You probably know someone who has been diagnosed with colon cancer, whether it’s a loved one, a friend or co-worker, or even yourself. Colon cancer is the third most common cancer in the United States, according to the American Cancer Society, and the second most common cause of cancer death.
While death rates have been consistently going down — thanks to better screening methods like colonoscopies — incidence rates among younger adults under age 50 are actually on the rise, says Richard Wender, MD, chief cancer control officer at the American Cancer Society.
However, there’s plenty you can do to protect yourself: In fact, almost half of all U.S. colorectal cancers each year could be prevented with lifestyle changes like staying at a healthy weight, eating a plant-based diet and being physically active, according to the American Institute for Cancer Research. Here’s what you need to know:
Get screened starting at age 45
Colon cancer and rectal cancers are rising in Gen Xers and millennials at record rates: About 30 percent of new rectal cancers, for example, are now diagnosed in people younger than age 55, which is double what they were in 1990, according to a 2017 study published in the Journal of the National Cancer Institute. “We think some of it is lifestyle related, since more people are overweight and obese, which are both risk factors, but we also see it in younger people who are thin and avid exercisers,” says Wender.
As a result, last year the ACS updated its guidelines to recommend screening start at age 45 — not 50 — as was previously suggested.
The gold standard is a colonoscopy, a test where your doctor uses a flexible, lighted tube to check for polyps in your rectum and colon while you’re under sedation. While these grape-like growths are common and usually harmless, some, known as adenomas, may eventually turn into cancer. But if you’re squeamish, you can do an at-home screening test, known as a fecal immunochemical test (FIT), which checks for hidden blood in your stool. (Your doctor gives you a test kit and instructions on how to collect your sample and send it off for analysis.) It’s just as reliable as having a colonoscopy, according to a review published in the February Annals of Internal Medicine. Just keep in mind that if the test comes back positive, you’ll need to have a colonoscopy, which is the only test that can rule out colon cancer, explains Wender.
Stay at a healthy weight
Women who are overweight or obese have up to twice the risk of developing colorectal cancer before age 50 compared to women who are at a normal BMI (for a 5’4’’ woman, that’s between 108 and 145 pounds), according to a Washington University study published in 2018 in the medical journal JAMA Oncology. In fact, about 22 percent of these cancer cases could have been prevented entirely if the subjects had been at an average weight, noted study researchers.
One theory is that heavier individuals have more inflammation in their bodies, which can lead to DNA damage that raises the risk of colon cancer. But it may also be that people at healthy weights are also more likely to eat a well-balanced diet and frequently exercise, which have both been shown to reduce risk, says Daniel M. Labow, MD, chief of surgical oncology at the Mount Sinai Hospital and site chair of surgery at Mount Sinai St. Luke’s and Mount Sinai West.
Eat a plant-based diet
It’s rich in fiber, which has been shown to lower the risk of colon cancer (every 10 grams consumed daily — the equivalent of around a cup of beans — reduces colon cancer risk by 10 percent), according to the American Institute for Cancer Research. Two-thirds of your plate at each meal should be filled with fruits, vegetables, whole grains, beans and nuts, with no more than one-third made up of animal protein like chicken, lean red meat or fish. And sub out your lunchtime deli meat sandwich for a hummus, tuna fish or peanut butter sandwich instead. Processed meat has been linked to an increased risk of colon cancer, while fish and plant-based proteins appear to be protective.
There’s also something to be said for having garlic breath. People who ate high amounts of garlic, leeks and onions had a 79 percent lower risk of having colon cancer than those who avoided them, according to a Chinese study published in the Asia Pacific Journal of Clinical Oncology this past February.
Exercise as much as possible
Working out lowers the risk of developing colon cancer — and the more active you are, the greater the benefits, says Wender. One analysis of more than 50 studies found that the most physically active folks had a 24 percent lower risk of colon cancer than the least active. You’re also less likely to develop colon adenomas, a type of colon polyp that’s more likely to turn into colon cancer, adds Wender.
If you’re in good enough shape, consider doing high-intensity interval training (HIIT), a type of workout where you alternate bursts of high-intensity activity (like sprints) with a recovery activity (like brisk walking). Colon cancer survivors who did just one session of this type of workout showed a reduced growth of colon cancer cells, according to a study published this past February in the Journal of Physiology.
Don’t smoke and back off booze
If you light up, you’re more likely to be diagnosed and die from colon cancer, says Wender. It’s particularly dangerous for women: Those who have smoked have an almost 20 percent increased risk for colon cancer, compared to women who have never taken a puff, according to a 2013 study published in Cancer Epidemiology, Biomarkers & Prevention. While an occasional cocktail is fine, it’s also smart not to imbibe to excess: People who down more than three drinks per day have a 50 percent increased risk of developing colon cancer, while a drink or two daily carries a 20 percent increased risk, according to a French study published in the Annals of Oncology.
Get enough ZZZs
Lack of sleep has been linked to a host of health ills, including high blood pressure, heart attack, weight gain and type 2 diabetes. Now you can add colorectal cancer to the list. Folks who sleep less than six hours a night have an almost 50 percent increase in risk of colorectal adenoma — a type of colon polyp that may turn into a cancerous tumor — than those who clocked at least seven hours, according to a Case Western Reverse Medical Center study published in the medical journal Cancer. One theory, say study authors, is that sleep deprivation lowers levels of melatonin, one of your body’s natural hormones that help repair damaged DNA.
Know your family history.
If you have at least one first-degree relative (parent, sibling or child) who was diagnosed with colon cancer before the age of 60, or at least two first-degree relatives diagnosed at any age, then you should begin screening for colon cancer earlier, ideally with a colonoscopy, says Labow. That’s usually either at age 40, or 10 years younger than your family’s earliest diagnosis.
Testing should be repeated every five years. If you have a first-degree relative who was diagnosed with colon cancer after age 60, or at least two second-degree relatives (grandparent, aunt or uncle) with colon cancer, then you’ll need to start colonoscopy at age 40, repeating every ten years. You may also want to talk to your doctor about genetic counseling. Up to about 10 percent of all colorectal cancers are caused by gene mutations. The two most common ones are familial adenomatous polyposis (FAP) and Lynch syndrome, but there are also other, rarer mutations.
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