tag:theconversation.com,2011:/africa/topics/colorectal-cancer-1551/articlesColorectal cancer – The Conversation2023-06-16T15:56:00Ztag:theconversation.com,2011:article/2076582023-06-16T15:56:00Z2023-06-16T15:56:00ZKeto diet may slow cancer tumour growth in mice – but not without potentially deadly consequences<figure><img src="https://images.theconversation.com/files/532367/original/file-20230616-17-p00ign.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5982%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The keto diet is very low in carbohydrates.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/keto-ketogenic-diet-low-carb-healthy-1075530926">SewCreamStudio/ Shutterstock</a></span></figcaption></figure><p>The ketogenic (keto) diet has been popular in recent years among people looking to lose weight and keep fit. But what many people don’t realise is that this low carb, high-fat diet has actually been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375425/">used for centuries</a> in the treatment of medical maladies, such as epilepsy. More recently, researchers have been investigating its use alongside chemotherapy to improve remission and survival in patients with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375425/">advanced metastatic cancers</a>.</p>
<p>A <a href="https://www.sciencedirect.com/science/article/abs/pii/S1550413123001857?via%3Dihub">recently published study</a> in mice has now shown that the keto diet may also have use in treating tumours. But while the diet appeared to slow the tumour growth in mice with colorectal and pancreatic cancers, it was also shown to accelerate the onset of cachexia – a severe wasting disease thought to cause <a href="https://www.cancer.gov/about-cancer/treatment/research/cachexia#:%7E:text=Cachexia%20is%20estimated%20to%20occur,failure%20related%20to%20muscle%20loss.">30% of all cancer-related deaths</a>. </p>
<p>To conduct their study, the authors selected two types of mice that were predisposed to cachexia. They then transplanted half of them with colorectal cancer and induced pancreatic cancer in the other half. The mice were then allocated into two groups: one group was fed a standard diet while the other group was fed a high-fat, low carb keto diet.</p>
<p>Over the course of the next month, the investigators found that mice on the keto diet showed slower tumour growth than the mice fed a standard diet. However, it also appeared that the keto diet was associated with shorter survival times due to the faster onset of cachexia. </p>
<h2>Keto and cancer</h2>
<p>The reason the ketogenic diet works to slow the growth of tumours is down to the way in which cancer cells metabolise their “food” compared to normal, healthy cells. </p>
<p>All the cells in our bodies get their energy from glucose (sugar) first and foremost, and then from fats. Since cancer cells grow quickly, they have much higher energy needs – so they rely solely on glucose for energy. </p>
<p>Glucose is released from the carbohydrates we’ve eaten as they’re broken down in our bodies. But since the keto diet has a very low carbohydrate intake, it’s thought that this “starves” the cancer cells of the energy they need to grow. This is what the authors were able to demonstrate in their study.</p>
<p>Keto also kick-starts a process called <a href="https://www.sciencedirect.com/science/article/abs/pii/S1550413123001857?via%3Dihub">lipid peroxidation</a>, which causes the body to use fats for the energy it needs instead. However, this process also creates a number of highly reactive molecules as a by-product which need to be cleared from the body before they cause further cell damage. </p>
<figure class="align-center ">
<img alt="A digital illustration of a cancer cell." src="https://images.theconversation.com/files/532368/original/file-20230616-17-npaaeo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532368/original/file-20230616-17-npaaeo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532368/original/file-20230616-17-npaaeo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532368/original/file-20230616-17-npaaeo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532368/original/file-20230616-17-npaaeo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532368/original/file-20230616-17-npaaeo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532368/original/file-20230616-17-npaaeo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Cancer cells have higher energy needs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/cancer-cell-human-body-340710245">Crevis/ Shutterstock</a></span>
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<p>Since the mice’s cells lacked an adequate energy supply to quickly remove these highly reactive molecules, this led to an increase of a molecule called GDF-15 which suppressed their appetite and contributed to their weight loss.</p>
<p>The researchers also found that the keto diet impaired the production of corticosteroids – naturally-occurring hormones which help reduce inflammation and regulate the immune system. This accelerated the onset of cachexia in the mice, shortening their overall survival.</p>
<p>Interestingly, when the researchers treated the mice with an injection of dexamethasone – a corticosteroid drug that counteracts the stress hormone cortisol and is often used to treat various cancer-related conditions, such as anemia – they were able to delay the onset of cachexia and improve their overall survival. </p>
<h2>Cancer treatment</h2>
<p>Although it’s tempting to draw conclusions from this research, it’s also important to bear a few things in mind. </p>
<p>First, this study was performed in mice – and of course, we aren’t mice. It’s imperative that further research be carried out to see whether the keto diet has a similar effect in humans – and crucially, whether treatment with dexamethasone delays the onset of cachexia in humans, too. At the moment, there are a <a href="https://clinicaltrials.gov/ct2/results?cond=cancer&term=ketogenic+diet&cntry=&state=&city=&dist=&Search=Search">number of ongoing trials</a> and some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375425/">emerging evidence</a> suggesting the keto diet has beneficial effects on many types of cancer.</p>
<p>Second, patients who follow a keto diet will experience different benefits depending on the stage of their cancer. For example, studies in cells have shown fasting or following the keto diet while undergoing chemotherapy may improve <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608686/">how responsive the cancer is</a> to chemotherapy – while also reducing damage to nearby healthy tissues.</p>
<p>This is because fasting (and keto) act like a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938162/#:%7E:text=Fasting%20or%20fasting%2Dmimicking%20diets,the%20effects%20of%20cancer%20therapies.">“magic shield”</a>, protecting healthy cells from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190229/">chemotherapy-induced damage</a>. </p>
<p>Fasting shuts down all non-essential processes, including metabolism. However, cancer cells ignore this message and continue growing. Chemotherapy targets rapidly growing cells – and so in a fasted state, it will target the cancer cells instead, leaving healthy cells safe.</p>
<p>Although this latest study demonstrates that the keto diet may also have the harmful effect of accelerating cachexia in mice, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8471358/#B65-nutrients-13-03202">several studies</a> looking at the effect of a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314860/">keto diet on pancreatic cancer</a> actually find keto <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8471358">protects against muscle loss</a>. </p>
<p>These differing results may be down to the methods used in each of these studies, with some experiments being conducted in cells, and others in mice. But given these contradictory findings, it will be important for more detailed investigations to be done.</p>
<p>While evidence suggests keto may have benefits for slowing cancer growth, less is known about any adverse effects it may have (such as accelerating cachexia). Given there’s still so much we don’t know, it’s advised that patients undergoing cancer treatment speak with their medical practitioner about any diet changes they may be planning to make.</p><img src="https://counter.theconversation.com/content/207658/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mhairi Morris does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The diet was shown to accelerate onset of a severe wasting disease.Mhairi Morris, Senior Lecturer in Biochemistry, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1980752023-02-17T13:24:41Z2023-02-17T13:24:41ZTurning 50? Here are 4 things you can do to improve your health and well-being<figure><img src="https://images.theconversation.com/files/508743/original/file-20230207-27-jzu8l0.jpg?ixlib=rb-1.1.0&rect=0%2C31%2C5184%2C3406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Turning 50 can be the time of your life – but it also means adapting to new challenges.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-retired-couple-stop-for-rest-and-hot-drink-royalty-free-image/1387313039?phrase=50%20year%20old&adppopup=true">monkeybusinessimages/iStock via Getty Images Plus</a></span></figcaption></figure><p>When the ball dropped on New Year’s Eve to mark the beginning of 2023, I came to grips with the fact that I would turn 50 years old this year. </p>
<p>Entering a new decade is often a time to pause and reflect on our lives, <a href="https://theconversation.com/midlife-isnt-a-crisis-but-sleep-stress-and-happiness-feel-a-little-different-after-35-or-whenever-middle-age-actually-begins-173131">particularly when reaching middle age</a>. For 50-year-old American men, the average remaining life expectancy <a href="https://www.cdc.gov/nchs/data/vsrr/vsrr023.pdf">is 28 more years; for women, it’s 32</a>. </p>
<p>As a <a href="https://scholar.google.com/citations?user=87v4Nk4AAAAJ&hl=en">public health professor</a> who is an expert in health promotion, I started to think about things one could do around this milestone birthday to improve the chances of living a healthy life for decades to come. </p>
<p>After reviewing the literature on healthy aging, I identified four things in particular that take on greater importance when you turn 50 – and that go beyond general health advice that’s beneficial at any age, like <a href="https://theconversation.com/kick-up-your-heels-ballroom-dancing-offers-benefits-to-the-aging-brain-and-could-help-stave-off-dementia-194969">staying active</a>, <a href="https://theconversation.com/ultra-processed-foods-like-cookies-chips-frozen-meals-and-fast-food-may-contribute-to-cognitive-decline-196560">eating well</a> and <a href="https://theconversation.com/better-sleep-for-kids-starts-with-better-sleep-for-parents-especially-after-holiday-disruptions-to-routines-196110">getting enough sleep</a>. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/F5rDA5k3R4c?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A TV reporter gets a colonoscopy.</span></figcaption>
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<h2>Get a colonoscopy</h2>
<p>Urging everyone to get a colonoscopy is certainly not the most fun piece of advice, but it’s one of the most important. The American Cancer Society estimates that there will be more than 105,000 new cases of colon cancer, more than 45,000 new cases of rectal cancer and <a href="https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html">over 50,000 deaths from colorectal cancer in 2023 alone</a>.</p>
<p>This makes colorectal cancer the <a href="https://seer.cancer.gov/statfacts/html/common.html#">second leading cause of cancer-related deaths</a> for men and women. </p>
<p>The good news is that the <a href="https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html">survival rate is high</a> if the cancer is detected early, before it spreads to other parts of the body. The survival rate drops precipitously if cancer is found in the later stages. </p>
<p>A <a href="https://www.niddk.nih.gov/health-information/diagnostic-tests/colonoscopy">colonoscopy</a> is a routine inpatient procedure that uses a <a href="https://theconversation.com/colonoscopy-is-still-the-most-recommended-screening-for-colorectal-cancer-despite-conflicting-headlines-and-flawed-interpretations-of-a-new-study-192374">scope to examine the rectum and colon</a> and that requires sedation or anesthesia.</p>
<p>In addition to detecting cancerous or potentially malignant polyps, your doctor can also detect swollen tissue and ulcers. These may indicate potential problems and increase the need for more frequent monitoring. </p>
<p>For people at low risk of colorectal cancer, there are <a href="https://www.health.harvard.edu/blog/colon-cancer-screening-decisions-whats-the-best-option-and-when-202206152762">less invasive tests</a> that can be done at home, <a href="https://www.healthline.com/health/cologuard">such as Cologuard</a>. This involves collecting and mailing a sample of poop to a lab. These options should be discussed with your doctor to figure out which screening is best for you. </p>
<p>In 2021 the U.S. Preventive Services Task Force, a national panel of experts, changed its recommendation for beginning colorectal cancer screening <a href="https://doi.org/10.1001/jama.2021.6238">from age 50 to 45</a> for people at low risk. As a result, <a href="https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-coverage-laws.html">insurance companies are required</a> to cover the cost of screening for anyone age 45 or older. </p>
<p>People at high risk <a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening">should get screened even earlier</a>. <a href="https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html">High risk</a> is defined as a family history of colorectal cancer or a diagnosis of <a href="https://www.cdc.gov/ibd/what-is-IBD.htm">inflammatory bowel disease</a>. Colorectal cancer can occur in younger people too; for example, the “Black Panther” star, actor Chadwick Boseman, <a href="https://www.nytimes.com/2020/08/28/movies/chadwick-boseman-dead.html">died of colon cancer at the age of 43</a> in 2020. </p>
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<a href="https://images.theconversation.com/files/510691/original/file-20230216-28-8dde3u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A photograph of a Black man wearing a tuxedo and bow tie." src="https://images.theconversation.com/files/510691/original/file-20230216-28-8dde3u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510691/original/file-20230216-28-8dde3u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510691/original/file-20230216-28-8dde3u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510691/original/file-20230216-28-8dde3u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510691/original/file-20230216-28-8dde3u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510691/original/file-20230216-28-8dde3u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510691/original/file-20230216-28-8dde3u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Actor Chadwick Boseman at the 2016 NAACP Image Awards in Pasadena, Calif. Boseman died of colon cancer in 2020 at age 43.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/actor-chadwick-boseman-poses-in-the-press-room-at-the-47th-news-photo/508687706?phrase=chadwick%20boseman&adppopup=true">Jason LaVeris/Film Magic via Getty Images</a></span>
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<h2>Get the shingles vaccine</h2>
<p>For many people who grew up in the 1970s and 1980s, getting chickenpox was a rite of passage. I had a particularly severe case around my 10th birthday. </p>
<p>Once you have chickenpox, <a href="https://theconversation.com/chickenpox-and-shingles-virus-lying-dormant-in-your-neurons-can-reactivate-and-increase-your-risk-of-stroke-new-research-identified-a-potential-culprit-194627">the virus lies dormant</a> in your body for the rest of your life. And it <a href="https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054">can reemerge as shingles</a>. </p>
<p>While shingles are not usually life-threatening, they cause a rash and can be extremely painful. Getting shingles also <a href="https://doi.org/10.1093/infdis/jiac405">greatly increases one’s risk of having a stroke</a> over the following year.</p>
<p>The good news is that the shingles vaccine is highly effective. The Centers for Disease Control and Prevention recommends that <a href="https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html">adults 50 and older get the two-shot regimen</a>, two to six months apart, which is 97% effective at preventing shingles. </p>
<h2>Bump up retirement savings, look for discounts</h2>
<p>Retirement might seem like a long way off, but the <a href="https://news.gallup.com/poll/394943/retiring-planning-retire-later.aspx">average retirement age</a> in the United States in 2022 was 61. The same study found that on average people thought they were going to retire at age 66. </p>
<p>For anyone born after 1960, full retirement benefits <a href="https://www.ssa.gov/benefits/retirement/planner/agereduction.html">don’t kick in until age 67</a>, leaving a six-year gap between that and the average retirement age. </p>
<p>Retiring earlier than you had planned can occur for many reasons, but involuntary ones, like job loss, injury or illness, can be a financial strain. The general rule is that you need about <a href="https://www.aarp.org/retirement/planning-for-retirement/info-2020/how-much-money-do-you-need-to-retire.html">80% of your pre-retirement income</a> to be financially comfortable in retirement. This consists of all sources of income, including Social Security benefits, pensions and investments. </p>
<p>If you are behind where you should be in savings, the Internal Revenue Service allows you <a href="https://www.irs.gov/retirement-plans/plan-participant-employee/retirement-topics-catch-up-contributions">to make catch-up contributions</a> starting the year you turn 50. Employees who are 50 or older with a 401(k), 403(b) or 457(b) can contribute an extra US$7,500 a year. This money grows tax-free and helps provide an extra cushion when you retire. At age 50, an extra $1,000 per year can also be contributed for <a href="https://www.irs.gov/retirement-plans/plan-participant-employee/retirement-topics-ira-contribution-limits">individual retirement accounts and Roth IRA accounts</a>.</p>
<p>Another way to save: Many hotels, restaurants and retail outlets offer senior discounts starting at age 50. </p>
<p>You can find reliable and up-to-date discounts by joining the <a href="https://www.aarp.org/membership/benefits/all-offers-a-z/?intcmp=GLOBAL-HDR-LNK-CLK-BENEFITS-UXDIA">AARP</a>. This nonprofit organization advocates for people ages 50 and older. Membership is under $20 per year and provides hundreds of discounts. </p>
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<figcaption><span class="caption">The challenges of turning 50.</span></figcaption>
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<h2>Get your paperwork in order</h2>
<p>While people in their 50s and beyond often still have their best decades ahead of them, it is vital to prepare for the unexpected – at any age. The <a href="https://www.statista.com/statistics/241572/death-rate-by-age-and-sex-in-the-us/">mortality rate for people ages 55 to 64 is double that</a> of those age 45 to 54. </p>
<p>This is an excellent time to decide how you want your affairs to be handled. According to the National Institute on Aging, this includes your <a href="https://www.nia.nih.gov/health/getting-your-affairs-order">will, living will and a durable power of attorney</a>. </p>
<p>A will describes how you would like your financial assets distributed after your death. However, <a href="https://theconversation.com/68-of-americans-do-not-have-a-will-137686">most Americans don’t have a will</a>. There are several <a href="https://theconversation.com/online-tools-put-will-writing-in-reach-for-most-people-but-theyre-not-the-end-of-the-line-for-producing-a-legally-binding-document-173569">online tools for wills</a> and <a href="https://theconversation.com/want-to-do-more-for-your-favorite-charity-consider-a-planned-gift-138241">bequests</a> that can make this process easier. </p>
<p><a href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303">Living wills</a> indicate the type of care you want or don’t want if you are unable to communicate your preferences. The <a href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303">durable power of attorney</a> is a document that allows someone you appoint to make health care decisions for you if you cannot. This is different from a general power of attorney, which ends if you can no longer make decisions on your own.</p>
<p>These may seem like a time-consuming list of things to do, but breaking them down into separate tasks makes it more manageable. So far, I have bumped up my retirement savings and scheduled my colonoscopy – even though I’m five years late on that one, based on the new recommendations. </p>
<p>I will get the rest done by the end of the year – and if you’re turning 50 or just planning ahead, I hope you do too. Admittedly, not all of it is fun, but everything on this checklist will add security to your years, and perhaps years to your life.</p><img src="https://counter.theconversation.com/content/198075/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jay Maddock does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Middle age means staying a step ahead on both the medical and financial fronts.Jay Maddock, Professor of Public Health, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1923742022-10-19T12:38:41Z2022-10-19T12:38:41ZColonoscopy is still the most recommended screening for colorectal cancer, despite conflicting headlines and flawed interpretations of a new study<figure><img src="https://images.theconversation.com/files/490183/original/file-20221017-7171-u96cve.jpg?ixlib=rb-1.1.0&rect=7%2C14%2C4812%2C3598&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Colorectal cancer is the second-leading cause of cancer death. But by finding polyps early on, colonoscopies can detect and prevent the cancer.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/polyp-found-during-a-colonoscopy-artwork-royalty-free-illustration/513096193?phrase=colonoscopies&adppopup=true">Sebastian Kaulitzki/Science Photo Library via Getty Images</a></span></figcaption></figure><p>A recently published study in a high-profile medical journal appeared to call into question <a href="https://doi.org/10.1056/NEJMoa2208375">the efficacy of colonoscopy</a>, a proven and widely utilized strategy for the screening and prevention of colorectal cancer. </p>
<p>News headlines were striking: “<a href="https://doi.org/10.1038/d41586-022-03228-z">Disappointing results on colonoscopy benefits</a>”; “<a href="https://thehill.com/policy/healthcare/3681186-new-study-suggests-benefits-of-colonoscopies-may-be-overestimated/">New study suggests benefits of colonoscopies may be overestimated</a>”; “<a href="https://www.statnews.com/2022/10/09/in-gold-standard-trial-colonoscopy-fails-to-reduce-rate-of-cancer-deaths/">In gold-standard trial, invitation to colonoscopy reduced cancer incidence but not death</a>.”</p>
<p>Such news coverage has ignited controversy and created some confusion about the study and its implications, leading people to question whether the results suggest that reevaluation of the utility and need for a colonoscopy is warranted. </p>
<p>As a <a href="https://sc.edu/study/colleges_schools/artsandsciences/biological_sciences/our_people/directory/berger_franklin.php">cancer research scientist</a> with over 20 years of experience studying colorectal cancer screening and prevention, I am confident that colonoscopy remains one of the most critical and effective tools to screen for, detect and prevent this prevalent and lethal form of cancer. </p>
<p>Colorectal cancer is the fourth-most prevalent and second-leading cause of cancer deaths in the U.S. The American Cancer Society estimates that there will be <a href="https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html">151,000 new cases of colorectal cancer</a> diagnosed in 2022 and nearly 53,000 deaths. Screening has contributed markedly <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf">to a decline</a> in colorectal cancer cases and deaths over the past several decades. </p>
<p>Current <a href="https://doi.org/10.1001/jama.2021.6238">U.S. Preventive Services Taskforce guidelines</a> recommend that people with average risk begin screening for colorectal cancer at the age of 45. This recommendation was <a href="https://theconversation.com/colorectal-cancer-screening-recommended-at-age-45-instead-of-50-its-no-fun-but-its-worth-it-155214">lowered from age 50</a> in 2021 due to the recent increase in colorectal cancer disease <a href="https://doi.org/10.1056/NEJMra2200869">prevalence among young adults</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/jNOF1FPmGOo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Although there are numerous ways to screen for colon cancer, a colonoscopy remains the most comprehensive way to test.</span></figcaption>
</figure>
<h2>Unpacking the new study</h2>
<p>Several investigations have shown that colonoscopy screening is <a href="https://doi.org/10.1001/jama.2021.6238">highly effective</a> in the detection and removal of precancerous polyps before they progress to cancer. </p>
<p>That is why media coverage of the new study published in the New England Journal of Medicine prompted confusion and concern among health care experts and the public. Many of these news reports mistakenly interpreted the study as showing that colonoscopies have a small effect on the incidence of colorectal cancer and are ineffective at reducing deaths. Such misinterpretations could have grave consequences with regard to efforts aimed at screening and preventing a form of cancer that affects the health and well-being of so many.</p>
<p>In the study, a team of European researchers performed a randomized clinical trial that examined the risk of colorectal cancer and death in healthy men and women between the ages of 55 and 64. Study participants, who were recruited from population registries in Norway, Sweden, Poland and the Netherlands, were either invited to undergo a colonoscopy or were not invited and received usual care.</p>
<p>After approximately 10 years, the research team gathered information on colorectal cancer incidence and deaths among 28,220 in the invited group and 56,365 in the uninvited group. They found that those in the invited group had a mere 18% decrease in the number of cases of colorectal cancer relative to those in the uninvited group. They also found that there was no significant reduction in deaths in the invited group. This seemingly disappointing result drove many of the more misleading headlines in the media.</p>
<p>But there is a critical caveat in all this that bears explaining. Only 42% of the participants who were invited to receive a colonoscopy did so. This percentage ranged from 33% among those from Poland, from where most of the participants were recruited, to 60.7% among those from Norway. </p>
<p>When the researchers determined the benefit among those who actually underwent a colonoscopy, they found that the incidence of colorectal cancer decreased by 31% and deaths decreased by 50% – results that are much closer to those <a href="https://doi.org/10.1056/NEJMoa1100370">expected from other studies</a>.</p>
<p>Another shortcoming of the study is the time between recruitment and screening of the participants. Colorectal cancer is <a href="https://health.clevelandclinic.org/how-quickly-do-colon-polyps-turn-cancerous/">typically slow to develop</a>, taking 10 or more years to progress from precancerous polyps to cancer. Thus, the 10-year window used in the study may be too short to measure the full impact of colonoscopy screening. The authors recognize this and indicate that they will be doing an analysis at 15 years.</p>
<p>These and other issues have been clearly outlined in responses to the study by several medical and advocacy groups comprised of experts with long-standing experience in colorectal cancer and its screening. These include the <a href="https://nccrt.org/crc-news-october-12-2022/">National Colorectal Cancer Roundtable</a>, the <a href="https://www.ccalliance.org/news/press-releases/statement-colonoscopies-prevent-crc-despite-one-study-headlines">Colorectal Cancer Alliance</a>, the <a href="http://pressroom.cancer.org/CRCScreeningStatement">American Cancer Society</a> and the <a href="https://www.asge.org/home/about-asge/newsroom/news-list/2022/10/10/colonoscopy-remains-best-and-proven-way-to-detect-and-prevent-colorectal-cancer-and-colorectal-cancer-deaths">American Society for Gastrointestinal Endoscopy</a>, among others. </p>
<p>All of the responses emphasize that, despite the tone of much of the media coverage, nothing in the study changes the recognized reliability or efficacy of colonoscopy screening. At best, the findings confirm that for many, a simple invitation to screening does not necessarily promote participation in screening. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/xCmnWsAqMlw?wmode=transparent&start=52" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">What the doctor sees during a colonoscopy – a close-up look.</span></figcaption>
</figure>
<h2>Colonoscopy remains the ‘gold standard’</h2>
<p>During a colonoscopy, a long flexible tube is inserted into the rectum and moved through the colon to allow the direct viewing, identification, imaging and removal of abnormal tissues such as precancerous polyps that could progress into colorectal cancer. As such, for quite some time, colonoscopies have been considered the “gold standard” for colorectal cancer screening and prevention, and still are. </p>
<p>However, there are several features of the procedure that can deter people from choosing it. It is invasive, and there is risk – though small – of <a href="https://doi.org/10.1053/j.gastro.2018.01.010">complications</a>. In addition, for the procedure to be effective, the colon must be cleared of any stool, requiring a protocol that many find distasteful and uncomfortable. Finally, it can be expensive, creating barriers for those who lack adequate insurance coverage.</p>
<p>Though not as sensitive as a colonoscopy, there are a number of <a href="http://nccrt.org/wp-content/uploads/2018ACSCRCGuidelineOverview_FINAL.NCCRT_.8.7.18.pdf">noninvasive alternatives</a> for colorectal cancer screening that are currently available and recommended by the <a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening">U.S. Preventive Services Task Force</a> for people with normal risk levels. Such alternatives include stool tests such as <a href="https://www1.nyc.gov/assets/doh/downloads/pdf/cancer/fobt-fact-sheet.pdf">high-sensitivity guaiac fecal occult blood tests</a>, <a href="https://medlineplus.gov/ency/patientinstructions/000704.htm">fecal immunochemical tests</a> and <a href="https://doi.org/10.1056/NEJMoa1311194">multitarget stool DNA tests</a>. </p>
<p>These methods vary in effectiveness, and each has advantages and disadvantages. The option of choice is based upon patient preference, determined with input from the medical provider. But those at higher risk, such as having a family history of colorectal cancer, certain symptoms such as blood in the stool or a history of polyps are <a href="https://doi.org/10.1001/jama.2021.6238">advised to get screened by a colonoscopy</a>.</p>
<p>Importantly, noninvasive screening tests do not on their own prevent the disease. Rather, they raise the possibility that a benign polyp or tumor may exist, and must therefore be followed up with a colonoscopy to confirm the presence of, and remove, any abnormal lesions. </p>
<h2>New directions for cancer screening</h2>
<p>Most recently, researchers have made significant progress in the development of <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2017/liquid-biopsy-detects-treats-cancer">liquid biopsies</a>, which involve the profiling of informative biomarkers in fluids such as blood. This type of profiling identifies signals for detecting and monitoring numerous cancers, including colorectal cancer. </p>
<p>There is particular enthusiasm in the scientific and medical communities around liquid biopsies that can aid in <a href="https://doi.org/10.1016/j.ccell.2022.01.012">multi-cancer early detection</a>. This approach offers great potential in the early detection of colorectal cancer as well as numerous other cancers for which there are currently no effective screening methods. Multi-cancer early detection tests are under development by many companies and are not yet approved by the Food and Drug Administration. Several are <a href="https://www.galleri.com/hcp/the-galleri-test/ordering">currently available</a> by prescription as laboratory-developed tests.</p>
<p>As with all noninvasive tests, liquid biopsies must be appropriately followed up to verify, remove and/or treat any identified lesions. Extensive research on liquid biopsies is ongoing, and results suggest that a new generation of highly sensitive, readily available and patient-friendly modes of cancer screening will emerge in the next few years.</p>
<p>Over the past several decades, screening has contributed significantly to a marked reduction in the incidence and mortality of colorectal cancer. Given the aging of the population, as well as the <a href="https://doi.org/10.1056/NEJMra2200869">recent rise in colorectal cancer</a> among young adults, detecting the disease sensitively and in its earliest stages is more important than ever.</p><img src="https://counter.theconversation.com/content/192374/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Franklin G. Berger receives funding from Centers for Disease Control & Prevention</span></em></p>Don’t be confused by recent media reports – colonoscopies are still the best way to detect and prevent colon cancer.Franklin G. Berger, Distinguished Professor Emeritus of Biological Sciences, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1853372022-09-08T12:32:16Z2022-09-08T12:32:16ZYes, Black patients do want to help with medical research – here are ways to overcome the barriers that keep clinical trials from recruiting diverse populations<figure><img src="https://images.theconversation.com/files/483100/original/file-20220906-4642-3md5uc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Creating a safe space for patients to ask questions and provide fully informed consent could help increase clinical trial recruitment.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ethnic-woman-in-medical-consultation-with-female-royalty-free-image/1168998661">FatCamera/E+ via Getty Images</a></span></figcaption></figure><p>Clinical trial participants are <a href="https://doi.org/10.1001/jamanetworkopen.2021.11516">predominantly white</a>. Despite Black and Hispanic people respectively making up 12% and 16% of the U.S. population in 2011, together they made up <a href="https://www.fda.gov/science-research/womens-health-research/dialogues-diversifying-clinical-trials">only 6% of clinical trial participants</a> overall that year. </p>
<p><a href="https://www.nimhd.nih.gov/resources/understanding-health-disparities/diversity-and-inclusion-in-clinical-trials.html">Clinical trials that are representative</a> of all patients are essential to ensure that treatments are effective for everyone. Drugs work differently for each person <a href="https://theconversation.com/why-prescription-drugs-can-work-differently-for-different-people-168645">based on different factors</a>. Including diverse patient populations in clinical trials makes sure these factors are accounted for. But the <a href="https://doi.org/10.1016/j.cpcardiol.2018.11.002">perception that recruiting white patients</a> is easier, less time-consuming and more cost-efficient than recruiting underrepresented or underserved patients contributes to health disparities seen today.</p>
<p>We are <a href="https://www.researchgate.net/profile/Julia-Liu-9">gastroenterology researchers</a> at Morehouse School of Medicine who run clinical trials and study ways to improve participant diversity. Identifying and addressing the barriers to enrolling in research that patients face can not only increase participation, but can also lead to better patient care.</p>
<h2>The problem of access</h2>
<p>Barriers to clinical trial participation start with a <a href="https://doi.org/10.1177%2F107327481602300404">lack of access to trials</a>. </p>
<p>Clinical trials have specific eligibility criteria, and may require a number of study-related visits to the hospital where they’re conducted. But underserved and underrepresented populations often aren’t seen in practices that recruit patients for clinical trials. </p>
<p>Typically, clinical trials are designed by research-focused physicians working in <a href="https://www.cancertodaymag.org/summer2017/a-new-look-for-clinical-trials-diversity/">urban medical centers</a>. The majority of Black and Hispanic patients have <a href="https://doi.org/10.1377/hlthaff.2021.01409">limited access to the health care system</a> as a whole, and the centers that serve them often do not have the research infrastructure or resources to run clinical trials.</p>
<p>While researchers have made attempts to <a href="https://doi.org/10.1093/ibd/izac124">increase the diversity of clinical trial participants</a>, <a href="https://doi.org/10.1016/j.cpcardiol.2018.11.002">misconceptions and biases</a> within the medical community about underrepresented populations limit these outreach efforts. For example, <a href="https://doi.org/10.1353%2Fhpu.2006.0126">beliefs persist</a> that Black patients aren’t willing to participate in research studies and are noncompliant and mistrustful due to historical abuse from medical researchers, such as in the <a href="https://doi.org/10.1093%2Fqje%2Fqjx029">Tuskegee syphilis study</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7qAld9bGwlA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Limited access to clinical trials is both a product of and driving factor behind health disparities.</span></figcaption>
</figure>
<h2>A colon cancer case study</h2>
<p>One example of how lack of diversity in clinical trial participation can lead to poor health for patients is outcomes for <a href="https://www.cdc.gov/ibd/what-is-IBD.htm">inflammatory bowel disease</a>. IBD is a chronic condition that comes in two forms, ulcerative colitis and Crohn’s disease. Patients with IBD have an <a href="https://doi.org/10.3748%2Fwjg.v20.i29.9872">increased risk of developing colorectal cancer</a>.</p>
<p>Black patients account for 75% of IBD cases at Morehouse School of Medicine. Many of our current patients were either previously misdiagnosed or only treated for their symptoms in the emergency room without further investigation. This has led to many of our patients getting diagnosed with IBD when the disease is already at an advanced stage, making it more difficult to treat.</p>
<p>Julia Liu started Morehouse’s <a href="https://clinicaltrials.gov/ct2/show/NCT04369053">first colorectal cancer clinical trial</a> in 2021. The Prevention of Colorectal Cancer Through Multiomics Blood Testing study evaluated whether a particular blood test could aid in early colorectal cancer screening. Due to misconceptions about Black patients’ interest in research, we anticipated few patients would participate in the trial because our patient base is 90% African American. The sponsor for the study expected an enrollment rate as low as one to three patients per week at our site. </p>
<p>However, when enrollment began, we saw high interest among our Black patients. After three months, we had enrolled <a href="https://eposters.ddw.org/ddw/2022/ddw-2022/353760/krystal.mills.fact.or.myth.black.patients.do.not.want.to.participate.in.html?f=listing%3D1%2Abrowseby%3D8%2Asortby%3D2%2Amedia%3D2%2Ace_id%3D2236%2Alabel%3D24500%2Aot_id%3D26916">100 patients, 85% of whom were Black</a>.</p>
<p>So how did we do it?</p>
<h2>Identifying barriers</h2>
<p>First, we identified the participation barriers our Black and Hispanic patients faced.</p>
<p>We conducted a pilot study to identify more broadly the main barriers to research participation in underserved and underrepresented populations in our area. We reviewed enrollment rates, failures to meet eligibility and data issues, among others, from our past studies to see where we could improve.</p>
<p>We evaluated the role of mistrust by <a href="https://doi.org/10.1093/ibd/izac124">surveying patients at an IBD education conference</a>. Although patients often cited mistrust of health care providers and systems as a major barrier to trial participation, 70% of patients with a college education trusted their gastroenterologists, and 100% of patients with less than a college education trusted their doctors. Moreover, while 83% of respondents knew about the Tuskegee syphilis study, only 23% indicated that their decision to not participate in research was influenced by that study.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Clinician showing clipboard to patient in exam room" src="https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There often isn’t enough time to talk about the details of participating in a clinical trial during an office visit.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-with-a-tablet-computer-royalty-free-image/898328226">FatCamera/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>We also identified other barriers based on our experience working with Black patients in other clinical trials. A significant one was low levels of <a href="https://medlineplus.gov/healthliteracy.html">health literacy</a>, or the ability to understand and make informed health care decisions. Another was limited access to specialty care, particularly when patients have been waiting for months for an appointment. Lack of transportation was another.</p>
<p>Time was another barrier. Because many of our patients have limited exposure to clinical studies, they have many questions and concerns that most clinicians <a href="https://doi.org/10.1016/j.cpcardiol.2018.11.002">do not have the time</a> to answer in the space of a standard appointment. Patients also could not afford the time commitment required for complex clinical trials. An informed consent process can take over an hour, and many trials require frequent and prolonged hospital visits, for which patients may not be able to take paid time off.</p>
<h2>Implementing solutions</h2>
<p>After identifying these barriers, we worked to create solutions to help our patients participate in research.</p>
<p>We pre-screened potential study participants by looking through their electronic medical records and provider referrals. This helped us identify qualifying patients and proactively reach out to them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two researchers looking at test tube" src="https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Training research and clinical staff on cultural competency could increase trial recruitment and improve care.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/detection-of-the-pathogen-coronavirus-infection-in-royalty-free-image/1207087144">valentinrussanov/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>We also trained research staff as well as hospital administration, faculty, staff and students on the study, offering tips on how to interact with underserved and underrepresented patients.</p>
<p>Most importantly, we encouraged our clinicians and researchers to create a safe space for participants to be able to ask questions. This also provides an opportunity to work out ways to accommodate a patient’s schedule. </p>
<h2>Making an effort</h2>
<p>Working with diverse participants can be challenging, but so is every other aspect of clinical research. Our results showed that intentional recruitment, flexibility and creative solutions can help increase enrollment of underrepresented populations in clinical trials.</p>
<p>Partnering with an institution dedicated to serving underserved populations can also help. But above all, research participants are looking for a genuine interest in their well-being.</p><img src="https://counter.theconversation.com/content/185337/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Overcoming the access barriers and biases that underrepresented and underserved communities face could not only improve research participation but also improve care.Julia Liu, Professor of Medicine, Morehouse School of MedicineRaKetra Snipes, Physician Assistant in Gastroenterology, Morehouse School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1777872022-02-24T15:24:09Z2022-02-24T15:24:09ZVegetarian, pescatarian or low meat diets may reduce cancer risk – new research<figure><img src="https://images.theconversation.com/files/448337/original/file-20220224-33175-nyx8j2.jpg?ixlib=rb-1.1.0&rect=51%2C0%2C5760%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vegetarians had a 14% lower risk of developing all types of cancer compared to people who regularly eat meat.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-lunch-party-home-vegetarian-meal-1662594976">Dejan Dundjerski/ Shutterstock</a></span></figcaption></figure><p>A growing number of people are choosing to eat less meat. There are many reasons people may choose to make this shift, but health is often cited as a popular motive.</p>
<p>A large body of research has shown that plant-based diets can have many health benefits – including lowering the risk of chronic diseases, such as <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002039">type 2 diabetes</a> and <a href="https://www.sciencedirect.com/science/article/pii/S0735109717375216?via%3Dihub">heart disease</a>. Two large studies – <a href="http://www.epic-oxford.org/">EPIC-Oxford</a> and the <a href="https://adventisthealthstudy.org/studies/AHS-2">Adventist Health Study-2</a> – have also suggested vegetarian or pescatarian diets (where the only meat a person eats is fish or seafood) may be linked to a slightly lower overall cancer risk. </p>
<p>Limited research has shown whether these diets could lower risk of developing specific types of cancer. This is what our <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-022-02256-w">recent study</a> aimed to uncover. We found that eating less meat lower a person’s risk of developing cancer – even the most common types of cancer.</p>
<p>We conducted a large-scale analysis of diet and cancer risk using data from the <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a> study (a database of detailed genetic and health information from nearly 500,000 British people). When participants were recruited between 2006 and 2010, they completed questionnaires about their diet – including how often they ate foods such as meat and fish. We then tracked participants for 11 years using their medical records to understand how their health had changed during this time.</p>
<p>Participants were then categorised into four groups depending on their diet. Around 53% were regular meat-eaters (meaning they ate meat more than five times a week). A further 44% of participants were low meat-eaters (eating meat five or less times a week). Just over 2% were pescatarians, while just under 2% of participants were classified as vegetarians. We included vegans with the vegetarian group as there weren’t enough to study them separately.</p>
<p>Our analyses were also adjusted to ensure other factors that might increase risk of cancer – such as age, sex, smoking, alcohol consumption and sociodemographic status – were taken into account.</p>
<p>Compared with regular meat-eaters, we found the risk of developing any type of cancer was 2% lower for low meat-eaters, 10% lower in pescatarians and 14% lower in vegetarians.</p>
<h2>Specific cancer risk</h2>
<p>We also wanted to know how diet affected risk of developing the three most common types of cancer seen in the UK. </p>
<p>We found that low meat-eaters had a 9% lower risk of colorectal cancer compared with regular meat-eaters. <a href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00444-1/fulltext">Previous research</a> has also shown that a higher intake of processed meat in particular is associated with higher colorectal cancer risk. We also found that vegetarians and pescatarians had a lower risk of colorectal cancer, however this was not statistically significant. </p>
<p>We also found that women who ate a vegetarian diet had an 18% lower risk of postmenopausal breast cancer in comparison to regular meat-eaters. However, this association was largely due to the lower average body weight seen in vegetarian women. Previous studies have shown that being overweight or obese after menopause increases <a href="https://www.wcrf.org/dietandcancer/breast-cancer/">risk of breast cancer</a>. No significant associations were observed between postmenopausal breast cancer risk among pescatarians and low meat-eaters.</p>
<figure class="align-center ">
<img alt="A woman holds a bowl of vegetarian foods." src="https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448338/original/file-20220224-5831-pbrr7g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vegetarian diets were linked with lower breast cancer risk in women.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/healthy-vegetarian-dinner-woman-jeans-warm-1317602774">Foxys Forest Manufacture/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Pescatarians and vegetarians also had a lower risk of prostate cancer (20% and 31% less respectively) in comparison to regular meat-eaters. But it’s not clear whether this is because of diet, or if it’s due to other factors – such as whether or not a person sought cancer screening. </p>
<p>As this was an observational study (meaning we only observed changes to a participant’s health without asking them to make changes to their diet), this means we can’t know for sure if the links we’ve seen are directly caused by diet, or if they’re due to other factors. Although we adjusted the results carefully to take into account other important causes of cancer, such as smoking and alcohol consumption, it’s still possible other factors may still have influenced the results we observed. </p>
<p>Another limitation of our study is that most of the participants <strong>(around 94%)</strong> were white. This means we don’t know whether the same link will be seen in other ethnic groups. It will also be important for future studies to look at a more diverse population, as well as larger numbers of vegetarians, pescatarians and vegans to explore whether this link between lower cancer risk and these types of diets is as strong as we observed. </p>
<p>It’s important to note that simply eliminating meat doesn’t necessarily make your diet healthier. For example, some people who follow a vegetarian or pescatarian diet may still eat low amounts of fruits and vegetables and high amounts of refined and processed foods, which might lead to poor health.</p>
<p>Most evidence showing an association between lower cancer risk and vegetarian or pescatarian diets also seems to suggest that greater consumption of vegetables, fruits and whole grains may explain this lower risk. These groups also don’t consume red and processed meat, which is linked with <a href="https://www.wcrf.org/dietandcancer/meat-fish-and-dairy/">higher colorectal cancer risk</a>. But more evidence will be needed to fully explore the reasons for the results we observed.</p>
<p>The links between red and processed meat and cancer risk are well known – which is why it’s <a href="https://www.wcrf.org/diet-and-cancer/cancer-prevention-recommendations/">widely recommended</a> people aim to limit the amount of these foods they consume as part of their diet. It’s also recommended that people consume a diet rich in whole grains, vegetables, fruits and beans as well as maintain a healthy body weight in order to reduce their risk of cancer.</p><img src="https://counter.theconversation.com/content/177787/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cody Watling receives funding from Nuffield Department of Population Health Doctoral Scholarship.
The authors would like to thank Dr. Caroline Wood for her writing assistance, language editing, and proofreading of this article.</span></em></p><p class="fine-print"><em><span>Aurora Perez-Cornago receives funding from Cancer Research UK and the World Cancer Research Fund. </span></em></p><p class="fine-print"><em><span>Tim Key receives funding from Cancer Research UK, Wellcome
</span></em></p>Eating less meat was also linked with a lower risk of colorectal, breast, and prostate cancer.Cody Watling, PhD Researcher, Cancer Epidemiology Unit, University of OxfordAurora Perez-Cornago, Senior Nutritional Epidemiologist, University of OxfordTim Key, Professor of Epidemiology, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1722112021-12-09T13:35:28Z2021-12-09T13:35:28ZColorful sweets may look tasty, but some researchers question whether synthetic dyes may pose health risks to your colon and rectum<figure><img src="https://images.theconversation.com/files/436174/original/file-20211207-27-1n10fff.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Early-onset colorectal cancer rates have been increasing since the 1990s.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/homemade-christmas-gingerbread-cookies-royalty-free-image/878594696">kajakiki/E+ via Getty Images</a></span></figcaption></figure><p>Early-onset colorectal cancer incidence among the young, defined as those under age 50, has been <a href="https://dx.doi.org/10.1155%2F2019%2F9841295">rising globally</a> since the early 1990s. Rates for colon and rectal cancers are expected to <a href="https://doi.org/10.1001/jamasurg.2014.1756">increase by 90% and 124%</a>, respectively, by 2030.</p>
<p>One suspected reason behind this trend is <a href="https://doi.org/10.1017/S136898002000350X">increased global consumption</a> of a <a href="https://dx.doi.org/10.1053%2Fj.gastro.2017.02.015">Westernized diet</a> that consists heavily of red and processed meats, added sugar and refined grains. <a href="http://dx.doi.org/10.1136/bmjopen-2015-009892">Sixty percent of the Standard American Diet</a>, also known as “SAD,” is made up of ultra-processed food such as industrial baked sweets, soft drinks and processed meat. SAD is associated with an <a href="https://doi.org/10.1001/jamanetworkopen.2021.34308">increased risk of colorectal cancer</a>. </p>
<p>One aspect of ultra-processed foods I’m concerned about is how colorful they are. This characteristic is on full display in many delicious foods and treats present during the year-end holidays. However, many of the colors that make up candy canes, sugar cookies and even cranberry sauce and roast ham, are synthetic. And there’s some evidence that these artificial food dyes may trigger cancer-causing processes in the body.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/435965/original/file-20211206-23-18akuko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Rainbow-colored gum drops in a glass bowl against a white background." src="https://images.theconversation.com/files/435965/original/file-20211206-23-18akuko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435965/original/file-20211206-23-18akuko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435965/original/file-20211206-23-18akuko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435965/original/file-20211206-23-18akuko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435965/original/file-20211206-23-18akuko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435965/original/file-20211206-23-18akuko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435965/original/file-20211206-23-18akuko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">While artificial food coloring may look pretty, potential health risks require further study.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rainbow-colored-candy-royalty-free-image/171363813">cmannphoto/E+ via Getty Images</a></span>
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<p>As the <a href="https://scholar.google.com/citations?user=zHSS6mQAAAAJ&hl=en">director of the Center for Colon Cancer Research</a> at the University of South Carolina, I have been studying the effects of these synthetic food dyes on colorectal cancer development. While research on the potential cancer risk of synthetic food dyes is only just starting, I believe that you may want to think twice before you reach for that colorful treat this holiday season. </p>
<h2>What are synthetic food dyes?</h2>
<p>The food industry uses synthetic dyes because they make food look better. The first food dyes were <a href="https://www.atlasobscura.com/articles/coal-tar-food-coloring-perkin">created from coal tar</a> in the late 1800s. Today, they are often synthesized from a chemical derived from petroleum called naphthalene to make a final product called an <a href="https://psiberg.com/azo-dyes-history-uses-synthesis/">azo dye</a>.</p>
<p>Food manufacturers prefer synthetic dyes over natural dyes like beet extract because they are <a href="https://www.washingtonpost.com/opinions/the-rainbow-of-food-dyes-in-our-grocery-aisles-has-a-dark-side/2011/03/21/AFyIwaYB_story.html">cheaper, brighter and last longer</a>. While manufacturers have developed hundreds of synthetic food dyes over the past century, the <a href="https://doi.org/10.1080/19440049.2016.1274431">majority of them are toxic</a>. Only nine are approved for use in food under U.S. <a href="https://www.fda.gov/industry/color-additive-inventories/summary-color-additives-use-united-states-foods-drugs-cosmetics-and-medical-devices#table1B">Food and Drug Administration</a> policy, and even fewer pass <a href="https://www.everydayhealth.com/diet-nutrition/why-are-some-food-additives-that-are-banned-in-europe-still-used-in-the-us/">European Union</a> regulations.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/6FPnag_rvU8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Food manufacturers in the U.S. started using synthetic dyes to standardize the coloring of their products as a marketing strategy.</span></figcaption>
</figure>
<h2>What drives colorectal cancer?</h2>
<p><a href="https://doi.org/10.1016/j.cell.2011.02.013">DNA damage</a> is the primary driver of colorectal cancer. When DNA damage occurs on cancer driver genes, it can result in a mutation that tells the cell to divide uncontrollably and turn cancerous.</p>
<p>Another driver of colorectal cancer is <a href="https://doi.org/10.2174/1871530320666200909092908">inflammation</a>. Inflammation occurs when the immune system sends out inflammatory cells to begin healing an injury or capture disease-causing pathogens. When this inflammation persists over time, it can harm otherwise healthy cells by releasing molecules called <a href="https://dx.doi.org/10.4103%2F0973-7847.70902">free radicals</a> that can damage DNA. Another type of molecule called <a href="https://dx.doi.org/10.3389%2Ffimmu.2018.01270">cytokines</a> can prolong inflammation and drive increased cell division and cancer development in the gut when there isn’t an injury to heal. </p>
<p>Long-term poor dietary habits can lead to a <a href="https://www.health.harvard.edu/staying-healthy/all-about-inflammation">simmering low-grade inflammation</a> that doesn’t produce noticeable symptoms, even while inflammatory molecules continue to damage otherwise healthy cells.</p>
<h2>Synthetic food dyes and cancer</h2>
<p>Although none of the FDA-approved synthetic food colors are classified as carcinogens, currently available research points to potential health risks I <a href="https://cspinet.org/resource/food-dyes-rainbow-risks">and others</a> find concerning.</p>
<p>For example, the bacteria in your gut can <a href="https://www.doi.org/10.2741/400">break down synthetic dyes</a> into molecules that are known to cause cancer. More research is needed on how the <a href="https://doi.org/10.1038/s41416-021-01467-x">microbiome</a> interacts with synthetic food coloring and potential cancer risk.</p>
<p>Studies have shown that artificial food dyes can <a href="https://doi.org/10.1089/dna.2010.1181">bind to the DNA</a> and <a href="https://doi.org/10.1016/j.compbiolchem.2015.04.006">proteins</a> inside cells. There is also some evidence that synthetic dyes can <a href="https://doi.org/10.1016/j.nut.2017.08.010">stimulate the body’s inflammatory machinery</a>. Both of these mechanisms may pose a problem for colon and rectal health.</p>
<p>Synthetic food dyes have been found to <a href="https://doi.org/10.2131/jts.35.547">damage DNA in rodents</a>. This is supported by unpublished data from my research team showing that Allura Red, or Red 40, and Tartrazine, or Yellow 5, can cause DNA damage in colon cancer cells with increased dosages and length of exposure in vitro in a controlled lab environment. Our results will need to be replicated in animal and human models before we can say that these dyes directly caused DNA damage, however.</p>
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<p>Finally, artificial food coloring may be of particular concern for children. It’s known that children are <a href="https://doi.org/10.1377/hlthaff.2011.0151">more vulnerable to environmental toxins</a> because their bodies are still developing. I and others believe that this concern may extend to <a href="https://oehha.ca.gov/risk-assessment/report/health-effects-assessment-potential-neurobehavioral-effects-synthetic-food">synthetic food dyes</a>, especially considering their prevalence in children’s food. A <a href="https://doi.org/10.1177/0009922816651621">2016 study</a> found that over 40% of food products marketed toward children in one major supermarket in North Carolina contained artificial food coloring. More research needs to be done to examine how repeated exposure to artificial food dyes may affect children.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/435966/original/file-20211206-17-zfqrkp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child eating a donut with blue frosting." src="https://images.theconversation.com/files/435966/original/file-20211206-17-zfqrkp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435966/original/file-20211206-17-zfqrkp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435966/original/file-20211206-17-zfqrkp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435966/original/file-20211206-17-zfqrkp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435966/original/file-20211206-17-zfqrkp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435966/original/file-20211206-17-zfqrkp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435966/original/file-20211206-17-zfqrkp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many foods marketed toward kids contain synthetic food coloring.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/enjoying-my-dessert-royalty-free-image/898216164">FluxFactory/E+ via Getty Images</a></span>
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<h2>Lowering your risk of colorectal cancer</h2>
<p>A few treats during the holidays won’t cause colorectal cancer. But a long-term diet of processed foods might. While more research is needed on the link between synthetic food dyes and cancer, there are evidence-based steps you can take now to <a href="https://www.cancer.org/latest-news/six-ways-to-lower-your-risk-for-colon-cancer.html">reduce your risk of colorectal cancer</a>.</p>
<p>One way is to get screened for colon cancer. Another is to increase your physical activity. Finally, you can eat a <a href="https://doi.org/10.1002/ijc.31198">healthy</a> <a href="https://doi.org/10.1093/annonc/mdx171">diet</a> with more whole grains and produce and less alcohol and red and processed meat. Though this means eating fewer of the colorful, ultra-processed foods that may be plentiful during the holidays, your gut will thank you in the long run.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/172211/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lorne J. Hofseth receives funding from the National Cancer Institute.</span></em></p>Sixty percent of the Standard American Diet consists of ultra-processed food, which isn’t great for colon health. Researchers are looking into whether artificial food colors play a role.Lorne J. Hofseth, Professor and Associate Dean for Research, College of Pharmacy, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1552142021-03-22T12:24:49Z2021-03-22T12:24:49ZColorectal cancer screening recommended at age 45 instead of 50 – it’s no fun, but it’s worth it<figure><img src="https://images.theconversation.com/files/390451/original/file-20210318-17-1gfwdxr.jpg?ixlib=rb-1.1.0&rect=0%2C64%2C4778%2C2773&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A man holds a photograph of Chadwick Boseman, who died from colon cancer at age 43. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/man-holds-a-photograph-of-the-late-us-actor-and-producer-news-photo/1228262421?adppopup=true">Frederic J. Brown via AFP/Getty Images</a></span></figcaption></figure><p>Colorectal cancer screenings should begin at age 45 instead of 50, according to the panel that sets guidelines for preventive screenings in the U.S. <a href="https://www.uspreventiveservicestaskforce.org/uspstf/">The U.S. Preventive Services Task Force</a> on May 18, 2021, <a href="https://doi.org/10.1001/jamasurg.2021.1939">officially recommended lowering the age recommendation</a> because of an increase in colorectal cancer among young adults by almost 15% in about a 15-year period.</p>
<p><a href="https://www.researchgate.net/scientific-contributions/Franklin-G-Berger-38259146">As a research scientist and an advocate for people with colorectal cancer</a>, I am particularly excited over this change. Along with a 2020 federal law that changed reimbursement to make sure the <a href="https://thehill.com/blogs/congress-blog/politics/541073-medicare-loophole-for-screening-colonoscopies-is-fixed-what-does">cost of a screening colonoscopy is fully covered</a> by Medicare, this development will likely save lives.</p>
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<figcaption><span class="caption">The actor Will Smith made a video story of his first colonoscopy.</span></figcaption>
</figure>
<h2>A deadly disease</h2>
<p>Colorectal cancer remains a major source of cancer incidence and mortality worldwide. The American Cancer Society <a href="https://doi.org/10.3322/caac.21654">recently estimated</a> that in 2021 there will be 149,500 new cases of colorectal cancer and 52,980 deaths in the U.S. alone. This places the disease fourth highest in cancer incidence and second highest in mortality in the country. Only lung cancer claims more lives from cancer in the U.S. In addition, African Americans are more likely to be diagnosed with the disease and to die from it.</p>
<p>And yet colorectal cancer is among the most preventable of cancers. Over the past three decades, timely screening and removal of precancerous lesions, called polyps, before they progress to cancer have contributed to <a href="https://doi.org/10.3322/caac.21601">sustained decreases</a> in colorectal cancer incidence and mortality. So progress is being made, but we have a way to go.</p>
<p>In 2000, <a href="https://clintonwhitehouse4.archives.gov/WH/New/html/20000301_1.html">President Bill Clinton</a> dedicated March as National Colorectal Cancer Awareness Month, indicating that “our most effective weapon in defeating colorectal cancer is early detection and treatment.” Each year, survivors, patients, medical providers, researchers and advocates collectively disseminate knowledge of colorectal cancer and its prevention to the general population, promoting awareness and action that will reduce the toll of this highly preventable disease.</p>
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<figcaption><span class="caption">African Americans are at higher risk of death from colorectal cancer.</span></figcaption>
</figure>
<h2>Alarming trend in young adults</h2>
<p>For quite some time, national guidelines recommended that colorectal cancer screening begin at the age of 50, when risk of the disease starts to climb markedly. However, in recent years, researchers and physicians have observed that the incidence of <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2020-2022.pdf">colorectal cancer is increasing</a> in people under age 50. Until now, screening has generally not been recommended for those under 50 unless major symptoms occur. </p>
<p>Those of us who study the disease do not fully understand the reasons behind this increase, but there is growing concern among doctors, researchers and, of course, patients and their families. This concern led to reconsideration of screening guidelines. In October 2020, the United States Preventive Services Task Force conducted a comprehensive and in-depth evaluation. It <a href="https://uspreventiveservicestaskforce.org/uspstf/draft-recommendation/colorectal-cancer-screening3">recommended that adults ages 45-49</a> be screened for colorectal cancer, bringing the task force in line with what the American Cancer Society <a href="https://doi.org/10.3322/caac.21457">recommended in 2018</a>.</p>
<p>The panel’s decision this week serves as an official update to recommendations it last made in 2016.</p>
<p>The <a href="https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/health-insurance-laws/the-health-care-law.html">Affordable Care Act</a> mandates that colorectal cancer screening follow <a href="https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-coverage-laws.html">these guidelines</a>, and that private insurers and Medicare cover approved screening tests with no copayments. </p>
<p>Now, adults ages 45-49, who are increasingly vulnerable to colorectal cancer, will become eligible for insurance that fully covers screening.</p>
<h2>Getting rid of surprise payments</h2>
<p>The second development concerns Medicare coverage of screening colonoscopies. While Medicare must cover colorectal cancer screening with no copayments, <a href="https://www.medicare.gov/coverage/colonoscopies">a copayment is charged</a> if a polyp or other tissue is found and removed during a colonoscopy. The rationale for this has been that removal of tissue is considered a diagnostic, rather than a screening, procedure.</p>
<p>This distinction has led to patients’ being surprised with a copayment they weren’t expecting. Thus, Medicare patients undergoing colonoscopy think that they are fully covered, only to be confused by being billed for a copayment after the procedure had been carried out.</p>
<p>This has been deemed unacceptable by medical providers and public health advocates, who view removal of precancerous lesions to be an integral part of the screening process. In all, this situation, known as the Medicare loophole, has <a href="https://gastro.org/advocacy-and-policy/policies-affecting-gi/patient-access-to-colorectal-cancer-screening/">become a barrier</a> to preventive colonoscopy in an older population that is at high risk of colorectal cancer. </p>
<p>After many years of advocacy and lobbying around this issue by organizations such as Fight Colorectal Cancer and the American Cancer Society Cancer Action Network, the loophole was finally closed in December 2020, when Congress passed, and President Trump signed, the <a href="https://www.congress.gov/bill/116th-congress/house-bill/1570">Removing Barriers to Colorectal Cancer Screening Act of 2020</a>. This act, part of the COVID-19 Economic Relief Bill, requires the waiving of coinsurance charges associated with colorectal cancer screening tests, regardless of whether tissue is removed during the test. It will be phased in during an eight-year period beginning in 2022. </p>
<figure class="align-center ">
<img alt="Three researchers at a university lab." src="https://images.theconversation.com/files/390490/original/file-20210318-13-1uga2oh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390490/original/file-20210318-13-1uga2oh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390490/original/file-20210318-13-1uga2oh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390490/original/file-20210318-13-1uga2oh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390490/original/file-20210318-13-1uga2oh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390490/original/file-20210318-13-1uga2oh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390490/original/file-20210318-13-1uga2oh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Researchers at a University of Colorado lab search for biomarkers that can identify colorectal cancer.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/university-of-colorado-research-team-headed-up-by-dr-news-photo/161183972?adppopup=true">Kathryn Scott Osler/The Denver Post via Getty Images</a></span>
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<h2>The future of colorectal cancer screening</h2>
<p><a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2021/03/01/a-proclamation-on-national-colorectal-cancer-awareness-month-2021/">President Biden</a>, in a proclamation to the nation on March 1, encouraged “all citizens, government agencies, private businesses, nonprofit organizations and other groups to join in activities that will increase awareness and prevention of colorectal cancer.” The new screening guidelines will help make that happen in the future.</p>
<p>A number of effective <a href="https://www.cancer.gov/types/colorectal/screening-fact-sheet#r24">options for colorectal cancer screening</a> were approved under the new guidelines. These include tests that look for the presence of blood or specific DNA biomarkers in fecal samples, and visualization tests that directly examine the inner lining of the colon and allow removal of tumors or precancerous lesions. </p>
<p>New technologies are emerging that should make screening easier and more effective. For example, <a href="https://doi.org/10.1016/j.currproblcancer.2018.08.004">liquid biopsies</a> involve analysis of easily obtained bodily fluids, such as blood or urine. Doctors may soon to able to isolate and analyze <a href="https://stm.sciencemag.org/content/11/507/eaay1984.short">cells or DNA</a> that come from tumors and that are present within the bloodstream. </p>
<p>Also, <a href="https://doi.org/10.1158/1055-9965.EPI-18-1291">molecules in urine</a> may be potentially important as biomarkers for detection of colorectal lesions.</p>
<p>Though the utility of technologies such as these is still under study, it is clear that in the near future we should witness the appearance of simpler, more accessible and more sensitive tests for colorectal cancer. It is important to note, however, that these noninvasive tests must be followed up by a colonoscopy if anything of concern is noted.</p>
<p>People of all ages need to be aware of risk factors for colorectal cancer, of symptoms that may be indicative of the disease, and of strategies and guidelines for screening and prevention. Talk to your doctor and your insurance provider about colorectal cancer and its prevention. And make sure you are aware of the recent changes in screening guidelines. The more you know, the better.</p><img src="https://counter.theconversation.com/content/155214/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Franklin G. Berger currently receives funding from the Centers for Disease Control and Prevention, and the General Assembly of the State of South Carolina. In the recent past, he has received funding from the National Institutes of Health, The Duke Endowment and the BlueCross BlueShield of South Carolina Foundation.</span></em></p>Screening for colorectal cancer should begin at 45, not 50. A colorectal cancer expert explains how that could save lives, and why the age was lowered.Franklin G. Berger, Distinguished Professor Emeritus of Biological Sciences, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1455442020-09-03T06:54:19Z2020-09-03T06:54:19ZChadwick Boseman died of colon cancer at just 43. Here’s what under 50s need to know about bowel cancer<figure><img src="https://images.theconversation.com/files/356232/original/file-20200903-14-tw8a42.jpg?ixlib=rb-1.1.0&rect=39%2C208%2C2356%2C2744&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>If you’re under 50, the recent death of Black Panther star Chadwick Boseman of colon cancer at just 43 may have prompted a worrying thought.</p>
<p>Isn’t colon cancer – also known as bowel cancer – an older person’s disease? If I’m around Boseman’s age or under, should I be getting tested?</p>
<p>The short answer is that anyone is free to go to the chemist and buy a home testing kit (officially known as a <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/early-detection-and-screening/understanding-your-fobt-results">faecal occult blood test</a> or FOBT), which can detect tiny traces of blood in your stool. </p>
<p>These tests, which involve dipping a sample stick into a bit of poo collected on paper, are <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/early-detection-and-screening/bowel-cancer-screening">sent free to eligible people when they turn 50</a>, but there’s nothing stopping a younger person buying one if they’re concerned.</p>
<p>If you have more serious <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/early-detection-and-screening/early-detection-of-bowel-cancer">symptoms</a>, however – such as the recent appearance of blood in the stool – make an appointment to see your GP as soon as possible.</p>
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<figcaption><span class="caption">Credit: The Australian government Department of Health.</span></figcaption>
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<strong>
Read more:
<a href="https://theconversation.com/whats-behind-the-increase-in-bowel-cancer-among-younger-australians-105484">What's behind the increase in bowel cancer among younger Australians?</a>
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<h2>Assessing your risk</h2>
<p>Age is the biggest risk factor for bowel cancer, and the absolute risk for young people remains low. </p>
<p>That said, <a href="https://theconversation.com/whats-behind-the-increase-in-bowel-cancer-among-younger-australians-105484">research</a> shows the incidence of bowel cancer, which includes colon and rectal cancer, has increased by up to 9% in people under 50 from the 1990s until now. </p>
<p>We can’t say for sure what’s driving this rise, but we do know increased bowel cancer risk is associated with obesity, eating lots of processed foods (including meats), alcohol, and not doing enough exercise.</p>
<p>The other key risk factor is a family history of bowel cancer in a close relative — meaning your mother, father, sister or brother has had it, particularly if they had it while young. Another symptom doctors look for is a low iron level, particularly in men.</p>
<p>Bowel cancer is also more common in men than in women. </p>
<p>Research suggests a <a href="https://theconversation.com/heres-what-you-can-eat-and-avoid-to-reduce-your-risk-of-bowel-cancer-120084">diet</a> high in fibre — including wholegrains, dairy, fruits and vegetables — reduces your overall bowel cancer risk.</p>
<h2>Going to the GP</h2>
<p>A really important symptom to look out for is new rectal bleeding when you pass a bowel movement. Some people may see bright red blood on the toilet paper from time to time over the years, but if it is a new symptom or you are concerned, you need to get checked out by your GP.</p>
<p>Your GP can work out if you need specialist review and further investigations. They’ll likely ask you to do a blood test, they’ll want to know your iron count and possibly do some stool testing. In some cases, a colonoscopy will be recommended. </p>
<p>A colonoscopy is where a doctor inserts a flexible instrument fitted with a camera into your anus and into your bowel while you’re under anaesthetic. It is not without <a href="https://www.bowelcanceraustralia.org/colonoscopy">risk</a>, so it is only done with good reason.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/356250/original/file-20200903-20-1nu9f6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman exercises at home." src="https://images.theconversation.com/files/356250/original/file-20200903-20-1nu9f6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/356250/original/file-20200903-20-1nu9f6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/356250/original/file-20200903-20-1nu9f6t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/356250/original/file-20200903-20-1nu9f6t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/356250/original/file-20200903-20-1nu9f6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/356250/original/file-20200903-20-1nu9f6t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/356250/original/file-20200903-20-1nu9f6t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Exercise can reduce your cancer risk.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Home testing kits</h2>
<p>The home testing faecal occult blood test (FOBT) kit is a screening test, so it doesn’t pick up all cases – but it’s reasonably accurate in low risk populations. They are designed for screening asymptomatic people. </p>
<p>If you are male, overweight and have a family history of bowel cancer and want to do a home testing kit, then see your GP to discuss this. </p>
<p>Importantly, keep your weight in a healthy range and exercise regularly. This will reduce your risk for many cancers, not just bowel cancer.</p>
<p>And if you are over 50, please make sure you use your free stool testing kit. Don’t just put it in the bathroom drawer – do it the day after it arrives. There’s no better day.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-what-you-can-eat-and-avoid-to-reduce-your-risk-of-bowel-cancer-120084">Here's what you can eat and avoid to reduce your risk of bowel cancer</a>
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<img src="https://counter.theconversation.com/content/145544/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Suzanne Mahady does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A really important symptom to look out for is new rectal bleeding when you pass a bowel movement. But anyone can buy a home testing kit if they’re concerned.Suzanne Mahady, Gastroenterologist & Clinical Epidemiologist, Senior Lecturer, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1453572020-09-02T12:23:07Z2020-09-02T12:23:07ZChadwick Boseman’s death underscores colorectal cancer increase in younger adults and health gaps for African Americans<figure><img src="https://images.theconversation.com/files/355872/original/file-20200901-20-wts8rh.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C3000%2C1940&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Actor Chadwick Boseman at the GQ Men of the Year party at the Chateau Marmont in Los Angeles, Dec. 3, 2015. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/GQMenoftheYearParty/5d0f008fb8934440a30e83ce2614fddb/photo?Query=chadwick%20AND%20boseman&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=849&currentItemNo=4">Jordan Strauss/Invision/AP</a></span></figcaption></figure><p>The <a href="https://www.cbsnews.com/news/chadwick-boseman-dies-age-43-colon-cancer-actor/">tragic death of Chadwick Boseman</a> at age 43 following a four-year battle against colorectal cancer underscores two important public health concerns.</p>
<p>First, the incidence of colorectal cancer has risen dramatically among adults under age 50 in the U.S. and in many countries around the world. Second, African Americans have a much greater likelihood of being diagnosed and dying from the disease at any age. Both issues are important to the public health community and efforts are ongoing to address them.</p>
<p>Colorectal cancer remains a major source of cancer incidence and death in the U.S. The <a href="https://doi.org/10.3322/caac.21601">American Cancer Society estimates</a> that in 2020, about 147,950 people will be diagnosed with colorectal cancer and 53,200 will die from the disease, making it the fourth most prevalent form of cancer and the second leading cause of cancer mortality.</p>
<p>As a <a href="https://sc.edu/study/colleges_schools/artsandsciences/biological_sciences/our_people/directory/berger_franklin.php">scientist conducting basic research on colorectal cancer</a>, I have been generally aware of these sobering trends. </p>
<h2>Increases in adults younger than 50</h2>
<p>In 2017, <a href="https://scholar.google.com/citations?user=xld5jaAAAAAJ&hl=en">Dr. Rebecca Siegel</a> and colleagues published detailed and compelling <a href="https://doi.org/10.1093/jnci/djw322">statistical data</a> clearly bringing the issue into sharp focus, stimulating greater coverage in the media. </p>
<p>Analysis of trends in colorectal cancer incidence and mortality have clearly shown a decline in the general U.S. population overall during the past few decades. Unfortunately, this has not been the case for young adults.</p>
<p>For example, <a href="https://doi.org/10.3322/caac.21601">incidence</a> has decreased by an average of 4% per year between 2007 and 2016 in those over 65 years of age, in contrast to an increase of 1.4% per year during the same period in those under 50. The observed decrease in older adults is likely due to preventive screening, which is recommended and advocated for people over 50 and has been undertaken by a larger fraction of the population. </p>
<p>Similarly, <a href="https://doi.org/10.3322/caac.21601">colorectal cancer mortality</a> has declined by 3% per year between 2008 and 2017 in those over 65, while it has increased by 1.3% per year in those under 50. </p>
<p>The American Cancer Society <a href="https://doi.org/10.3322/caac.21601">predicts 17,930 new cases of colorectal cancer within the under-50 population and 3,640 deaths</a> in 2020. Expectations are that the fraction of cases occurring in young adults will increase even more over the next decade, and may carry over to those over 50.</p>
<p>I have met a number of young people, including several in their 20s and 30s, who had been diagnosed with colorectal cancer and were in the midst of fighting it. I have also met parents who lost young adult children to the disease, and were still trying to understand how this could have happened. </p>
<p>I have been struck by the intensity and complexity of emotions displayed by these people, including anger, resentment, embarrassment, hopelessness, fear and resolve. While a cancer diagnosis at any age is scary and disorienting, it extracts a particularly powerful psychological and social toll on young adults. </p>
<p>What is causing the increase in young adults? We do not know for certain. Several studies have indicated that the <a href="https://doi.org/10.1016/j.giec.2020.03.001">disease in young people is different</a> with regard to the specific location of the tumor within the colon or rectum. </p>
<p>Also, the pathology, genetics and response to treatment differ. <a href="https://www.npr.org/sections/health-shots/2017/02/28/517563769/why-are-more-young-americans-getting-colon-cancer">Lifestyle trends</a>, such as overweight and obesity, lack of physical activity and changing diets, have been suggested to play roles. Studies have indicated that obesity is associated with increased risk of early-onset <a href="https://doi.org/10.1001/jamaoncol.2018.4280">colorectal cancer in women</a>. </p>
<p>While these trends may contribute, they are not fully explanatory. Physicians have told me anecdotally that many of their younger patients are thin, fit, physically active and in general good health, suggesting that something else must be going on. </p>
<p>What could that something else be? One intriguing possibility may lie in the <a href="https://doi.org/10.1038/nm.4142">billions of microbes</a>, collectively termed the microbiota, that live on and within our bodies. <a href="https://www.medscape.com/viewarticle/924282#vp_2">Preliminary findings</a> reported at the 2020 Gastrointestinal Symposium recently indicated that there may be differences between the microbiota within tumors from younger versus older colorectal cancer patients. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Microbes that make up the microbiome affect health in different ways.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/intestinal-microbiome-bacteria-colonizing-different-parts-1031178730">Kateryna Kon/Shutterstock.com</a></span>
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<h2>African Americans and colorectal cancer</h2>
<p>The death of Boseman has also underscored the long-standing racial disparity for colorectal cancer. African Americans suffer from high incidences and mortalities, regardless of age. <a href="https://doi.org/10.3322/caac.21601">Incidence in African Americans</a> was 18% higher than in whites during 2012-2016, while mortality was 38% higher during the same period. For reasons we do not yet know, incidence in younger African Americans has been relatively stable in contrast to that in younger whites. </p>
<p>Increased incidence and death from colorectal cancer in African Americans is likely a consequence of lower rates of screening, as well as environmental, socioeconomic and lifestyle factors. Reduction of the disparities may depend upon addressing these factors. </p>
<h2>Screening can prevent colorectal cancer</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Precancerous growths called polyps can be easily removed during a colonoscopy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/polypectomy-using-colonoscopy-789408859">Sezer33/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Screening for colorectal cancer not only detects the disease but is also highly effective in preventing it. Screening can readily identify precancerous growths called <a href="https://www.fascrs.org/patients/disease-condition/polyps-colon-and-rectum">polyps</a>, as well as early-stage cancers. These often can be removed before they progress to life-threatening stages. </p>
<p>Any of a number of methods for <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2">colorectal cancer screening</a> are now available, including colonoscopy, <a href="https://www.mayoclinic.org/tests-procedures/flexible-sigmoidoscopy/about/pac-20394189">flexible sigmoidoscopy</a>, imaging and several stool-based tests. </p>
<p>In addition, research is underway to find new methods for colorectal cancer screening based upon analysis of easily obtained body fluids such as <a href="https://doi.org/10.1002/ijc.33217">blood</a> and <a href="https://doi.org/10.1007/s00384-019-03419-7">urine</a>. </p>
<p>Based upon the knowledge that about 90% of colorectal cancer cases occurs in those 50 and over, the U.S. Preventive Services Task Force <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2">currently recommends</a> that screening should begin at age 50 for those who have no predisposing symptoms. This population is experiencing the decrease in colorectal cancer incidence and death that is currently being observed overall.</p>
<p>But screening is not typically recommended for those under 50, and most health insurers do not pay for screening in this group. </p>
<p>This lack of screening, combined with a general lack of awareness about colorectal cancer and its symptoms among young people can result in late diagnoses. Later diagnoses can often result in more <a href="https://doi.org/10.1007/s11938-019-00219-4">advanced stages of the disease</a>, when it is harder to treat and significantly more lethal.</p>
<p>Recently, the American Cancer Society recommended lowering the <a href="https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines/colorectal-cancer-screening-guidelines.html">screening age to 45</a>, in order to catch a good percentage of the younger people whose risk may be increasing. Health-related professional organizations such as the <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2">U.S. Preventive Services Task Force</a> and the <a href="https://www.cdc.gov/cancer/colorectal/basic_info/screening/index.htm">Centers for Disease Control and Prevention</a> have yet to adopt them. This may change, as discussions are ongoing.</p>
<p>There is also a need to increase screening in the African American community. At present, recommendations vary. In contrast to the <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2">U.S. Preventive Services Task Force</a> and the <a href="https://www.cdc.gov/cancer/colorectal/basic_info/screening/index.htm">CDC</a>, the <a href="https://www.asge.org/docs/default-source/education/practice_guidelines/piis0016510717318059.pdf?sfvrsn=e7e83550_0">U.S. Multi-Society Task Force</a> recommends that screening in African Americans should begin at age 45 rather than 50. I hope these influential organizations will reach a consensus on this issue.</p>
<p>Sorting out the causes of age and race disparities in colorectal cancer incidences and mortalities, and understanding the nature of the disease more thoroughly, will take time. </p>
<p>As Boseman’s untimely death reminds us, colorectal cancer is a difficult and emotional disease for all people at any age. Awareness of signs and symptoms, along with engagement in screening as appropriate, will lead to the eventual eradication of the disease as a major form of cancer.</p>
<p><em>Editor’s note: This article is an updated version of an <a href="https://theconversation.com/colorectal-cancer-increase-in-younger-adults-what-could-be-the-cause-113980">article originally published March 26, 2019</a>.</em></p><img src="https://counter.theconversation.com/content/145357/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Franklin G. Berger has received funding from the National Institutes of Health, the BlueCross BlueShield of South Carolina Foundation, and The Duke Endowment</span></em></p>Chadwick Boseman’s death at age 43 is emblematic of two disturbing health trends.Franklin G. Berger, Distinguished Professor Emeritus of Biological Sciences, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1310862020-02-04T13:31:47Z2020-02-04T13:31:47ZCancer deaths decline in US, with advances in prevention, detection and treatment<figure><img src="https://images.theconversation.com/files/313354/original/file-20200203-41476-1hzpaqx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Former President Jimmy Carter pictured at an Atlanta Braves-Toronto Blue Jays game in Atlanta on Sept. 17, 2015, shortly after being treated for melanoma.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Blue-Jays-Braves-Baseball/834e4ba1ad1a4a528b045739bdd89528/30/0">AP Photo/John Bazemore</a></span></figcaption></figure><p>The American Cancer Society recently reported a drop in the overall cancer death rate in the U.S., with an <a href="https://doi.org/10.3322/caac.21590">overall 29% decline</a> in cancer deaths from 1991 to 2017.</p>
<p>This resulted in 2.9 million fewer deaths over this span. </p>
<p>This decline was mainly attributable to progress in the four most common cancers: lung, colorectal, breast and prostate cancer. This included a <a href="https://doi.org/10.3322/caac.21590">record decline of 2.2%</a> in the last year of the report (2016-2017), led by a particularly steep recent drop in lung cancer. And, an article published Jan. 29 in the New England Journal of Medicine found that <a href="https://doi.org/10.1056/NEJMoa1911793">screening current and former heavy smokers</a> with a low-dose CT scan is helping to detect the disease earlier, which is contributing to lower mortality.</p>
<p>I am the <a href="https://www.umassmed.edu/medicine/about-us/department-administration/division-chiefs/">chief of hematology/oncology and medical director</a> of the Cancer Center at the University of Massachusetts Medical School and UMass Memorial Health Care. I take care of patients with cancer, with particular expertise in leukemia and related diseases. The steady decline in cancer deaths is quite encouraging, particularly in lung cancer – which provides a great example of how public health campaigns can change the course of a disease.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/u4bvisvSAu8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">More women die of lung cancer each year than breast cancer. Low-dose CT screening has been show to make a difference.</span></figcaption>
</figure>
<h2>Lung cancer deaths drop signficantly</h2>
<p>A number of factors have contributed to the reduction in lung cancer deaths, according to the report. Prevention has had a profound impact in reducing lung cancer over the past 25-plus years, primarily through smoking prevention and cessation programs. Smoking among adults is at an all-time low in the U.S., <a href="https://www.cdc.gov/tobacco/data_statistics/fact_sheets/index.htm">at 13.7%</a>. Tobacco is a risk factor for most cancers, and this is particularly true for lung cancer, where smoking is the single greatest cause. </p>
<p>Improved <a href="https://www.cancer.org/latest-news/radon-gas-and-lung-cancer.html">radon detection and mitigation</a> has also helped, as radon exposure represents the <a href="https://www.cancer.org/cancer/cancer-causes/radiation-exposure/radon.html">second most preventable cause</a> of lung cancer. </p>
<p>The advent of <a href="https://doi.org/10.1056/NEJMoa1911793">low-dose computer tomograhy (CT) screening</a> for high-risk patients – current and former heavy smokers – has also played a critical role. Early detection by CT has found lung cancers at a still curable stage, leading to at least a 20% decrease in death rates. </p>
<p>Advances in treatment have accounted for the remainder of progress in lung cancer. The introduction of new drugs, including immunotherapy – which won the <a href="https://www.cancer.org/latest-news/nobel-prize-awarded-to-cancer-immunotherapy-researchers.html">2018 Nobel in Medicine and Physiology</a> for its ability to harness the power of the immune system to kill cancer cells – provides hope for previously untreatable patients. </p>
<p>Despite these successes, lung cancer is still the leading cause of cancer death, with <a href="https://doi.org/10.3322/caac.21590">228,820 new cases and 135,720 deaths</a> predicted for 2020 in the U.S.</p>
<h2>Has progress stalled in the other common cancers?</h2>
<p>The gains in treating <a href="https://doi.org/10.3322/caac.21590">breast, prostate and colorectal cancer</a> have slowed a bit over the past decade. However, to put this in perspective, more deaths are predicted in the U.S. this year from lung cancer than from these other three cancers combined. </p>
<p>Breast, prostate and colorectal cancers have also all benefited from <a href="https://doi.org/10.3322/caac.21590">longstanding screening programs and earlier therapeutic successes</a>, thus setting a higher bar for further improvement compared to lung cancer. </p>
<p>Some of the stalled progress may also reflect rising rates of <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet">obesity</a>, which represents a risk factor for death from each of these cancers.</p>
<p>Last, <a href="https://www.cancerresearch.org/blog/january-2020/cancer-immunotherapy-in-2020-and-beyond">immunotherapy has not yet realized the same gains</a> in these cancers, as in lung and others. </p>
<p>That said, these data extend only up to 2017; so more recent breakthroughs are not yet reflected in the report.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313357/original/file-20200203-41495-1qo0zzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313357/original/file-20200203-41495-1qo0zzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=358&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313357/original/file-20200203-41495-1qo0zzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=358&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313357/original/file-20200203-41495-1qo0zzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=358&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313357/original/file-20200203-41495-1qo0zzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=450&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313357/original/file-20200203-41495-1qo0zzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=450&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313357/original/file-20200203-41495-1qo0zzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=450&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A nurse reaches for blood samples from a patient at the Fred Hutchinson Cancer Center in Seattle that were to be used in CAR-T cell therapy March 21, 2017.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Genetic-Frontiers-Living-Cancer-Drugs/2dde4a1d038640bcb09ef8ea415eaaac/3/0">AP Photo/Elaine Thompson</a></span>
</figcaption>
</figure>
<h2>Dramatic breakthroughs</h2>
<p>Some groundbreaking advances have yielded great successes in selected cancers, with the hope that such treatments may be more broadly applicable. Immunotherapy has proven highly successful <a href="https://doi.org/10.5114/wo.2018.73889">in melanoma</a>. Some may recall the treatment of former <a href="https://www.cancerresearch.org/join-the-cause/cancer-immunotherapy-month/30-facts/20">President Jimmy Carter with pembrolizumab</a>, an immunotherapeutic drug.</p>
<p>This breakthrough, along with the introduction of drugs that specifically target cancer cells to kill them or at least slow their growth, or what scientists call molecular inhibitors, has led to the most pronounced reduction in cancer death rates for melanoma since 2013. These same principles have since been applied with some degree of success to a variety of other cancers. Indeed, this very strategy has been responsible for the some of the <a href="https://doi.org/10.1007/978-3-030-02505-2_3">recent success with lung cancer.</a></p>
<p>Even more impressively, a specific class of drugs called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/tyrosine-kinase-inhibitor">tyrosine kinase inhibitors</a> dramatically changed the course of chronic myeloid leukemia (CML) over the past two decades. These drugs shut off a key signaling pathway that the CML cells depend upon for their growth and survival, thus converting CML from a universally fatal disease to one with which most patients will live a near normal lifespan. Targeted inhibitors have also revolutionized the treatment and prognosis of chronic lymphocytic leukemia and a number of other blood cancers. </p>
<p>In addition, the past quarter century has seen tremendous advances in the treatment of pediatric acute lymphocytic leukemia – the most common form of childhood cancer, with cure rates now <a href="https://www.cancer.org/cancer/leukemia-in-children/detection-diagnosis-staging/survival-rates.html">approaching 90%</a>. Another type of leukemia, <a href="https://www.lls.org/sites/default/files/National/USA/Pdf/Publications/APL_FactSheet_10_15FINAL.pdf">acute promyelocytic leukemia</a>, also now has cure rates in excess of 80%, thanks to the introduction of <a href="https://doi.org/10.1038/sj.onc.1204763">all-trans retinoic acid</a> (an active form of Vitamin A) and the subsequent addition of arsenic over the past several decades. </p>
<p>One of the most exciting advances has been another form of immunotherapy – <a href="https://doi.org/10.3390/jcm8020207">chimeric antigen receptor (CAR) T cells</a> – which have produced extraordinary results in some of the most challenging blood cancers. These genetically re-engineered immune cells are reprogrammed to seek out and destroy cancer cells with remarkable efficiency. This highly promising therapy is now FDA-approved for some types of leukemia and lymphoma; it is also now being explored in many other types of cancer, including solid tumors.</p>
<h2>Putting it all in perspective</h2>
<p>These remarkable advances in cancer prevention, detection and treatment provide great hope. In fact, it is important to note that the ACS data extend only through 2017, so many recent breakthroughs are not yet reflected in the report. </p>
<p>That said, there is still much work to be done, and funding support for ongoing research remains critical.</p>
<p>Improved participation in, increased availability of, and better design of clinical trials are also desperately needed to advance the field. Cancer is rapidly approaching heart disease as the number one cause of death in the U.S., and we have made far too little progress with many types of cancer. </p>
<p>Furthermore, access to state-of-the-art, much less cutting-edge, cancer care remains limited, with significant racial and socioeconomic disparities. This is particularly true for <a href="https://doi.org/%2010.1200/JGO.18.00200">developing countries</a>, where many tests and therapies are prohibitively expensive and are simply not available to most citizens. </p>
<p>Armed with a better understanding of cancer and a host of new strategies to treat it, we oncologists are quite optimistic that the next decade will yield impressive results in the battle against cancer. We must ensure not only continued progress, but also that these advances reach all patients, in an effort to stamp out cancer across the world.</p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/131086/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan M. Gerber does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Cancer mortality has dropped in the US, due largely to lower smoking rates, as well as early detection and better treatments. These advances often do not extend to people in developing nations.Jonathan M. Gerber, Chief of Hematology/Oncology, Medical Director of the Cancer Center, and Eleanor Eustis Farrington Chair in Cancer Research, UMass Chan Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1139802019-03-26T10:39:40Z2019-03-26T10:39:40ZColorectal cancer increase in younger adults: What could be the cause?<figure><img src="https://images.theconversation.com/files/265687/original/file-20190325-36260-1g76ta8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An increase in colorectal cancer in adults younger than 50 is troubling to doctors and often tragic for patients. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-young-woman-suffering-headache-abdominal-789132703">kan-chana/Shutterstock.com</a></span></figcaption></figure><p>Colorectal cancer remains a major source of cancer incidence and death in the United States. The <a href="https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html">American Cancer Society estimates</a> that in 2019, there will be 145,600 new cases of the disease and 51,020 deaths across the United States, making it the fourth most diagnosed form of cancer and the second leading cause of cancer mortality.</p>
<p>This means that every hour, 17 families in the nation will learn that one of their members has colorectal cancer, or cancer of the large intestine or rectum, and that six families will lose one of their members to the disease. Despite these sobering numbers, there is good news.</p>
<p>Overall incidence and mortality rates for colorectal cancer have actually been <a href="https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html">on the decline</a> since the mid-1980s, primarily as a consequence of increased engagement in preventive screening, more effective diagnosis and treatment, and greater awareness of risk factors (such as family history, obesity, physical inactivity, smoking, heavy alcohol use, and diets rich in red and processed meats) and symptoms (chronic diarrhea or constipation, narrowing of the stool, rectal bleeding, blood in the stool, cramping or abdominal pain, and chronic weakness and fatigue).</p>
<p>Unfortunately, such is not the case for young people. Colorectal cancer incidences and deaths have been <a href="https://link.springer.com/article/10.1007%2Fs11894-018-0618-9">increasing over the last 30 years</a> in people under 50 years of age. As a scientist conducting basic research on colorectal cancer, I have been generally aware that this was occurring. However, two recent events impassioned me about the issue. </p>
<p>First, in 2017, Dr. Rebecca Siegel and colleagues published detailed and compelling <a href="https://academic.oup.com/jnci/article/109/8/djw322/3053481">statistical data</a> clearly showing that while the disease in younger people remains a relatively small fraction of the total, it is rising at an alarming rate. </p>
<p>This is in striking contrast to the situation for older people, in whom colorectal cancer is decreasing. These findings significantly brought the young adult issue into focus, and raised <a href="https://www.healio.com/hematology-oncology/gastrointestinal-cancer/news/in-the-journals/%7B50ec6f05-e289-498b-84f2-fa69fbb53ad1%7D/colorectal-cancer-rates-rising-dramatically-in-young-adults">public awareness of its existence</a>.</p>
<p>Second, at about the same time, I attended a conference where I met a number of young people, including several in their 20s and 30s, who had been diagnosed with colorectal cancer and were in the midst of fighting it. I also met parents who lost young adult children to the disease. The emotions displayed by these people were particularly acute, representing the intersection of anger, resentment, embarrassment, hopelessness and fear. I came away from that meeting committed to gaining an understanding of the increase in colorectal cancer among young adults, and doing something about it.</p>
<h2>Screening can actually be a cure</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/265692/original/file-20190325-36273-sp0aq8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Precancerous growths called polyps can be easily removed during a colonoscopy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/polypectomy-using-colonoscopy-789408859">Sezer33/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>With screening, precancerous growths called <a href="https://www.fascrs.org/patients/disease-condition/polyps-colon-and-rectum">polyps</a> and early-stage cancers can be readily detected and actually removed before they advance to dangerous, life-threatening stages. Thus, screening has become an indispensable strategy for the early-detection and prevention of colorectal cancer. Any of a number of methods for <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2">colorectal cancer screening</a> are now available, including colonoscopy, <a href="https://www.mayoclinic.org/tests-procedures/flexible-sigmoidoscopy/about/pac-20394189">flexible sigmoidoscopy</a>, imaging and several stool-based tests.</p>
<p>The U.S. Preventive Services Task Force <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2">currently recommends</a> that for the general population, screening should begin at age 50, based on the knowledge that approximately 90 percent of cases occurs in those 50 and over. It is this population that is experiencing the decrease in colorectal cancer incidence and death that is currently being observed.</p>
<p>However, screening is not typically recommended for those under 50. This, along with a general lack of awareness about colorectal cancer and its symptoms among young people, their families and their primary care providers, results in prolonged times for symptomatic patients to obtain a firm diagnosis. Late diagnoses often result in more <a href="https://link.springer.com/article/10.1007%2Fs11938-019-00219-4">advanced stages of the disease</a>, when it is harder to treat.</p>
<p>To address this, the American Cancer Society recently recommended lowering the <a href="https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines/colorectal-cancer-screening-guidelines.html">screening age to 45</a> in order to catch a good percentage of the younger people who may be at risk for disease. Though this recommendation is based upon detailed analysis of the efficacy and costs of colorectal cancer screening, health-related professional organizations such as the <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2">U.S. Preventive Services Task Force</a> and the <a href="https://www.cdc.gov/cancer/colorectal/basic_info/screening/index.htm">Centers for Disease Control and Prevention</a> have yet to adopt them. </p>
<h2>A perplexing medical mystery</h2>
<p>What is causing colorectal cancer to increase in young adults? In short, we do not know for certain, but a great deal of ongoing research is aimed at answering this vitally important question. Several studies have indicated that the disease in young people is <a href="https://link.springer.com/article/10.1007%2Fs11938-019-00219-4">different</a> in pathology, genetics and response to treatment from that in older people. <a href="https://www.npr.org/sections/health-shots/2017/02/28/517563769/why-are-more-young-americans-getting-colon-cancer">Lifestyle trends</a>, such as being overweight and obesity, lack of physical activity and changing diets, have been suggested to play roles.</p>
<p>Indeed, a recent study shows that obesity is associated with increased risk of early-onset <a href="https://jamanetwork.com/journals/jamaoncology/article-abstract/2705608">colorectal cancer in women</a>.</p>
<p>While these trends may be involved, many physicians have told me anecdotally that many of their young colorectal cancer patients appear thin, fit and active, suggesting that something else may be going on.</p>
<p>What could that something else be? There is <a href="https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1542356518309467?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1542356518309467%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2F">persuasive evidence</a> that features of early life contribute to risks for a number of adverse health effects that occur in later childhood, teen ages, and even in young adults. This include such things as: whether a baby was born via Caesarian section or vaginally; diet and nutrition; antibiotic use; whether a baby was nursed or fed formula; contact with microbes; and stress.</p>
<p>The health effects of these various factors have been linked to obesity, immune disorders, allergies, asthma and diabetes, among others. The <a href="https://www.nature.com/articles/nm.4142">billions of microbes</a> that live on and within our bodies, collectively termed the microbiota, undergo many changes during the period between birth and ages 3 to 4, and are highly susceptible to perturbation by the kinds of exposures listed above.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/265694/original/file-20190325-36270-gai6zi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microbes that make up the microbiome affect health in different ways.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/intestinal-microbiome-bacteria-colonizing-different-parts-1031178730">Kateryna Kon/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>It is possible, therefore, that microbes may be key in linking early life exposures to later life health. <a href="https://cccr.sc.edu/about-us/investigators">Our research group</a> is currently examining the possibility that increasing colorectal cancer incidences in young adults may be a consequence of environmental exposures that occur at very young ages, during the first few years after birth. For example, we have recently shown that in mice, <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1460">antibiotic treatment</a> causes depletion of the microbiota, along with an increase in development of precancerous tumors.</p>
<p>Sorting out the causes of young-adult colorectal cancer, and understanding the nature of the disease more thoroughly, will take time. While this research is going on, it is critical that young people, their families and their primary care providers become aware of, and pay attention to, family histories, lifestyles and symptoms, so the possible occurrence of colorectal cancer is recognized early and dealt with in a timely manner.</p>
<p>Colorectal cancer is a difficult and emotional disease at any age. This is especially so in young adults. Awareness of signs and symptoms, along with engagement in screening as appropriate, will lead to the eventual eradication of the disease as a major form of cancer.</p><img src="https://counter.theconversation.com/content/113980/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Franklin G. Berger has received funding from the National Institutes of Health, the BlueCross BlueShield of South Carolina Foundation, and The Duke Endowment. </span></em></p>Colorectal cancer rates among older adults have been declining, but diagnoses in adults younger than 50 have increased. As Colorectal Cancer Awareness Month winds down, a researcher offers insight.Franklin G. Berger, Research and Outreach Director, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1085102019-01-25T01:15:37Z2019-01-25T01:15:37ZDrinking water study raises health concerns for New Zealanders<figure><img src="https://images.theconversation.com/files/250607/original/file-20181214-185240-t6f37i.jpg?ixlib=rb-1.1.0&rect=350%2C373%2C4343%2C3370&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A study of drinking water sourced from groundwater in areas of intensive farming and horticulture found nitrate levels are already high and rising.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Last year, a Danish <a href="https://www.ncbi.nlm.nih.gov/pubmed/29435982">study</a> reported a link between nitrate in drinking water and the risk of developing colorectal (bowel) cancer. This finding could have important implications for New Zealanders. </p>
<p>New Zealand has one of the <a href="https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/bowel-cancer">highest bowel cancer rates in the world</a>. Recent data show also that drinking water supplies in some parts of New Zealand have nitrate levels more than three times higher than the threshold level for colorectal cancer risk identified in the Danish study. </p>
<p>This study and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6068531/">other research</a> raise an important question about the contribution nitrate exposure through drinking water may be making to New Zealand’s high rates of bowel cancer. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-behind-the-increase-in-bowel-cancer-among-younger-australians-105484">What's behind the increase in bowel cancer among younger Australians?</a>
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<h2>Health implications of nitrates in drinking water</h2>
<p>Nitrate fertiliser is added to pasture and crops to accelerate plant growth. Much of it <a href="https://www.dairynz.co.nz/news/latest-news/solutions-to-reduce-n-leaching-and-maintain-profit/">enters waterways</a> either directly with rain and irrigation or through animal urine.</p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/29435982">Danish study</a>, published in the International Journal of Cancer, was extensive both in number of participants and length of follow-up. It included 2.7 million people over 23 years and monitored their individual nitrate exposure levels and colorectal cancer rates. </p>
<p>The findings confirmed widely held suspicions that <a href="https://www.healio.com/gastroenterology/oncology/news/online/%7B49675916-a44d-4e62-a4b8-95789a17413d%7D/colon-cancer-risk-linked-to-nitrate-in-drinking-water-even-at-safe-levels">long-term exposure to nitrate may be linked to cancer risk</a>. The investigators propose that the risk results from nitrate converting into a carcinogenic compound (N-nitroso) after ingestion.</p>
<p>The research found a statistically significant increase in colorectal cancer risk at 0.87ppm (parts per million) of nitrate-nitrogen in drinking water. There was a 15% increase in risk at levels over 2.1ppm, compared with those who have the least exposure. </p>
<p>One key implication is that the current <a href="https://www.who.int/water_sanitation_health/gdwqrevision/nitrate-nitrite-fs-2017.pdf?ua=1">nitrate standard for drinking water</a> used in most countries, including New Zealand, is probably too high. </p>
<h2>International nitrate standards</h2>
<p>The cancer risk level (0.87ppm) identified in the study is less than a tenth of the <a href="https://www.health.govt.nz/system/files/documents/publications/drinking-waterstandards-2000.pdf">current maximum allowable value</a> (MAV) of nitrate-nitrogen of 11.3ppm (equivalent to 50ppm of nitrate). This level has been in use in many countries for decades and comes from the <a href="http://apps.who.int/iris/handle/10665/75380">World Health Organisation</a>’s limit. It is based on the <a href="https://www.who.int/water_sanitation_health/dwq/chemicals/nitrate-nitrite-background-jan17.pdf">risk of “blue baby syndrome”</a> (infantile methaemoglobinaemia, a condition that reduces the ability of red blood cells to release oxygen to tissues) – but not the risk of cancer.</p>
<p><a href="https://www.stuff.co.nz/environment/108988223/possible-watercancer-link-a-need-to-know-for-cantabrians">Rates of bowel cancer</a> vary across New Zealand, with the <a href="https://www.hqsc.govt.nz/assets/Health-Quality-Evaluation/Atlas/BowelCancerSF/atlas.html">highest incidence</a> in South Canterbury, with an age-standardised rate of 86.5 cases per 100,000 people. Bowel cancer is the second-highest cause of cancer death in New Zealand and each year around 3,000 people are diagnosed and <a href="https://beatbowelcancer.org.nz/our-work/atlas/">1,200 die of the disease</a>. </p>
<p>A recent <a href="http://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2016/vol-129-no-1447-16-december-2016/7100">epidemiological review</a> estimated the contribution of a range of modifiable “lifestyle” risk factors to colorectal cancer in New Zealand. In order of importance, these factors are obesity, alcohol, physical inactivity, smoking and consumption of red meat and processed meat. It would be useful to conduct more research to see if nitrate exposure in drinking water should be added to this list.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/250608/original/file-20181214-185268-1vurzxg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/250608/original/file-20181214-185268-1vurzxg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=459&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250608/original/file-20181214-185268-1vurzxg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=459&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250608/original/file-20181214-185268-1vurzxg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=459&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250608/original/file-20181214-185268-1vurzxg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=577&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250608/original/file-20181214-185268-1vurzxg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=577&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250608/original/file-20181214-185268-1vurzxg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=577&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This map shows the nitrate-nitrogen trends at monitored sites. The Canterbury region, on the east coast of the South Island, shows that groundwater quality has worsened.</span>
<span class="attribution"><span class="source">Ministry for the Environment, Stats NZ</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>A recent <a href="https://fishandgame.org.nz/">Fish and Game New Zealand</a> investigation of <a href="https://fishandgame.org.nz/news/canterbury-mater-testing-raises-health-concerns/">drinking water supplies</a> in the Canterbury region found that nitrate levels in drinking water sourced from groundwater in areas of intensive farming and horticulture are already high and rising. The findings are consistent with data from the regional council <a href="https://www.ecan.govt.nz/">Environment Canterbury</a>. The latest <a href="https://api.ecan.govt.nz/TrimPublicAPI/documents/download/3159733">groundwater report</a> showed that half of the wells they monitor have values greater than 3ppm nitrate-nitrogen, more than three times the Danish study’s trigger level for colorectal cancer risk. </p>
<p><a href="https://www.ccc.govt.nz/">Christchurch City Council</a> <a href="https://fyi.org.nz/request/4508-nitrate-concentrations-in-christchurch-drinking-water-in-the-past-5-years?fbclid=IwAR2iLarEPJ6d6GovxMoZK22C7G5SK9jTAm6rzA6Cvc4-bFRkmAxc007ab7E">data</a> show that of 420 samples collected during five years from 2011 to 2016, 40% exceeded 0.87ppm. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/youve-heard-of-a-carbon-footprint-now-its-time-to-take-steps-to-cut-your-nitrogen-footprint-98762">You've heard of a carbon footprint – now it's time to take steps to cut your nitrogen footprint</a>
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<h2>Impact on ecosystems</h2>
<p>When nitrate enters waterways, it accelerates algae growth. Freshwater scientists have long been pushing for nitrate limits to curtail algal proliferation, but restrictions have been slow and in some regions non-existent. An important coincidence is that the <a href="http://www.mfe.govt.nz/fresh-water/technical-guidance-and-guidelines/australian-and-new-zealand-guidelines-fresh-and-marine">Australian and New Zealand guideline for healthy aquatic ecosystems</a> for nitrate is at <a href="http://www.waterquality.gov.au/anz-guidelines/guideline-values/default/water-quality-toxicants/toxicants/nitrate-2000">0.7mg/l nitrate-nitrogen</a>, close to the level required to stay under the colorectal cancer risk value found in the Danish study.</p>
<p>The Canterbury region exemplifies the problems resulting from the <a href="http://www.mfe.govt.nz/sites/default/files/media/Environmental%20reporting/our-fresh-water-2017_1.pdf">failure of central and local government policy</a> in New Zealand to protect both ground and surface water. These failures cannot be blamed on a lack of awareness as these outcomes were predicted decades ago. For example, in 1986 the <a href="http://docs.niwa.co.nz/library/public/pHCC6.pdf">Ministry of Works predicted</a> the nitrate contamination we now see as a consequence of regional irrigation schemes. It made it clear that alternative drinking water supplies would have to be found for Canterbury residents.</p>
<p>Apart from health and ecological concerns, another worry is that public fears about drinking water safety will prove a boon for water bottling companies, which have <a href="https://www.stuff.co.nz/the-press/news/100296047/simmering-frustrations-over-water-bottling-mean-new-levy-could-be-in-the-pipeline">free access to New Zealand’s cleanest water</a>.</p>
<p>While many New Zealanders face significant and increasing costs for water treatment, water bottlers pay virtually nothing. The only cost, apart from bottling costs, is a <a href="https://www.ecan.govt.nz/data/consent-search/consentdetails/CRC145424">one-off 35-year regional council consent fee</a>. This anomaly highlights the urgent need for government to put tougher limits on nitrate loss and face up to dealing with water ownership issues in New Zealand. </p>
<p>In conclusion, surface water in many parts of New Zealand is highly contaminated with nitrates as a result of intensified farming. These elevated levels are undoubtedly damaging freshwater ecosystems and biodiversity, and may also be harming human health. </p>
<p>At the very least, public health authorities need to conduct a systematic survey to assess current nitrate levels in New Zealand drinking waters, including those that are not part of the routinely monitored networked system. This information could then be used to provide a quantitative estimate of the colorectal cancer burden in New Zealand that can be attributed to this hazard.</p><img src="https://counter.theconversation.com/content/108510/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael (Mike) Joy has received funding for technical reports from many New Zealand Regional Councils and the Ministry for the Environment</span></em></p><p class="fine-print"><em><span>Michael Baker does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nitrate in drinking water has been linked to an increased risk of colorectal cancer. That could have implications for some parts of New Zealand where nitrate levels are high.Mike Joy, Senior Researcher; Institute for Governance and Policy Studies, Te Herenga Waka — Victoria University of WellingtonMichael Baker, Professor of Public Health, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/896732018-01-08T22:47:34Z2018-01-08T22:47:34ZMeat is not the ‘new tobacco,’ and shouldn’t be taxed<figure><img src="https://images.theconversation.com/files/200826/original/file-20180104-26169-xpun6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is meat the new tobacco? Some are suggesting it is, and urging a "sin tax" on beef, pork and other meats.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The idea of having to pay a sin tax for environmentally detrimental foods is gaining more support. For some, eating meat is a sin, and therefore meat products should be taxed like alcohol and tobacco. </p>
<p><a href="http://www.fairr.org/resource/livestock-levy-regulators-considering-meat-taxes/">A new report published recently by a British group called Farm Animal Investment Risk and Return Initiative (FAIRR)</a> argues that a tax on meat is inevitable.</p>
<p>The meat industry, particularly beef producers, has been facing relentless criticism over the last decade. Very rarely have we seen reports encouraging consumers to eat more meat. </p>
<p>For one thing, science-based findings linking climate change and meat have been accumulating. The United Nations Food and Agriculture Organization <a href="http://www.fao.org/ag/againfo/resources/en/publications/tackling_climate_change/index.htm">has reported that livestock account for about 14.5 per cent</a> of the world’s greenhouse gas emissions. Other surveys have suggested the sector may represent up to 18 per cent. </p>
<p>Greenhouse gas emissions produced by the livestock industry will only increase as the middle class in both India and China expand, and, as such, <a href="http://www.ibtimes.co.uk/global-meat-consumption-increasing-driven-china-india-527128">demand for animal protein is exploding.</a></p>
<p>And then there’s health.</p>
<p>In 2015, the World Health Organization <a href="https://www.cancer.org/latest-news/world-health-organization-says-processed-meat-causes-cancer.html">linked meat consumption to cancer.</a> The report indicated that eating processed meat products increases the risk of developing cancer. </p>
<p><a href="http://www.straitstimes.com/asia/australianz/australia-says-who-study-linking-processed-meat-to-cancer-is-a-farce">Several meat-producing countries</a>, including <a href="http://nationalpost.com/news/canada/agriculture-canada-challenged-whos-cancer-warnings-on-meat-according-to-newly-released-documents">Canada</a>, the U.S., Brazil and Australia, ridiculed the report because processed meats were added to the same category as asbestos. </p>
<h2>Meat-eating discouraged in some countries</h2>
<p>But several other governments, <a href="https://www.theguardian.com/world/2016/jun/20/chinas-meat-consumption-climate-change">including China</a> and some European countries, have actively discouraged their citizens from consuming an unreasonable amount of meat. That’s not a signal the meat industry needs.</p>
<p>The other major headwind the industry faces is related to the ethical treatment of animals. Some believe livestock production is unethical and that the industrial production of meat <a href="http://www.debatingeurope.eu/2016/09/20/intensive-animal-farming-banned/#.Wk5ZIbQ-cW8">should be outlawed</a>, period. </p>
<p>The ethics narrative around meat has been gaining traction over the last decade or so.</p>
<p>Now, if you think the FAIRR initiative is some minor, under-resourced group desperately trying to seek attention, think again. It includes a portfolio of 57 investors with more than US$2.3 trillion under management.</p>
<p>This alliance clearly wants to influence the plant-based protein agenda, and has had its fair share of success in doing so. Already, agri-food giants like Tyson Foods and Cargill <a href="https://www.fastcompany.com/40508181/get-ready-for-a-meatless-meat-explosion-as-big-food-gets-on-board">are looking at “beyond-meat” solutions.</a></p>
<p>Demand-focused companies are seeing the writing on the wall. Many consumers are <a href="https://theconversation.com/less-meat-more-choice-a-look-at-key-food-issues-in-2018-89489">re-evaluating their relationship with animal proteins</a>, although in cattle country, a large number remain in deep denial and blame interest groups for fear-mongering.</p>
<h2>Canadians still love their meat</h2>
<p>Statistics show that demand for meat in Canada is still stubbornly robust. The average Canadian typically consumes <a href="http://www.agr.gc.ca/eng/industry-markets-and-trade/market-information-by-sector/red-meat-and-livestock/red-meat-and-livestock-market-information/protein-disappearance-and-demand-by-species/?id=1415860000022">about 87 kilograms of meat products</a> in one year, which is just slightly lower than the amount from five years ago. </p>
<p>This year, beef consumption in our country reached 25.4 kilograms per capita, and some expect demand for the product to increase to 25.5 kilograms next year. Surprising, perhaps, but beef prices have come down, making the product more attractive for the consumer on a budget. </p>
<p>Some <a href="https://caes.usask.ca/members/_pdf/2017%20Canadian%20Agricultural%20Outlook.pdf">significant variations among provinces</a> should be noted, though. Alberta is by far the largest consumer of beef; the average adult Albertan male will eat 83 grams a day. That’s 53 per cent more than the average in Newfoundland, and 18 per cent more than in neighbouring British Columbia. Affordability and lifestyle are probable reasons for such a difference. </p>
<p>Canadian consumers have stayed on the side of our livestock industry, but numbers are showing signs of a change in consumer habits. </p>
<p>Demand for pork is <a href="https://www.discoverwestman.com/ag-news/39921-canadian-pork-council-discusses-strategic-planning-at-fall-meeting">expected to fall to unprecedented levels in 2018,</a> dropping 13 per cent from its 2015 level. Demand for chicken, one of the cheapest types of animal protein out there, plateaued in 2016 and has since softened.</p>
<p>Although beef could experience a rebound in 2018, expected increases aren’t spectacular given how low retail prices are these days. Canadians are not giving up on meats, but they are willing to spend more time away from the meat counter. Animal protein still has market currency, but plant-based alternatives to meat are increasingly attractive.</p>
<p>But little can be accomplished by taxing meat. Taxing food in general — any food product — is morally questionable. A retail tax on food is regressive and can potentially penalize the underprivileged who need affordable sources of protein. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/200822/original/file-20180104-159080-1y8vcm3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some have floated the idea of taxing meat as a type of sin tax.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
</figcaption>
</figure>
<h2>Meat the new tobacco?</h2>
<p>Some have argued that <a href="https://www.huffingtonpost.com/kathy-freston/animal-products-cancer_b_1316222.html">meat is the new tobacco</a>. This sensationalist parallel is unwise, since tobacco is not essential to life and food is. </p>
<p>The implementation of such a tax would also be challenging. </p>
<p>If federal or provincial governments were to tax meat, funds would likely be used to support other relevant public programs. But as with any tax, transparency on how funds are dispersed within the massive, bureaucratic governmental machinery is weak. </p>
<p>What’s more, many small businesses around the country have offered high-quality meat products to local markets. Many of them are family businesses. Taxing sausages and steaks would compromise the viability of many stores valued by communities across the country.</p>
<p>Meat has played a significant part in consumers’ lives in the Western world for centuries. Penalizing consumers for continuing a culinary tradition is unfair.</p>
<p>Taxing a food product that’s been entrenched in our culture for so long is idealistically silly. We should let the market evolve and allow consumers to make their own choices. </p>
<p>That said, the livestock industry must pore over market data and start listening to consumers in order to better appreciate their concerns. Given that they are <a href="https://www.producer.com/2017/10/who-do-consumers-trust-farmers-favoured-for-reliable-info/">one of the most trusted groups in our economy</a>, livestock producers are ideally positioned to renew their social contract with the public.</p><img src="https://counter.theconversation.com/content/89673/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sylvain Charlebois does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Taxing a food product like meat, which has been entrenched in our culture for so long, is silly. We should let the market evolve and allow consumers to make their own choices.Sylvain Charlebois, Professor in Food Distribution and Policy, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/739662017-03-06T01:57:32Z2017-03-06T01:57:32ZColonoscopy: nothing to fear from the ‘silver stallion’<p>I recently had a colonoscopy, an invasive medical procedure to examine the bowel, and was hugely relieved to get the all-clear. I posted a description of my experience to my friends on Facebook and got a range of responses. </p>
<p>Among the bad puns about me having “updated” my status and many thumbs up, were some that indicated people misunderstood why anyone would have a colonoscopy. Some close friends also muttered comments that it was tacky to post about such intimacies.</p>
<p>People have colonoscopies for a range of reasons, including looking for signs of bowel (colorectal) cancer.</p>
<p>Bowel cancer is Australia’s <a href="http://www.cancer.org.au/about-cancer/types-of-cancer/bowel-cancer/">second biggest</a> cancer killer after lung cancer, claiming the lives of 4,162 people every year, nearly 95% of whom are aged 50 years or more. A total of 14,958 people were newly diagnosed with the disease in 2013. Both men and women are at risk of developing bowel cancer, with a split of around 55% male and 45% female.</p>
<p>But compared to some more high profile (mainly female specific) cancers, bowel cancer has long suffered a far lower profile than its prevalence, impact and potential for early intervention warrant.</p>
<h2>Why isn’t bowel cancer mentioned on TV?</h2>
<p>Bowel cancer barely makes it on the TV news when you compare how common it is. Our 2010 <a href="https://www.ncbi.nlm.nih.gov/pubmed/19382099">research</a> showed bowel cancer news reports accounted for 4.1% of all news reports about cancer but bowel cancer represents 13.5% of newly diagnosed cancers and 11.5% of cancer deaths.</p>
<p>Compared to cancers receiving greater TV news coverage, there were hardly any reports of celebrity diagnoses, and mention of bowel cancer advocacy groups.</p>
<p>At that time, the national colorectal screening program, which began in 2006, received limited coverage. Breast cancer received 13 times the number of reports than did colorectal cancer.</p>
<p>Reports produced to support planning for the national campaign highlighted the importance of celebrities prepared to discuss their conditions in the media to raise awareness of breast cancer. In contrast, no celebrities were then known to be involved in bowel cancer publicity. There were also no special high-profile appeals, awareness weeks or advertising campaigns.</p>
<p>This is changing with efforts such as celebrity bowel cancer ambassadors and greatly increased publicity being driven by the <a href="http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/bowel-screening-1">national campaign</a> and cancer councils.</p>
<p>Factors known to stop people taking part in bowel cancer screening mainly relate to procrastination and its perceived unpleasantness. Then there’s the fear of discovering a potentially fatal illness; fatalism (beliefs that there’s not much you can do about it if you’ve got it); no symptoms and/or family history of the disease; and squeamishness about getting stool samples.</p>
<p>Given some of my friends’ reaction, the importance of participation in bowel screening, and on-going challenges in getting higher rates of participation in screening, I thought I’d walk readers through what’s involved.</p>
<h2>It started when I turned 50</h2>
<p>I had my first colonoscopy when I turned 50, along with some other minor repair work. The surgeon said:</p>
<blockquote>
<p>We’ll use the opportunity to take a look inside you.</p>
</blockquote>
<p>Thankfully, I was clear of problems.</p>
<p>One memory was how far anaesthesia had advanced since my unpleasant memories of the ether-soaked mask descending over my face when I had my appendix removed in the early 1960s.</p>
<p>Another memory was the unexpected greeting a bunch of medical students, who were about to cast their wide eyes on my nether regions, gave me in the prep room. One bubbled in the seconds before I went under:</p>
<blockquote>
<p>Hey! Hello Prof Chapman!</p>
</blockquote>
<p>Oh great.</p>
<p>At 65, I was perhaps overdue for a second encounter. The death of a neighbour in his 50s and two colleagues diagnosed with bowel cancer in recent years gave me no hesitation when the trigger of a mailed invitation and kit from the <a href="https://www.bowelcanceraustralia.org/national-bowel-cancer-screening-program">National Bowel Cancer Screening Program</a> to have a faecal occult blood test (FOBT) arrived. </p>
<p>My stool sample was positive (it contained blood), as are the results for about one in 14 people who take an FOBT test. But there are many reasons other than cancer for blood in the stool. I take a low-dose aspirin tablet every day, which can cause <a href="http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/art-20046797">intestinal bleeding</a>, and that may have been responsible.</p>
<p>A letter arrived strongly urging I book a colonoscopy. I’d be renewing my acquaintance with the “silver stallion”, as proctologists sometimes call it.</p>
<h2>Watch what you eat, purge, repeat</h2>
<p>I booked in for a Tuesday. Over the weekend I was told to eat no fibre, with Monday being the “purgatory” day. From waking, you can eat nothing but water, then 2-8pm you drink three sachets of purgative. I’ve drunk more foul brews (castor oil, as a child), but not many. I found the best strategy was to re-imagine myself in my undergraduate days, sculling a schooner of beer, mentally block out the thought of the taste, and just keep swallowing.</p>
<p>About an hour after the first sachet you begin your impersonation of a human fire hydrant. By the end of the evening, your newly svelte correspondent had lost 2.5kg.</p>
<p>My appointment was for 9am. I joined about 12 others of a similar vintage, some with supportive partners stroking their hands. I then discovered there was one final, by far the worst, purgative.</p>
<p>I was made to sit in a waiting room for about three hours watching commercial morning TV. This was an endless advertorial gushing about vacuum cleaners, kitchen slicers and stain removers. Watching this stuff would be enough to give anyone the trots.</p>
<h2>A view from both ends</h2>
<p>When it was my turn, I got into the backless gown with a rear neck tie and waited on the trolley bed. A very pleasant nurse came to insert the cannula for the anaesthetic in my hand and explain what lay ahead. </p>
<p>She noted I was also having an endoscopy to check my throat and stomach after I’d had a reflux incident. In case I might have wondered, she assured me:</p>
<blockquote>
<p>We don’t use the same camera.</p>
</blockquote>
<p>I was, apparently, in a classy establishment.</p>
<p>I looked at my watch as I was wheeled in, and again when I woke up afterwards. Some 20 minutes had passed. And within a minute or so, the doctor was at my beside with the news I was clear of any problems in both ends. </p>
<p>I dressed, was picked up and went to a Vietnamese restaurant where I murdered a giant bowl of beef pho, ravenous. The next day I drove from Sydney to Melbourne, fully alert and comfortable.</p>
<p>To me, the procedure itself was an utter non-event. Serious complications like bowel perforation are rare. The voiding is just a “grit your teeth and get on with it” exercise that you quickly forget. But the peace of mind afterwards is wonderful.</p>
<h2>Lives saved</h2>
<p>Last month <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2817%2930396-3/fulltext#.WLejZSv1Uf0.email">The Lancet</a> published results from the longest follow-up study of people screened for bowel cancer.</p>
<p>Researchers followed 170,034 people for a median 17.1 years, some screened once with <a href="https://www.scripps.org/news_items/4457-what-is-the-difference-between-a-colonoscopy-and-a-sigmoidoscopy">sigmoidoscopy</a>, which is like a colonoscopy but doesn’t go as deep into the bowel, and others who had not had sigmoidoscopy.</p>
<p>After adjusting for non-compliance such as study drop-outs, the number of new cases of bowel cancer were reduced by 35% in the group that had had a single sigmoidoscopy versus the control group; deaths from bowel cancer were reduced by 41%.</p>
<p>This is another ringing endorsement for early intervention.</p>
<p>The Cancer Council Australia <a href="http://www.cancer.org.au/about-cancer/early-detection/screening-programs/bowel-cancer-screening/">recommends</a> people over 50 years have a FOBT test every two years. People in The Lancet report only had one sigmoidoscopy. But FOBT can show evidence of asymptomatic bleeding that you may have never noticed, allowing early life-saving intervention.</p>
<hr>
<p><em><a href="https://www.bowelcanceraustralia.org/">Bowel Cancer Australia</a> provides extensive information and answers to frequently asked questions about the disease and the screening program.</em></p><img src="https://counter.theconversation.com/content/73966/count.gif" alt="The Conversation" width="1" height="1" />
I recently had a colonoscopy, an invasive medical procedure to examine the bowel, and was hugely relieved to get the all-clear. I posted a description of my experience to my friends on Facebook and got…Simon Chapman, Emeritus Professor in Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.