Colorectal Cancer

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Causes, Risk Factors, and Prevention TOPICS

Can colorectal cancer be prevented?

Even though we don't know the exact cause of most colorectal cancers, it is possible to prevent many of them.

Screening

Regular colorectal cancer screening is one of the most powerful weapons for preventing colorectal cancer. Screening is the process of looking for cancer or pre-cancer in people who have no symptoms of the disease.

From the time the first abnormal cells start to grow into polyps, it usually takes about 10 to 15 years for them to develop into colorectal cancer. Regular screening can, in many cases, prevent colorectal cancer altogether. This is because most polyps can be found and removed before they have the chance to turn into cancer. Screening can also result in finding colorectal cancer early, when it is highly curable.

People who have no identified risk factors (other than age) should begin regular screening at age 50. Those who have a family history or other risk factors for colorectal polyps or cancer, such as inflammatory bowel disease, should talk with their doctor about starting screening at a younger age and/or getting screened more frequently. (See our screening guidelines in the section “American Cancer Society recommendations for colorectal cancer early detection.”)

Genetic testing, screening, and treatment for those with a strong family history

If you have a strong family history of colorectal polyps or cancer, you should talk with your doctor about genetic counseling to review your family medical tree, see how likely it is that you have one of these syndromes, and discuss whether or not genetic testing may be right for you. This can also help you decide to take steps to prevent colon cancer, like getting screened and treated at an early age.

Before getting genetic testing, it's important to know ahead of time what the results may or may not tell you about your risk. Genetic testing is not perfect, and in some cases the tests may not be able to provide solid answers. This is why meeting with a genetic counselor or cancer genetics professional is crucial in deciding if testing should be done. More about this can be found in our document Genetic Testing: What You Need to Know.

Genetic tests can help determine if members of certain families have inherited a high risk for developing colorectal cancer due to syndromes such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC). Without genetic testing, all members of a family known to have an inherited form of colorectal cancer should start screening at an early age, and get screened frequently. If genetic testing is done for a known mutation within a family, those members who are found not to have the mutated gene may be able to be screened at the same age and frequency as people at average risk.

When looking at whether testing might be appropriate, a genetic counselor will try to get a detailed view of your family history. For example, doctors have found that many families with HNPCC tend to have certain characteristics:

  • At least 3 relatives have colorectal cancer.
  • One should be a first-degree relative (parent, sibling, or child) of the other 2 relatives.
  • At least 2 successive generations are involved.
  • At least 1 relative had their cancer when they were younger than age 50.

These are called the Amsterdam criteria. If these hold true for your family, then you might want to seek genetic counseling. But even if your family history satisfies the Amsterdam criteria, it doesn't always mean you have HNPCC. Only about half of families who meet the Amsterdam criteria have HNPCC. The other half do not, and although their colorectal cancer rate is about twice as high as normal, it is not as high as that of people with HNPCC. On the other hand, many families with HNPCC do not meet the Amsterdam criteria.

A second set of criteria, called the revised Bethesda guidelines, are used to determine whether a person with colorectal cancer should have his or her cancer tested for genetic changes that are seen with HNPCC. These criteria include at least one of the following:

  • The person is younger than 50 years.
  • The person has or had a second colorectal cancer or another cancer (endometrial, stomach, pancreas, small intestine, ovary, kidney, brain, ureters, or bile duct) that is associated with HNPCC.
  • The person is younger than 60 years and the cancer has certain characteristics seen with HNPCC when viewed under the microscope or with other lab tests.
  • The person has a first-degree relative younger than 50 who was diagnosed with colorectal cancer or another cancer often seen in HNPCC carriers (endometrial, stomach, pancreas, small intestine, ovary, kidney, brain, ureters, or bile duct).
  • The person has 2 or more first- or second-degree relatives who had colorectal cancer or an HNPCC-related cancer at any age (second-degree relatives include uncles, aunts, grandparents, nieces, nephews and grandchildren).

If a person with colorectal cancer has any of the Bethesda criteria, genetic testing to look for an inherited HNPCC-associated gene mutation is advised. Still, most people who meet the Bethesda criteria do not have HNPCC, and not all families with HNPCC meet any of the criteria listed.

Even if you don’t have cancer, your doctor may suspect that HNPCC runs in your family based on cases of colorectal cancer and other cancers associated with this syndrome in your relatives. In that case, your doctor may recommend genetic counseling to evaluate your risk.

The lifetime risk of colorectal cancer for people with an HNPCC mutation may be as high as 80%. In families known to carry an HNPCC gene mutation, doctors recommend that family members who have tested positive for the mutation and those who have not been tested should start colonoscopy screening during their early 20s to remove any polyps and find any cancers at the earliest possible stage (see the section “Can colorectal polyps and cancer be found early?”). People known to carry one of the gene mutations may also be offered the option of removal of most of the colon.

Genetic counseling and testing is also available for those at risk of FAP. Their lifetime risk of developing colorectal cancer is near 100%, and in most cases it develops before the age of 40. People who test positive for the gene change linked to FAP should start colonoscopy during their teens (see the section “Can colorectal polyps and cancer be found early?”). Most doctors recommend they have their colon removed when they are in their 20s to prevent cancer from developing.

Diet, exercise, and body weight

You can lower your risk of developing colorectal cancer by managing the risk factors that you can control, like diet and physical activity.

Most studies have found that being overweight or obese increases the risk of colorectal cancer in both men and women, but the link seems to be stronger in men. Having more belly fat (that is, a larger waistline) has also been linked to colorectal cancer.

Overall, diets that are high in vegetables, fruits, and whole grains (and low in red and processed meats) have been linked with lower colorectal cancer risk, although it's not exactly clear which factors are important. Many studies have found a link between red meat or processed meat intake and increased colorectal cancer risk.

Studies show a lower risk of colorectal cancer and polyps with increasing levels of activity. Moderate activity on a regular basis lowers the risk, but vigorous activity may have an even greater benefit.

In recent years, some large studies have suggested that fiber in the diet, especially from whole grains, may lower colorectal cancer risk. Research in this area is still under way.

Several studies have found a higher risk of colorectal cancer with increased alcohol intake, especially among men.

At this time, the best advice about diet and activity to possibly reduce your risk of colorectal cancer is to:

  • Increase the intensity and amount of physical activity.
  • Limit intake of red and processed meats.
  • Get the recommended levels of calcium and vitamin D (see below).
  • Eat more vegetables and fruits.
  • Avoid obesity and weight gain around the midsection.
  • Avoid excess alcohol.

For more information about diet and physical activity, refer to our document American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention.

Vitamins, calcium, and magnesium

Some studies suggest that taking a daily multi-vitamin containing folic acid, or folate, may lower colorectal cancer risk, but not all studies have found this. In fact, some studies have hinted that folic acid might help existing tumors grow. More research is needed in this area.

Some studies have suggested that vitamin D, which you can get from sun exposure, in certain foods, or in a vitamin pill, can lower colorectal cancer risk. Because of concerns that excessive sun exposure can cause skin cancer, most experts do not recommend this as a way to lower colorectal cancer risk at this time.

Other studies suggest that increasing calcium intake may lower colorectal cancer risk. Calcium is important for a number of health reasons aside from possible effects on cancer risk. But because of the possible increased risk of prostate cancer in men with high calcium intake, the American Cancer Society does not recommend increasing calcium intake specifically to try to lower cancer risk.

Calcium and vitamin D may work together to reduce colorectal cancer risk, as vitamin D aids in the body's absorption of calcium. Still, not all studies have found that supplements of these nutrients reduce risk.

A few studies have looked at a possible link between a diet high in magnesium and reduced colorectal cancer risk. Some, but not all, of these studies have found a link, especially among women. More research is needed to determine if this link exists.

Nonsteroidal anti-inflammatory drugs

Many studies have found that people who regularly use aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin®, Advil®) and naproxen (Aleve®), have a lower risk of colorectal cancer and adenomatous polyps. Most of these studies looked at people who took these medicines for reasons such as to treat arthritis or prevent heart attacks. Other, stronger studies have provided evidence that aspirin can prevent the growth of polyps in people who were previously treated for early stages of colorectal cancer or who previously had polyps removed.

But aspirin and other NSAIDs can cause serious or even life-threatening side effects such as bleeding from stomach irritation, which may outweigh the benefits of these medicines for the general public. For this reason, experts do not recommend NSAIDs as a cancer prevention strategy for people at average risk of developing colorectal cancer.

The value of these drugs for people at increased colorectal cancer risk is being actively studied. Celecoxib (Celebrex®) has been approved by the US Food and Drug Administration for reducing polyp formation in people with familial adenomatous polyposis (FAP). This drug may cause less bleeding in the stomach than other NSAIDs, but it may increase the risk of heart attacks and strokes.

Aspirin or other NSAIDs can have serious side effects, so check with your doctor before starting to take any of them on a regular basis.

Female hormones

Taking estrogen and progesterone after menopause (sometimes called menopausal hormone therapy or combined hormone replacement therapy) may reduce the risk of developing colorectal cancer in postmenopausal women, but cancers found in women taking these hormones after menopause may be at a more advanced stage. Taking estrogen and progesterone after menopause also lowers the risk of developing osteoporosis (bone thinning). But it can also increase a woman's risk of heart disease, blood clots, and cancers of the breast and lung.

The decision to use menopausal hormone therapy should be based on a careful discussion of the possible benefits and risks with your doctor.

Some studies have found that the use of oral contraceptives (birth control pills) may lower the risk of colorectal cancer in women. More research is needed to confirm this link.


Last Medical Review: 07/30/2013
Last Revised: 01/31/2014