Lifestyle, Nutrition, and Colorectal Cancer

Colorectal Cancer Under Fifty

Caroline Dombrowski

Although colorectal cancer is declining for many groups in the US, cases continue to rise in patients under the age of 50 years.1 People under the age of 50 also tend to have more aggressive colorectal cancers, which is a prime example of a condition that can be prevented with lifestyle interventions.2 Screening for colorectal cancer begins at 50 years of age, and early detection is highly correlated with decreased mortality.1

This 2018 data line up with a study from 2017, which found a 22% increased rate of colon cancer in people under the age of 50, as well as an increased risk of death from colon cancer in this younger group.2

Many factors are likely to contribute, including:

  • Alcohol use: Moderate and heavy alcohol use raises the risk of colorectal cancer,3,4 and alcohol use and binge drinking is soaring throughout the US, with significant increases in alcohol usage, high-risk drinking, and alcohol use disorder across most sociodemographic groups, with greater increases for most non-white populations.5
  • Oral health: Although still emerging, research suggests poor oral health may raise the risk for colorectal cancer.6 A recent study links periodontal disease to increased risk of colorectal cancer.3 Estimates are that almost half of Americans have periodontal disease.7,8 Risk of periodontal disease is much higher in lower-income groups.8 Periodontitis may be a risk factor for many cancers,9,10 especially smoking-related cancers (note that this study found no correlation between periodontitis, nonsmokers, and colorectal cancer).10 Tooth loss has also been correlated with increased risk for colorectal cancer, possibly due to associated Fusobacteria.11
  • Processed meat consumption: Processed meat is known to have carcinogenic effects,12 and the International Agency for Research on Cancer concludes that it contributes to colorectal cancer.13 Men consume more meat than women,14 which may play a role in their increased colorectal cancer risk. The highest meat consumption is among people aged 20 to 49, and over the last century, meat intake has gone up dramatically in the US.15
Recommendations for At-Risk Patients

Many of the recommendations for preventing colorectal cancer are core tenets of Functional Medicine. For instance, high fruit and vegetable consumption appears to be protective.4 Research supports the benefits of a high-fiber, low-meat diet to prevent colorectal cancer.16 Diets with lower overall nutrition are linked to many forms of cancer, including colorectal.17

In addition, consumption of green tea has strong research support as preventative for colorectal cancer, primarily in cohort and case-controlled studies in Asia and America.18,19 This effect may be stronger in women.19

Aspirin also seems to be protective against developing colon cancer20,21 and may aid in survival for patients with KRAS wild-type tumors.22

Finally, the importance of screening cannot be understated. One estimate has found that 79% of “averted colorectal cancer deaths” were due to prevention by removing adenomatous polyps,23 which reinforces the notion that colorectal screening is critical for patients at risk.

References

  1. Ansa BE, Coughlin SS, Alema-Mensah E, Smith SA. Evaluation of colorectal cancer incidence trends in the United States (2000-2014). J Clin Med. 2018;7(2):E22. doi:3390/jcm7020022.
  2. Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017;67(3):177-193. doi:3322/caac.21395.
  3. Lee D, Jung KU, Kim HO, Kim H, Chun HK. Association between oral health and colorectal adenoma in a screening population. Medicine (Baltimore). 2018;97(37):e12244. doi:1097/MD.0000000000012244.
  4. Johnson CM, Wei C, Ensor JE, et al. Meta-analyses of colorectal cancer risk factors. Cancer Causes Control. 2013;24(6):1207-1222. doi:1007/s10552-013-0201-5.
  5. Grant BF, Chou SP, Saha TD, et al. Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry. 2017;74(9):911-923. doi:1001/jamapsychiatry.2017.2161.
  6. Barton MK. Evidence accumulates indicating periodontal disease as a risk factor for colorectal cancer or lymphoma. CA Cancer J Clin. 2017;67(3):173-174. doi:3322/caac.21367.
  7. Eke PI, Dye BA, Wei L, et al. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91(10):914-920. doi:1177/0022034512457373.
  8. Rozier RG, White BA, Slade GD. Trends in oral diseases in the U.S. population. J Dent Educ. 2017;81(8):eS97-eS109. doi:21815/JDE.017.016.
  9. Corbella S, Veronesi P, Galimberti V, Weinstein R, Del Fabbro M, Francetti L. Is periodontitis a risk indicator for cancer? A meta-analysis. PLoS One. 2018;13(4):e0195683. doi:1371/journal.pone.0195683.
  10. Michaud DS, Kelsey KT, Papathanasiou E, Genco CA, Giovannucci E. Periodontal disease and risk of all cancers among male never smokers: an updated analysis of the Health Professionals Follow-up Study. Ann Oncol. 2016;27(5):941-947. doi:1093/annonc/mdw028.
  11. Momen-Heravi F, Babic A, Tworoger SS, et al. Periodontal disease, tooth loss and colorectal cancer risk: results from the Nurses’ Health Study. Int J Cancer. 2017;140(3):646-652. doi:1002/ijc.30486.
  12. Bouvard V, Loomis D, Guyton KZ, et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncol. 2015;16(16):1599-1600. doi:1016/S1470-2045(15)00444-1.
  13. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. IARC Monographs Volume 114: Red Meat and Processed Meat. Lyon, France: International Agency for Research on Cancer; 2018. https://monographs.iarc.fr/wp-content/uploads/2018/06/mono114.pdf. Accessed October 8, 2018.
  14. Clonan A, Roberts KE, Holdsworth M. Socioeconomic and demographic drivers of red and processed meat consumption: implications for health and environmental sustainability. Proc Nutr Soc. 2016;75(3):367-373. doi:1017/S0029665116000100.
  15. Daniel CR, Cross AJ, Koebnick C, Sinha R. Trends in meat consumption in the USA. Public Health Nutr. 2011;14(4):575-583. doi:1017/S1368980010002077.
  16. Pan P, Yu J, Wang LS. Colon cancer: what we eat. Surg Oncol Clin N Am. 2018;27(2):243-267. doi:1016/j.soc.2017.11.002.
  17. Deschasaux M, Huybrechts I, Murphy N, et al. Nutritional quality of food as represented by the FSAm-NPS nutrient profiling system underlying the Nutri-Score label and cancer risk in Europe: results from the EPIC prospective cohort study. PLoS Med. 2018;15(9):e1002651. doi:1371/journal.pmed.1002651.
  18. Yang G, Shu XO, Li H, et al. Prospective cohort study of green tea consumption and colorectal cancer risk in women. Cancer Epidemiol Biomarkers Prev. 2007;16(6):1219-1223. doi:1158/1055-9965.EPI-07-0097.
  19. Chen Y, Wu Y, Du M, et al. An inverse association between tea consumption and colorectal cancer risk. Oncotarget. 2017;8(23):37367-37376. doi:18632/oncotarget.16959.
  20. Qiao Y, Yang T, Gan Y, et al. Associations between aspirin use and the risk of cancers: a meta-analysis of observational studies. BMC Cancer. 2018;18(1):288. doi:1186/s12885-018-4156-5.
  21. Din FV, Theodoratou E, Farrington SM, et al. Effect of aspirin and NSAIDs on risk and survival from colorectal cancer. 2010;59(12):1670-1679. doi:10.1136/gut.2009.203000.
  22. Hua X, Phipps AI, Burnett-Hartman AN, et al. Timing of aspirin and other nonsteroidal anti-inflammatory drug use among patients with colorectal cancer in relation to tumor markers and survival. J Clin Oncol. 2017;35(24):2806-2813. doi:1200/JCO.2017.72.3569.
  23. Doroudi M, Schoen RE, Pinsky PF. Early detection versus primary prevention in the PLCO flexible sigmoidoscopy screening trial: which has the greatest impact on mortality? 2017;123(24):4815-4822. doi:10.1002/cncr.31034.