- What is colorectal cancer?
- Importance of colorectal cancer screening
- Risk factors for colorectal cancer
- Finding colorectal cancer early
- Signs and symptoms of colorectal cancer
- Colorectal cancer screening tests
- American Cancer Society recommendations for colorectal cancer early detection
- Colorectal cancer screening – state and federal coverage laws
- Additional resources
- References: Colorectal cancer early detection
Risk factors for colorectal cancer
A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for lung cancer, as well as many others.
But risk factors don’t tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get the disease. And some people who get the disease may not have any known risk factors. Even if a person with colorectal cancer has a risk factor, it’s often very hard to know how much that risk factor might have contributed to the cancer.
Researchers have found several risk factors that may increase a person’s chance of developing colorectal polyps or colorectal cancer.
Risk factors you cannot change
Younger adults can develop colorectal cancer, but the chances increase markedly after age 50; More than 9 out of 10 people diagnosed with colorectal cancer are at least 50 years old.
Personal history of colorectal polyps or colorectal cancer
If you have a history of adenomatous polyps (adenomas) in the colon or rectum, you are at increased risk of developing colorectal cancer. This is especially true if the polyps are large or if there are many of them. Other types of polyps, like hyperplastic polyps, do not increase your risk of colorectal cancer.
If you have had colorectal cancer, even though it has been completely removed, you are more likely to develop new cancers in other areas of the colon and rectum. The chances of this happening are greater if you had your first colorectal cancer when you were younger.
Personal history of inflammatory bowel disease
Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease, 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, your risk of developing colorectal cancer is increased, and you may need to be screened for colorectal cancer more frequently.
Inflammatory bowel disease is different from irritable bowel syndrome (IBS), which does not carry an increased risk for colorectal cancer.
Family history of colorectal cancer or adenomatous polyps
Most colorectal cancers occur in people without a family history of colorectal cancer. Still, as many as 1 in 5 people who develop colorectal cancer have other family members who have been affected by this disease.
Those with a history of colorectal cancer in one or more first-degree relatives (parents, siblings, or children) are at increased risk. The risk is about doubled in those with a single affected first-degree relative. It 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 cancerous.)
People with a family history of adenomatous polyps or colorectal cancer should talk with their doctor about 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 cause the disease. Often, these defects lead to cancer that occurs at a younger age than is common. Identifying families with these inherited syndromes is important because it allows doctors to recommend specific steps, such as screening and other preventive measures, at an early age.
Several types of cancer can be linked with these syndromes, so it’s important to check your family medical history not just for colon cancer and polyps, but also for any other type of cancer. While cancer in close (first-degree) relatives is most concerning, any history of cancer in more distant relatives is also important. This includes aunts, uncles, grandparents, nieces, nephews, and cousins. People with a family history of cancer or colorectal polyps should discuss this history with their doctor. They may benefit from genetic counseling to review their family medical tree to see how likely it is that they have a family cancer syndrome and a discussion about whether or not gene testing is right for them. People who have an abnormal gene can take steps to prevent colon cancer, such as getting screened at an early age or even having surgery.
The 2 most common inherited syndromes linked with colorectal cancers are familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (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 due to FAP.
People with this disease typically develop hundreds or thousands of polyps in their colon and rectum, usually 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 this disorder will have developed colon cancer if the colon isn’t removed first to prevent it.
Gardner syndrome is a type of FAP that also involves benign (non-cancerous) tumors of the skin, soft connective tissue, and bones.
Hereditary non-polyposis colon cancer (HNPCC): HNPCC, also known as 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 gene MLH1 or the gene MSH2, but other genes can also cause HNPCC. Most of the genes involved normally help repair DNA damage.
The cancers in this syndrome also develop when people are relatively young. People with HNPCC can have polyps, but they 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%.
Women with this condition also have a very high risk of developing cancer of the endometrium (lining of the uterus). Other cancers linked with HNPCC include cancer of the ovary, stomach, small bowel, pancreas, kidney, brain, ureters (tubes that carry urine from the kidneys to the bladder), and bile duct.
For more information on HNPCC, see the sections “Do we know what causes colorectal cancer?” and “Can colorectal cancer be prevented?” in our longer document, 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 can be caused by gene changes similar to those seen in FAP, in which cases the brain tumors are medulloblastomas.
- The other can also be caused by gene changes similar to those seen in HNPCC, 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 polyp in their digestive tracts (called hamartoma). They are at a greatly increased risk for colorectal cancer, as well as several other cancers, which usually appear at a younger age than usual. This syndrome is caused by mutations in the gene STK1.
MUTYH-associated polyposis: People with this syndrome develop colon polyps which will become cancerous if the colon is not removed. They also have an increased risk of cancers of the small intestine, skin, ovary, and bladder. This syndrome is caused by mutations in the gene MUTYH.
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 DNA 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 developing colorectal cancer. Both type 2 diabetes and colorectal cancer share some of the same risk factors (such as excess weight). 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.
Several 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.
Certain types of diets
A diet that is high in red meats (such as beef, pork, lamb, or liver) and processed meats (hot dogs and some luncheon meats) can increase colorectal cancer risk. Cooking meat at very high temperatures (frying, broiling, or grilling) creates chemicals that might increase cancer risk, although it’s not clear how much this might contribute to an increase in colorectal cancer risk. Diets high in vegetables, fruits, and whole grains have been linked with a decreased risk of colorectal cancer, but fiber supplements do not seem to help. Whether other dietary components (like certain types of fats) affect colorectal cancer risk is not clear.
If you are not physically active, you have a greater chance of developing colorectal cancer. Increasing activity may help reduce your risk.
If you are very overweight, your risk of developing and dying from colorectal cancer is increased. Obesity raises the risk of colon cancer in both men and women, but the link seems to be stronger in men.
Long-term smokers are more likely than non-smokers to develop and die from colorectal cancer. Smoking is a well-known cause of lung cancer, but it is also linked to other cancers, like colorectal. If you smoke, you can learn about stopping in our Guide to Quitting Smoking
Heavy alcohol use
Colorectal cancer has been linked to the heavy use of alcohol. 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.
Factors with uncertain, controversial, or unproven effects on colorectal cancer
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 have received.
Several studies have suggested that men who received 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, and the effect of more modern radiation methods on rectal cancer risk is not clear. There are many possible side effects of prostate cancer treatment that men should consider when making treatment decisions. Some doctors recommend that the risk of rectal cancer be considered as one of those possible side effects.
The American Cancer Society and several other medical organizations recommend earlier screening for people with an increased colorectal cancer risk. These recommendations differ from those for people at average risk. For more information, speak with your doctor and refer to the tables in the section “American Cancer Society recommendations for colorectal cancer early detection.”
Last Medical Review: 08/05/2013
Last Revised: 01/31/2014