By Abdulraheem Qasem, MD, Board-certified Medical Oncologist and Hematologist, AdventHealth Cancer Institute
Fifty years ago, it was not very common to know a young adult with colorectal cancer. But unfortunately, that is no longer the case and we are seeing more incidents of colorectal cancer among younger individuals over the past several years. So what is causing the concerning trend and what can you do to prevent colorectal cancer?
Many factors may be contributing to the rise in cases, including how we live and genetics.
Lifestyle factors: Unhealthy dietary patterns, such as high consumption of red and processed meats, low fiber intake and diets rich in ultra-processed foods, have been linked to a higher risk of colorectal cancer. Additionally, sedentary lifestyles and obesity are significant risk factors. These lifestyle choices can lead to inflammation and metabolic changes that promote cancer development.
Environmental exposures: Increased exposure to environmental toxins, including microplastics and chemicals found in everyday products, may play a role in the rising cancer rates among younger populations. These substances can disrupt hormonal and immune systems, potentially leading to cancer.
Gut microbiome alterations: Changes in the gut microbiota, possibly due to dietary patterns, antibiotic use and other environmental factors, have been implicated in colorectal cancer development. An imbalance in gut bacteria can influence inflammation and immune responses, contributing to cancer risk.
Genetic predisposition: While most colorectal cancer cases are sporadic, hereditary factors such as Lynch syndrome and familial adenomatous polyposis can increase risk. However, these genetic conditions account for a small percentage of cases and do not fully explain the rising incidence in younger individuals.
While these factors are associated with an increased risk of colorectal cancer, the exact reasons for the rising incidence among younger individuals remain under investigation.
Regardless, preventing colorectal cancer not only involves adopting lifestyle modifications, but requires regular screening as well, especially because early detection significantly improves treatment outcomes.
Screening saves lives
Several screening options exist, each with advantages and limitations. The choice depends on individual risk factors, personal preferences and health care access.
- Colonoscopy – the gold standard
Colonoscopy remains the gold standard for colorectal cancer screening. It is the only test that allows for both detection and prevention by identifying and removing precancerous polyps in the colon and rectum in a single procedure. If your colonoscopy result is normal, the test is typically repeated every 10 years. Colonoscopy requires bowel preparation and sedation, plus there is a small risk of complications such as bleeding or perforation.
- Stool-based home test kits
Home test kits are an alternative for those who prefer a non-invasive option or have difficulty accessing a colonoscopy. They are best suited for average-risk individuals and need to be done more frequently. The fecal immunochemical test (FIT) detects hidden blood in the stool which may indicate cancer or large polyps. It is non-invasive with no diet restrictions and done annually at home. This test cannot detect polyps directly; if positive, a colonoscopy is needed. The multitarget stool DNA test detects hidden blood and DNA mutations linked to cancer. It is more sensitive than FIT and done every three years. There is a higher false-positive rate, and it requires a follow-up colonoscopy if positive.
- CT colonography (virtual colonoscopy)
This screening method uses a CT scan to visualize the colon. It is less invasive with no sedation, but it does require bowel prep and a follow-up colonoscopy is needed if abnormalities are found.
Know the best screening option for you
With a multitude of screening options, how do you know which is right for you?
A home test kit may be a good option if you are:
- Considered average risk for colorectal cancer, which means no family history of colorectal cancer and no personal history of polyps.
- Unwilling or unable to undergo colonoscopy.
- Needing interim screening between colonoscopies as recommended by a doctor.
A colonoscopy should be prioritized if:
- You are a high-risk individual with a family history of colorectal cancer, history of polyps or inflammatory bowel disease.
- Stool-based tests return a positive result.
- You prefer a single test with long-term assurance (every 10 years).
While colonoscopy remains the most effective screening tool, stool-based home tests are a valuable option for those who want a non-invasive alternative. The best screening test is the one that gets done, so choosing the most practical and accessible method for each individual is key to improving early detection and prevention of colorectal cancer.
To learn more about colorectal cancer screening and the AdventHealth Cancer Institute, visit CancerCareKC.com.
Abdulraheem Qasem, MD, is an experienced, Board-certified medical oncologist and hematologist with the AdventHealth Cancer Institute at AdventHealth Shawnee Mission. He treats all types of cancer with a special interest in gastrointestinal cancers.
