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How to Reduce Your Risk of Colorectal Cancer in 2020

Cancer stories are powerful. They start off with some shock and disbelief, then the fighting for life comes and in some cases, the story has a fairly happy ending of remission. In a lot more cases, however, the story does not end well. These latter stories are full of reminiscing about life before illness and living well while dying from cancer. The incidence of cancer worldwide is on a continuous rise, with approximately 17 million new cancer cases in 2018 and an estimated 27.5 million new cancer cases each year, by 2040. Cancer research is trying to keep up with the rising incidence and although survival rates, by cancer, are increasing, cancer is still the second leading cause of death globally.
Colorectal cancer, a cancer that starts as a growth (or polyp) on the inner lining of the colon or rectum, is the third most common type of cancer and the second most common cause of cancer related death worldwide. In Canada, colorectal cancer accounts for 12% of new cancer cases, as well as cancer related deaths. The colorectal cancer incidence rate is highest in North America, northwestern Europe and Australia. Rates are lower in less industrialized countries, including those in Asia, Africa and South America. Since 1990, better treatment and surgical options have made a difference in survival rates. The growths/polyps are slow growing and colorectal cancer may not show any signs or symptoms in its early stages and additionally, other health conditions can cause symptoms similar to colorectal cancer, including diarrhea, constipation, blood in stool and bleeding from the rectum, as well as nausea, vomitting, fatigue and weakness, to name a few.
Understanding the risk factors that predispose us to colorectal cancer can help reduce the propensity/risk for developing this and some other cancer types. In general, lifestyle factors appear more important than genetic factors in determining the development of colorectal cancers. Some of the risk factors for colorectal cancer include age, familial/personal history of colorectal cancer, rare genetic conditions, physical inactivity, type II diabetes, a diet high in red meat, polyps in the colon and rectum, smoking and certain lifestyle choices.
Not all colorectal cancer will develop in people exposed to the risk factors associated with colorectal cancer and every day brings with it a new potential risk factor, so making conscious choices to reduce the risks of developing colorectal cancer is essential.
There are six main steps that may help prevent or reduce the risk of developing colorectal cancer and they are;

  1. Get screened: this is especially important, as we get older, as most diagnosis of colorectal cancer is in people over the age of 50. Although many people have a fear of colonoscopies, the fear of dying from colorectal cancer should take precedence.
  2. Aspirin intake: Aspiring is a non-steroidal anti-inflammatory drug (NSAID) that might be useful in reducing the risk of cancer, especially since chronic inflammation is a big risk factor for many cancers and inflammatory bowel disease (IBD) is one of the risk factors for colorectal cancer. The U.S. Preventive Services Task Force found that taking low-dose aspirin could help prevent cardiovascular disease and colorectal cancer in some adults, depending on age and risk factors. However, this is not recommended for widespread use, as aspirin intake is associated with an increased risk of gastrointestinal bleeding and ulcer formation.
  3. Increased vitamin D intake: several studies have linked low levels of vitamin D (less than 20 ng/ml) with increased risk of developing colorectal cancer. Some health care practitioners recommend at least 2000 IU of vitamin D per day for risk reduction.
  4. Diet & Supplementation: Cooking meat at high temperatures – including beef, pork and poultry) and fish at high temperatures (such as well done, fried, broiled or barbecued) creates chemicals called heterocyclic amines (HCAs). Some HCAs are associated with a higher risk of developing colorectal cancer. Additional evidence against red meat and animal by-products are studies that show that vegetarian diets are associated with an overall reduced risk of colorectal cancer. Studies looking at region specific colorectal cancer risk have determined a favourable role of the Mediterranean diet on colorectal cancer risk, as well as other cancers. This diet includes frequent consumption of vegetables, legumes, fruits and nuts, cereals, fish and olive oil, with a modest consumption of wine, a low-to-moderate consumption of dairy products and a low consumption of meat. Medical experts often recommend a diet low in animal fats and high in fruits, vegetables, and whole grains to reduce the risk of other chronic diseases, such as coronary artery disease and diabetes. This diet also may reduce the risk of colorectal cancer. Vegetarian and plant based diets have been associated with an overall reduced risk of colorectal cancer. Several other compounds have been studied for their roles in reducing the risk of colorectal cancer. These include carbohydrates/fibers like inulin, unsaturated omega-3 fatty acids, vitamins like vitamin D, minerals like calcium and selenium, phytochemicals like resveratrol, curcumin and green tea polyphenols, which affect inflammatory pathways or have antioxidant activity that could be useful in preventing the initiation and progression of colorectal cancer.
  5. Exercise: More than 50 published studies show an associated between exercise and the risk of colorectal cancer. This risk is associated with the increased production of insulin in obese population, which increases cell growth. Additionally, obesity increases the risk for type II diabetes, which then increases the risk for colorectal cancer. Therefore exercising can reduce both the risk of type II diabetes and colorectal cancer, as well as a host of other chronic diseases.
  6. Know your risk factors: Risk factors could be a behaviour, substance or condition that increase the chances of developing a disease. Most cancers, including colorectal cancer are the result of a combination of risk factors, although in a few cases, these risk factors may be hard to pinpoint. Some of the risk factors associated with colorectal cancer are listed above and should be reviewed with health care practitioners, along with yearly physicals and current lifestyle choices.
    Although the incidence rates of cancers, especially colorectal cancer may be decreasing with the introduction of newer therapeutic options, the mortality rates appear to remain constant across the globe. It is essential to take responsibility for our health and take the necessary steps to reduce our exposure and risk to colorectal cancer, as well as other chronic conditions.
    What’s your favourite risk reducing step? Are there any other risk factors you’re aware of?

References:
https://www.cdc.gov/cancer/colorectal/basic_info/prevention.htm
https://www.health.harvard.edu/cancer/5-simple-steps-that-may-help-prevent-colorectal-cancer
https://www.cancer.ca/en/cancer-information/cancer-type/colorectal/risks/?region=on
https://www.who.int/news-room/fact-sheets/detail/cancer
McCulloch, M., Broffman, M., Van Der Laan, M., Hubbard, A., Kushi, L., Abrams, D. I., … Colford, J. M. (2011). Colon cancer survival with herbal medicine and vitamins combined with standard therapy in a whole-systems approach: Ten-year follow-up data analyzed with marginal structural models and propensity score methods. Integrative Cancer Therapies, 10(3), 240–259.
https://doi.org/10.1177/1534735411406539
Orlich, M. J., Singh, P. N., Sabaté, J., Fan, J., Sveen, L., Bennett, H., … Fraser, G. E. (2015). Vegetarian dietary patterns and the risk of colorectal cancers. JAMA Internal Medicine, 175(5), 767–776. https://doi.org/10.1001/jamainternmed.2015.59
Rosato, V., Guercio, V., Bosetti, C., Negri, E., Serraino, D., Giacosa, A., … Tavani, A. (2016). Mediterranean diet and colorectal cancer risk: A pooled analysis of three Italian case-control studies. British Journal of Cancer, 115(7), 862–865.
https://doi.org/10.1038/bjc.2016.245
Terzić, J., Grivennikov, S., Karin, E., & Karin, M. (2010). Inflammation and Colon Cancer. Gastroenterology, 138(6), 2101–2114. https://doi.org/10.1053/j.gastro.2010.01.058

Dr. Pamela Ovadje, PhD

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