Colorectal cancer is the second leading cause of cancer-related deaths in the U.S. behind lung cancer. According to the American Cancer Society (ACS), the lifetime risk of developing colorectal cancer is about 1 in 22 (4.49%) for men and 1 in 24 (4.15%) for women. And while colorectal cancer rates have dropped overall, the numbers are rising in younger adults, many in their 20s and even some in their teens.¹

A report from the Cleveland Clinic states that the risk of getting colon cancer before age 50 is now twice as high, and the risk of getting rectal cancer is four times as high, for people born in 1990 as it was for those born in 1950.¹

These concerning statistics have prompted the ACS to lower their recommended screening age from 50 to 45 for those at average risk.

While researchers work to identify the contributing factors for today’s youth, many point to lifestyle as diet, exercise and social habits such as smoking and drinking have all been linked to adult onset of colorectal cancers.

“Diet plays a very important role in preventing these cancers,” says gastroenterologist Mehrdad Asgeri, MD, of Palm Springs. He encourages all to “keep things moving” as constipation increases the exposure to toxins which irritate the lining of the colon. Additionally, he says, chronic inflammation increases your chance of these cancers, and a healthy diet can decrease inflammation.

Asgeri recommends eating fibrous foods that keep your system working properly such as leafy greens, figs (one of the most fibrous foods), fresh fruits and raw vegetables; eliminating processed meat, limiting grass-fed red meat, and eating more white meat and fresh fish. “Metamucil and other fiber supplements are good as they not only alleviate constipation, but also absorb toxins.”

He emphasizes avoiding aspartame, the artificial sweetner found in diet beverages and sugar-free foods, as it has been scientifically linked to colorectal cancers.

“Exercise has also been shown to decrease and prevent colon cancer,” adds the father of two with expressing concern for the younger generations. “Many young people are so bound to their computers and spend less time being physically active. We need to encourage them to get outdoors and play, and that goes for the rest of us as well!”

Other risk factors

In addition to lifestyle choices – poor nutrition, inactivity, smoking, and drinking – a history of inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn’s disease can also increase risk. Dr. Asgeri adds diabetics and those who use narcotics, muscle relaxants and steroids to the list.

Genetics do play a role and genetic testing can help identify mutations and risks. Those with a history of colorectal cancer in the family should begin screenings as early as 25 years of age.

Symptoms

Symptoms of colorectal cancer include rectal bleeding, blood in the stool, abdominal cramping, a change in stool shape and consistency, and weakness and fatigue. However, many of these symptoms can also be caused by something other than cancer such as infection, hemorrhoids, or irritable bowel syndrome.² Asgeri adds that other common symptoms he sees include unintentional weight loss, loss of appetite and change in bowel habits.

Preventative screening

Colorectal cancer almost always develops from abnormal growths, or polyps, in the colon or rectum. Screening tests can find precancerous polyps, so that they can be removed before turning cancerous. Screening can also find colorectal cancer early, when treatment works best,³ and is important because the condition is standardly non-symptomatic in the early stages.

However, it is estimated that only 53% of Americans over 50 have undergone appropriate screening.⁴ “We have to be diligent about screening,” says Asgeri. “Because by the time it is symptomatic, the cancers are often too progressed for positive outcomes.”

As stated, the new ACS recommendation is to start screenings at age 45 and earlier for those with hereditary risk factors (identified genes or affected family members) and those with IBS conditions.

Standard of care most often recommended is a colonoscopy which is covered by insurance as preventative. If benign polyps are found, then colonoscopies are repeated every ten years; if polyps are found to be cancerous, then every 2-5 years based on the type of cancer cells identified. Other screening options include:

Virtual colonoscopy, a CT scan with ingested contrast and observation of the lining of the colon. While there is a 95% accuracy rate, it is less favorable due to the X-ray exposure, and if polyps are identified (25-35% of the population), a gastroenterologist is then called in for a colonoscopy to biopsy.
Fecal immunochemical, or FIT, test is a fecal sample collected at home and sent to the lab to test for blood in the stool. It is recommended annually and reported to be 95% effective.
Fecal DNA tests are the newest
option and are also a home collection. They look for abnormalities characteristic of the DNA in colorectal cancer. With an 80% efficacy, they are recommended every three years, but significantly more expensive than FIT.
Sigmoidoscopy is a less invasive procedure than colonoscopy and can be done in a primary care office, but only checks the lower three feet of the large intestine where more aggressive polyps usually occur. Because it does not check the entire colon, Dr. Asgeri recommends this procedure more often in rural areas where access to comprehensive options is limited.

For more information, visit the American Cancer Society at www.cancer.org.

References: 1) https://health.clevelandclinic.org/rising-colon-cancer-rates-in-young-adults-prompt-earlier-screening; 2) Signs and Symptoms of Colorectal Cancer. American Cancer Society. May 30, 2018; 3) https://www.cdc.gov/cancer/colorectal/basic_info/screening/index.htm; 4)Winawer S, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993; 329:1977-1981.