What are the risk factors for colorectal cancer?
Over 1.4 million Americans are currently living with colorectal cancer, also known as bowel cancer. In 2024, 152,810 people in the US are expected to be diagnosed with colorectal cancer, and 53,010 people are expected to die from it.In the general population, the lifetime risk of developing colorectal cancer is 1 in 23 for men and 1 in 25 for women. However, some environmental and genetic risk factors can increase a person’s risk of developing bowel cancer.
Risk factors for colorectal cancer
Modifiable risk factors
Non-modifiable risk factors
Alcohol consumptionSmokingLack of exerciseOverweight and obesityExcess consumption of carbs, processed carbs, processed meats, red meat, and saturated fatsInsufficient consumption of vitamin D, and omega-3 fatty acidsDysbiosis (imbalance of gut microbes)
Age and sexGenetic predispositionPrevious medical procedures including radiation therapy in the abdomen or pelvis, kidney transplant, and gall bladder removalDiabetes and prediabetesInflammatory bowel diseases including ulcerative colitis and Crohn’s diseaseCoronary heart diseaseAntibiotic use
Modifiable risk factors Alcohol consumptionAlcohol consumption increases the risk of developing colorectal cancer. The amount of alcohol matters, as the risk goes up with increasing alcohol consumption. Heavy drinkers are therefore at a higher risk of colorectal cancer.Interestingly, some studies have reported that while alcohol increased the risk of colorectal cancer, coffee consumption decreased the risk.
Swap alcohol for coffee to reduce the risk of colorectal cancer
SmokingResearch studies have repeatedly associated smoking with an increased risk of colorectal cancer. Even though the toxins from cigarette smoke are inhaled and first come in contact with the airways of the lungs, they eventually make their way to the colon’s mucosal cells. The colon’s mucosal cells are pale pink cells with a smooth glistening surface through which the underlying blood vessels can be seen. Long-term exposure of mucosal cells to carcinogens from cigarette smoke can cause cancer in these cells. There is a dose-dependent response– the more someone smokes, the higher their risk of cancer.In addition to the exposure to toxins, cigarette smoking may also increase the risk of colorectal cancer by changing the gut microbiome- the composition of the beneficial organisms that live inside the gut.While women have a reduced risk of colorectal cancer than men, and women who smoke also tend to smoke less than men, smoking-related risk of colorectal cancer was similar for men and women.Lack of exerciseExercise can significantly reduce the risk of cancer, particularly colorectal cancer. Exercise can decrease the risk of colon cancer by 16-19% and rectal cancer by 13%. About 15% of colon cancers can be prevented by exercising regularly.Exercise has a strong, linear, and dose-dependent effect. Gains are made with any addition to the duration or intensity of the workout.Overweight and obesityObesity and being overweight are risk factors for developing colorectal cancer. In some studies, 12% of global cases of colorectal cancer were attributed to being overweight or obese.Unhealthy dietDifferent dietary components can positively or negatively affect the risk of colorectal cancer.Eating too many carbohydrates, especially refined carbohydrates and sugary drinks increases the risk of colorectal cancer. On the other hand, eating whole grains lowers the risk of colorectal cancer.A high-fat diet can increase the risk of colorectal cancer by increasing inflammation, changing metabolism, stem cell regulation, and intestinal microbial diversity. However, omega-3 fatty acids may be beneficial as they help inhibit cancer growth and spread.Vitamin D reduces the risk of colorectal cancer by affecting immune cell function and cytokine production. Specifically, vitamin D reduces the risk of cancer formation by reducing inflammation and inhibiting cancer growth and spread.Eating processed meat and red meat can increase the risk of colorectal cancer. According to estimates, every 50 g of processed meat consumed per day increases the risk of colorectal cancer by 16%, whereas every 100 g of red meat consumed per day increases the risk by 12%.DysbiosisDysbiosis is the imbalance of microbes in our bodies, especially in the gut. Our gut is home to viruses, protozoa, and over four hundred species of bacteria. These microbes play many roles from synthesizing hormones to maintaining immunity. It is being increasingly understood that overpopulation of the gut with harmful microbes and depletion of beneficial microbes can cause a variety of diseases including colorectal cancer. Therefore, probiotics are being studied to prevent colorectal cancer and potentially treat the disease.
Non-modifiable risk factors
Older adults are at a higher risk of colorectal cancer
AgeWhile younger individuals can also get colorectal cancer, the disease is more common in older adults. The risk of colorectal cancer increases after age 50.SexBiological sex affects the likelihood of getting colorectal cancer. Estrogens (the female sex steroid hormones) may have a protective role against colorectal cancer whereas androgens (the male sex steroid hormones) may increase the risk. In general, men have a higher risk of colorectal cancer than women.Genetic predispositionSome genes when mutated can increase the risk of colorectal cancer. Lynch syndrome, recognized by mutations in some genes that repair DNA, increases colon cancer risk. Other hereditary mutations that increase colorectal cancer risk include those in the APC gene (familial adenomatous polyposis), and BReast CAncer genes 1 and 2 (BRCA1 and BRCA2). However, these mutations do not explain the occurrence of all or even most hereditary colorectal cancers. Other genetic factors that predispose individuals to colorectal cancer are yet to be discovered.Previous medical proceduresSome previous medical procedures can make it more likely to develop colorectal cancer.Previous radiation therapy in the abdomen or pelvis, as would be done for treating prostate cancer, can increase the risk.Gallstone removal, gall bladder disease, and gall bladder removal are associated with increased risk.Diabetes and prediabetesDiabetes is associated with a 47% increase in the risk of colorectal cancer. Additionally, prediabetes- a condition when someone’s blood sugar is higher than normal but not so high as to be characterized as diabetic- is an independent risk factor for colorectal cancer. In prediabetes, the excess blood sugar, excess insulin production, and excess generation of fat cells all contribute to molecular pathways that increase the risk of colorectal cancer.Inflammatory bowel diseases Having an inflammatory bowel disease (e.g. ulcerative colitis and Crohn’s disease) increases the risk of colorectal cancer. Patients who have ulcerative colitis, an autoimmune disease that inflames the colon, have an average risk of 1.4% for developing colorectal cancer. Crohn’s disease causes inflammation in the colon as well, resulting in higher cancer risk. By controlling inflammatory bowel diseases through medication and diet, the amount of inflammation may be reduced reducing the cancer risk. Regular colonoscopy screenings are also recommended for monitoring the colon lining and supporting early cancer detection.Coronary heart diseaseUnfavorable cardiovascular risk factors and cardiovascular diseases are associated with an increased risk of developing colorectal cancer.Antibiotic useAntibiotics can be lifesaving medicines that can stop infections such as syphilis and Lyme disease before they can do irreversible damage to our brain and other organs. However, antibiotics can also wipe out the beneficial microbes in our bodies and guts that protect us from other diseases. Antibiotics that wipe out gut bacteria increase the risk of early onset of colorectal cancer by as much as 49%. Antibiotics that did not affect the gut microbiome also did not affect cancer risk.
The information provided in our blog posts is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
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