancer in both the early and late stages of the disease. It’s only when both surgery and chemotherapy have failed that immunotherapy comes into play.

When colon cancer is caught relatively early, surgery has a fairly high success rate as a treatment. When other treatments have failed, immunotherapy is typically used. There is a lot to learn about immunotherapy and a lot more developments underway. One day, immunotherapy may be considered to be a much more promising treatment.

 

 

 

 

 

 

 

 

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COVID-19 Doesn’t Stop for Colorectal Cancer

Seventeen organizations from across the globe – who individually have made a significant impact in the fight to end colorectal cancer – are joining together in solidarity #atadistance to let their collective communities know that even in the wake of a global pandemic they are unified in and fiercely committed to saving, improving, and extending the lives of millions at risk for or living with the world’s third cancer killer.
‎#InThisTogether‎, #AllInThisTogether

On Tuesday, June 9th, these organizations will collectively celebrate and lift up the over 4.6 million colorectal cancer survivors around the world and reach out to the thousands who are newly diagnosed every day to offer a message of hope.

Colorectal cancer hasn’t stopped for COVID-19. “We know patients and caregivers affected by this disease need our support now more than ever.”Cindy Borassi, Colon Cancer Foundation, “And, we are here to help those most affected by CRC navigate cancer in the weeks and months to come.”

 AliveAndKickn                                                          Aliveandkickn.org

Beat Liver Tumors                                                    beatlivertumors.org

Blue Hat Foundation                                                bluehatbowtie.org

Colorectal Cancer Canada                                      colorectalcancercanada.com

Colon Cancer Coalition                                            coloncancercoalition.org

Colon Cancer Foundation                                       coloncancerfoundation.org

Colon Cancer Prevention Project                           coloncancerpreventionproject.org/

Colon Cancer Stars                                                  colonstars.org

Colorectal Cancer Alliance                                      ccalliance.org

Colontown                                                                 colontown.org

Fight Colorectal Cancer                                           fightcrc.org

GI Cancers Alliance                                                  GICancersAlliance.org

Michael’s Mission                                                     michaelsmission.org

Minnesota Colorectal Cancer Research Foundation  minnesotacolorectal.org

The Raymond Foundation                                       TheRaymondFoundation.org

The Colon Club                                                         colonclub.org

The Gloria Borges WunderGlo Foundation    wunderglofoundation.org

 

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