- What is colorectal cancer?
- Importance of colorectal cancer screening
- Colorectal cancer risk factors
- Can colorectal cancer be prevented?
- Genetic testing, screening, and prevention for people with a strong family history of colorectal cancer
- Colorectal cancer screening tests
- American Cancer Society recommendations for colorectal cancer early detection
- Colorectal cancer screening: Insurance coverage
- Additional resources
- References: Colorectal cancer prevention and early detection
Colorectal cancer risk factors
A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a person’s age or family history, can’t be changed.
But having a risk factor, or even many risk factors, does not mean that you’ll get the disease. And some people who get the disease may not have any known risk factors.
Researchers have found risk factors that might increase a person’s chance of having colorectal polyps or colorectal cancer.
Risk factors you can change
Many lifestyle-related factors have been linked to colorectal cancer. In fact, the links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer.
Being overweight or obese
If you are overweight or obese (very overweight), your risk of developing and dying from colorectal cancer is higher. Being overweight raises the risk of colon cancer in both men and women, but the link seems to be stronger in men.
If you’re not physically active, you have a greater chance of developing colorectal cancer. Being more active might help lower your risk.
Certain types of diets
A diet that’s high in red meats (beef, pork, lamb, or liver) and processed meats (such as hot dogs and some luncheon meats) can raise your colorectal cancer risk.
Cooking meats at very high temperatures (frying, broiling, or grilling) creates chemicals that might raise your cancer risk, but it’s not clear how much this might increase your risk.
Diets high in vegetables, fruits, and whole grains have been linked with a lower risk of colorectal cancer, but fiber supplements have not been shown to help.
It’s not clear if other dietary components (for example, certain types of fats) affect colorectal cancer risk.
People who have smoked for a long time are more likely than non-smokers to develop and die from colorectal cancer. Smoking is a well-known cause of lung cancer, but it’s also linked to other cancers, like colorectal cancer. If you smoke and would like to learn more about quitting, see our Guide to Quitting Smoking.
Heavy alcohol use
Colorectal cancer has been linked to heavy alcohol use. Limiting alcohol use to no more than 2 drinks a day for men and 1 drink a day for women could have many health benefits, including a lower risk of colorectal cancer.
Colorectal cancer risk factors you cannot change
The risk of colorectal cancer goes up as you age. Younger adults can develop colorectal cancer, but the chances increase markedly after age 50.
Personal history of colorectal polyps or colorectal cancer
If you have a history of adenomatous polyps (adenomas) in the colon or rectum, you have a higher risk of developing colorectal cancer. This is especially true if the polyps are large or if there are many of them.
If you’ve had colorectal cancer, even though it has been completely removed, you’re more likely to develop new cancers in other areas of the colon and rectum. The chances of this happening are greater if you first had colorectal cancer when you were younger.
Personal history of inflammatory bowel disease
If you have inflammatory bowel disease (IBD), including either ulcerative colitis or Crohn’s disease, you have a higher risk of colorectal cancer.
IBD) is a condition in which the colon is inflamed over a long period of time. People who have had IBD for many years often develop dysplasia. Dysplasia is a term used to describe cells in the lining of the colon or rectum that look abnormal (but not like true cancer cells) when seen under a microscope. These cells can change into cancer over time.
If you have IBD, you may need to start colorectal cancer screening at a younger age and be screened more often.
Inflammatory bowel disease is different from irritable bowel syndrome (IBS). IBS is not linked to an increased risk for colorectal cancer.
Family history of colorectal cancer or adenomatous polyps
Most colorectal cancers are found in people without a family history of colorectal cancer. Still, as many as 1 in 5 people with colorectal cancer have other family members who have had it.
People with a history of colorectal cancer in a first-degree relative (parent, sibling, or child) are at increased risk. The risk is even higher if the first-degree relative was diagnosed when they were younger than 45, or if more than one first-degree relative is affected.
The reasons for the increased risk are not clear in all cases. Cancers can “run in the family” because of inherited genes, shared environmental factors, or some combination of these.
Having family members who have had adenomatous polyps is also linked to a higher risk of colon cancer. (Adenomatous polyps are the kind of polyps that can become cancer.)
If you have a family history of adenomatous polyps or colorectal cancer, ask your doctor if you should start screening before age 50. If you have had adenomatous polyps or colorectal cancer, it’s important to tell your close relatives so that they can pass along that information to their doctors and start screening at the right age.
About 5% to 10% of people who develop colorectal cancer have inherited gene defects (mutations) that can cause family cancer syndromes and lead to them getting the disease.
The most common inherited syndromes linked with colorectal cancers are familial adenomatous polyposis (FAP) and Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC), but other rarer syndromes can also increase colorectal cancer risk.
Familial adenomatous polyposis (FAP): FAP is caused by changes (mutations) in the APC gene that a person inherits from his or her parents. About 1% of all colorectal cancers are caused by FAP.
In the most common type of FAP, hundreds or thousands of polyps develop in a person’s colon and rectum, usually starting in their teens or early adulthood. Cancer usually develops in 1 or more of these polyps as early as age 20. By age 40, almost all people with FAP will have colon cancer if their colon hasn’t been removed to prevent it. People with FAP also have an increased risk of cancers of the stomach, small intestines, and some other organs.
- In attenuated FAP, which is a subtype of this disorder, patients have fewer polyps (less than 100) and colorectal cancer tends to occur at a later age.
- Gardner syndrome is a type of FAP that also leads to benign (non-cancer) tumors of the skin, soft tissue, and bones.
Lynch syndrome (hereditary non-polyposis colon cancer, or HNPCC): Lynch syndrome accounts for about 2% to 4% of all colorectal cancers. In most cases, this disorder is caused by an inherited defect in either the MLH1 or MSH2 gene, but changes in other genes can also cause Lynch syndrome. These genes normally help repair DNA damage.
The cancers in this syndrome develop when people are relatively young. People with Lynch syndrome can have polyps, but they tend to only have a few, not hundreds as in FAP. The lifetime risk of colorectal cancer in people with this condition may be as high as 80%, but this depends on which gene is affected.
Women with this condition also have a very high risk of cancer of the endometrium (lining of the uterus). Other cancers linked to Lynch syndrome include cancer of the ovary, stomach, small intestine, pancreas, kidney, brain, ureters (tubes that carry urine from the kidneys to the bladder), and bile duct.
For more information on Lynch syndrome, see “Genetic testing, screening, and prevention for people with a strong family history of colorectal cancer.”
Turcot syndrome: This is a rare inherited condition in which people are at increased risk of adenomatous polyps and colorectal cancer, as well as brain tumors. There are actually 2 types of Turcot syndrome:
- One is caused by gene changes similar to those seen in FAP, in which cases the brain tumors are medulloblastomas.
- The other is caused by gene changes similar to those seen in Lynch syndrome, in which cases the brain tumors are glioblastomas.
Peutz-Jeghers syndrome: People with this rare inherited condition tend to have freckles around the mouth (and sometimes on their hands and feet) and a special type of polyps (called hamartomas) in their digestive tracts. These people are at a greatly increased risk for colorectal cancer, as well as several other cancers, which usually appear at a younger than normal age. This syndrome is caused by mutations in the STK1 gene.
MUTYH-associated polyposis: People with this syndrome develop colon polyps which will become cancer if the colon is not removed. These people also have an increased risk of cancers of the small intestine, skin, ovary, and bladder. This syndrome is caused by mutations in the MUTYH gene.
People with these inherited syndromes often get cancer at a younger age than usual. These syndromes are also linked to some other types of cancer. Identifying families with these syndromes is important because it lets doctors recommend specific steps such as screening and other preventive measures at an early age.
Information on risk assessment, and genetic counseling and testing for some of these syndromes can be found in “Genetic testing, screening, and prevention for people with a strong family history of colorectal cancer.”
Racial and ethnic background
African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the United States. The reasons for this are not yet understood.
Jews of Eastern European descent (Ashkenazi Jews) have one of the highest colorectal cancer risks of any ethnic group in the world. Several gene mutations leading to an increased risk of colorectal cancer have been found in this group. The most common of these gene changes, called the I1307K APC mutation, is present in about 6% of American Jews.
Type 2 diabetes
People with type 2 (usually non-insulin dependent) diabetes have an increased risk of colorectal cancer. Both type 2 diabetes and colorectal cancer share some of the same risk factors (such as being overweight or obese). But even after taking these factors into account, people with type 2 diabetes still have an increased risk. They also tend to have a less favorable prognosis (outlook) after diagnosis.
Factors with less clear effects on colorectal cancer risk
Night shift work
Results of one study suggested working a night shift at least 3 nights a month for at least 15 years may increase the risk of colorectal cancer in women. The study authors suggested this might be due to changes in levels of melatonin (a hormone that responds to changes in light) in the body. More research is needed to confirm or refute this finding.
Previous treatment for certain cancers
Some studies have found that men who survive testicular cancer seem to have a higher rate of colorectal cancer and some other cancers. This might be due to the treatments they had.
Several studies have suggested that men who had radiation therapy to treat prostate cancer may have a higher risk of rectal cancer because the rectum receives some radiation during treatment. Most of these studies are based on men treated in the 1980s and 1990s, when radiation treatments were less precise than they are today. The effect of more modern radiation methods on rectal cancer risk is not clear.
Last Medical Review: 10/15/2014
Last Revised: 02/01/2016