Am I at Risk?

Who gets colorectal cancer?

Anyone can get colorectal cancer. Colon cancer is the third most commonly diagnosed cancer for men and women combined (except for skin cancers), and it is the second most common cause of cancer death in the United States. It is expected to cause more than 51,000 deaths in 2019. More than 101,000 people in the United States are diagnosed with colon cancer each year, and more than 44,000 are diagnosed with rectal cancer.

Does food intolerance or lactose intolerance increase your risk for colon or rectal cancer?
Very little hard data exists indicating that consumption of lactose products or that lactose intolerance is a risk factor for colorectal cancer. However, much new literature suggests that probiotic therapy is healthy and that the microflora of the colon may be altered by dietary dairy products so that the risk for colon cancer is lessened.

Is there a connection between stomach cancer and colorectal cancer?
There is no association between stomach (gastric) cancer and colon cancer, except in individuals with Hereditary Non-Polyposis Colorectal Cancer (HNPCC). This is a rare genetic syndrome in which affected individuals are at risk of colorectal cancer, as well as other cancers including gastric cancer, at a young age. Individuals with a strong family history of colorectal cancer, or colon cancer and endometrial (uterus) cancer, may have this syndrome and may warrant genetic testing and/or screening with colonoscopy.

Is Irritable Bowel Syndrome a risk factor for developing colorectal cancer?
Ir
ritable Bowel Syndrome (IBS) is a chronic functional problem of the gut, usually characterized by patterns of diarrhea and loose stools alternating with constipation. IBS may also be associated with abdominal cramping and pain. IBS is not associated with an increased risk of developing colorectal cancer. Patients with IBS have normal life expectancies but should follow the recommended screening guidelines appropriate to their population. If your IBS symptoms change from their usual behavior or regular pattern, or if you see blood in your stool, notify your physician and gastroenterologist.

Can I inherit risk factors for colorectal cancer?  There are two hereditary syndromes that are important risk factors for colorectal cancer. Read more about these below. 

What other things can increase my risk? 
It is thought that consuming red meat, being overweight, smoking, alcohol use, and older age can all contribute to a higher risk for colorectal cancer. 

Can people under 45 get colorectal cancer?

In general, it is very uncommon for younger people to get colorectal cancer if there is no family history and if the person is under 30.

However, there are two well-recognized hereditary syndromes in which cancer can develop in young people. The first is Familial Adenomatous Polyposis (FAP). This is a disease in which affected people develop hundreds to thousands of precancerous polyps in the colon. Unless the colon is removed, 100% of these patients will get colorectal cancer, usually by their late 30s.

The other disorder is Hereditary Non-Polyposis Colorectal Cancer (HNPCC). In this syndrome, cancers also occur early and develop from polyps. The disease also can present at a later age. The standard recommendation is colonoscopy in at-risk younger people of affected families beginning at age 25 and repeated every two years. Genetic testing may also be helpful. 

See below for more information about hereditary syndromes that increase a person's risk for CRC.

In addition, recent studies have reported an increase in colorectal cancer (CRC) in people younger than 50 years of age (early-onset CRC), despite a decrease in the incidence of CRC in older individuals (late-onset CRC. Tumors from early-onset CRC patients tend to have certain characteristics, features and location within the colon. The reasons for this increase in CRC in younger people who do not have the two well-recognized hereditary syndromes are not well understood. 

We do know that, even without one of the above syndromes, children of people who developed colon cancer at a young age are at higher risk for early colon cancers themselves. When discussing screening with your doctor, make sure to note the age at which any relative had their first polyp or when they developed cancer. This will help to determine at what age you should begin screening -- typically ten years earlier than the age at which your family member was diagnosed.

In addition, experts recommend that physicians keep this early-onset trend in mind when evaluating patients who report rectal bleeding or other symptoms that could indicate CRC.



Hereditary Syndromes 

There are two well-recognized hereditary syndromes in which cancer can develop in young people. The first is Familial Adenomatous Polyposis (FAP). This is a disease in which affected people develop hundreds to thousands of precancerous polyps in the colon. Unless the colon is removed, 100% of these patients will get colorectal cancer, usually by their late 30s. The disease is inherited directly from an affected parent (autosomal dominant inheritance), and the average age for polyp development in this syndrome is the mid-teens. 

If a family is known to have FAP, the affected parent and at-risk children may be screened for a gene mutation with a genetic test. Children who do not or cannot have genetic tests should start having sigmoidoscopies or colonoscopies at about 10 or 12 years old and every 6 to 12 months to look for polyps. Once numerous polyps start developing, surgery is planned. The good news about this disease is that the surgical options are very good and now the colon can often be removed by a laparoscopic approach called colectomy. The bowel is put directly back together and no bag is necessary. 

The other disorder is Hereditary Non-Polyposis Colorectal Cancer (HNPCC). In this syndrome, cancers also occur early and develop from polyps. The disease also can present at a later age. The standard recommendation is colonoscopy in at-risk children of affected families beginning at age 25 and repeated every two years. Genetic testing may also be helpful. 

As you can see, there are specific recommendations for children in families with high rates of colon cancer. However, the specific syndrome must be known. It is very important for children from families with FAP or HNPCC to be seen by experts who have experience with these syndromes and in institutions where genetic counseling and testing services are available. 

Prevention 

What diet should I follow to prevent colorectal cancer from occurring? Are there any foods that actually cause colorectal cancer?

There are no foods that cause colorectal cancer. However, there appears to be a slightly increased risk of developing colorectal cancer in countries with higher red meat, processed meat, or non-dairy (meat-associated) fat intake. Similarly, decreased rates of colorectal cancer have been linked to increased fiber intake, though studies are not conclusive.  In general, experts recommend a diet high in vegetable fiber, low in fat, low in processed foods, and moderate to low amounts of red meat. There remain many unanswered questions in this area. No matter what your dietary intake is, remember to ask your doctor about the appropriate screening test to identify polyps and early cancers.

Can vitamins help prevent colon cancer?

Green vegetables, which are rich in the antioxidant vitamins C, E and beta-carotene and a good source of dietary fiber, seem to provide some protection against colorectal cancer. Tea catechins and related polyphenols may have a positive effect. Grape juice also may help inhibit development of colorectal cancer. Finally, calcium, vitamin D and, perhaps, folic acid appear to have protective effects in the colon. Clinical trials are needed to find out more. Be careful of over-the-counter dietary supplements touted to decrease the risk of colon (or any other) cancer. Let your doctor know if you are taking any over-the-counter medications to try to decrease your cancer risk, so he or she can make sure that they are right for you.

Does fiber play a protective role in colorectal cancer?

The question of whether fiber plays a protective role against colorectal cancer is controversial. Early studies suggested that fiber is indeed protective, whereas more recent and highly publicized studies find no protective effect. Pending additional studies that may resolve this controversy, a high-fiber diet is recommended because of its overall nutritional value, and because it promotes good bowel function. Furthermore, fiber is also beneficial for individuals with diabetes, heart disease, hypertension and a variety of other medical conditions.

Are there lifestyle changes that I can make to prevent colon cancer?

There are several lifestyle factors that seem to influence the risk of colon cancer. Smoking has been associated with an increased risk of multiple cancers including colon cancer. Additionally, being overweight or obese and leading a relatively inactive, sedentary lifestyle has been associated with an increased risk of colon cancer. In general we recommend leading a healthy lifestyle by incorporating routine exercise, maintaining a healthy weight, eating a nutritious diet, and abstaining from tobacco.  

Does an aspirin a day help?

There is evidence that suggests that people who are regularly taking aspirin or other non-steroidal anti-inflammatories such as ibuprofen and naproxen may have lower risks of colon cancer than others. However, these medications also may have unwanted side effects, such as stomach inflammation and ulcers. If your doctor has already prescribed aspirin to help protect your heart, you may also be lowering your risk of colon cancer. However, if you have not been put on an aspirin regimen by your doctor, do not start taking aspirin without consulting with your physician. It may not be right for you.

Who's at Risk for Colon Cancer?

The American Society for Gastrointestinal Endoscopy (ASGE) has produced educational videos for patients to learn about endoscopic procedures and the conditions they are used to diagnose and treat.