This column comes in observation of National Colon Cancer Awareness Month.

According to the American Cancer Society, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. Though the death rate from colorectal cancer has been dropping for decades, an estimated 51,020 deaths are expected to occur in 2019, making it important to have a basic knowledge of the disease and its associated risk factors.

The first step to prevention and early detection is understanding that colorectal cancer is a disease in which abnormal cells in the colon or rectum divide uncontrollably, ultimately forming a malignant tumor. The term “colorectal cancer” is used to describe cancer of the colon and/or rectum, which are often grouped together due to many common characteristics shared between the two. Together, the colon and rectum make up the large intestine, a question mark-shaped bowel four feet long.

What are potential risk factors?

There are several risk factors associated with the development of colorectal cancer, some of which can be controlled through lifestyle modifications like diet and exercise. Being aware of other factors like genetics and age can help you and your doctor develop a plan to reduce risks through tests and regular screenings. Risk factors to be aware of include:

• Age: The likelihood of colorectal cancer diagnosis increases after the age of 40, rising sharply after 50. However, increasing incidence of colorectal cancer in young adults has created cause for concern in the medical community. Colorectal cancer is now in the top ten most common cancers in people younger than 49 years old. In 2018, the American Cancer Society lowered the suggested screening from 50 to 45. If you are 45 or older, you should talk to your doctor about your screening and prevention options.

• Family History: Individuals with family history of colorectal cancer or adenomatous polyps are at increased risk for developing colorectal cancer. If someone in your immediate family has a history of colorectal cancer or polyposis, talk with your doctor about obtaining earlier screening evaluations and prevention options.

• Diet: A study published by PubMed Central reports meta-analyses (large pooled study analyses) show a 20 to 30 percent higher risk of developing colorectal cancer in higher consumers of red and processed meat. Reducing red and processed meat intake while increasing fiber intake can lower your risks. To get the fiber your body needs (25-35 grams per day), eat a well-balanced diet that includes fiber-rich foods like vegetables, fruits and whole grains.

• Obesity: According to, people who are obese are 30 percent more likely to develop colorectal cancer than people of average weight. Being physically active reduces your risk of colorectal cancer by 20 percent. With the added benefit of exercise in reducing hypertension and insulin secretion, the value of increasing activity is immense. The American Heart Association recommends at least 150 minutes per week of moderate-intensity aerobic activity, 75 minutes per week of vigorous aerobic activity and/or moderate to high-intensity muscle-strengthening activity at least twice a week.

• Alcohol Intake: Meta-analyses demonstrate that heavy alcohol users have a 60 percent greater risk of developing colorectal cancer than nondrinkers or moderate drinkers. Additionally, alcohol use is associated with younger onset of colorectal cancer. The Centers for Disease Control and Prevention (CDC) defines moderate alcohol consumption as one drink per day for women and up to two drinks per day for men.

• Smoking: Cancer-causing compounds associated with smoking increase risk of developing polyps, the precursor to development of cancer. A study published in the US National Library of Medicine reports that nearly 12 percent of colorectal cancer deaths are attributable to smoking. The best way to limit risks associated with smoking cigarettes is to quit smoking altogether, however, alternatives such as nicotine gum and patches are available to those wishing to reduce their risk.

What are the steps to get screened?

Once you’ve determined your risk factors, screening may be a necessary step in managing your health. Several screening options exist for detecting signs of cancer and precancerous cells. As a medical oncologist focused on gastrointestinal malignancies at Cancer Treatment Centers of America (CTCA), Atlanta, I recommend an initial colonoscopy beginning at age 45 for people without high-risk factors (strong family history of colorectal cancer or certain types of polyps; prior ulcerative colitis or Crohn’s disease; and known carriers of inherited syndromes such as Lynch or familial polyposis syndromes).

A colonoscopy can detect precancerous polyps so they can be removed before becoming cancerous. Screening may also help find colorectal cancer at an early stage, when there are more treatment options and a better chance of being cured. When detected early and treated appropriately, colorectal cancer has a nearly 90 percent, five-year survival rate.

Colonoscopies can sometimes intimidate patients from getting screened, leading them to elect stool tests as an alternative. While technology has improved the accuracy of stool tests in detecting DNA mutations or signs of blood that may indicate cancer, negative results miss the possibility that small polyps may be lurking, posing risks of developing into tumors later.

Colorectal cancer, in most circumstances, is preventable. Education regarding a healthy lifestyle and access to screening can significantly reduce risk of developing this potentially deadly disease. Stay on top of your health by knowing your risk factors and working with your doctor to schedule appropriate screenings, if needed.

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Eyal Meiri, MD, is the interim chief of medical oncology and member of the Gastrointestinal Cancer Center at Cancer Treatment Centers of America in Newnan, Georgia.


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