When someone says the word “cancer,” what pops into your head? For many people, it’s a well-known form of the disease, like skin cancer or breast cancer.
But colorectal cancer (CRC), which can develop either in your colon or rectum, should be on that list, too. Around the world, nearly 2 million people are diagnosed with colorectal cancer each year. The disease also accounts for about 900,000 deaths annually, making CRC one of the most common and lethal cancers globally.
At the same time, about one in five new colorectal cancer cases now occurs in people under 55, and clinicians are increasingly diagnosing patients in their late 20s, 30s and early 40s. In the U.S., it’s also now the leading cause of cancer deaths among people under 50, with colorectal cancer deaths rising about 1.1% per year during the last two decades, even as mortality rates from other major cancers in younger adults has fallen.
But the good news is that screening has allowed for early detection and, in many cases, prevention of colorectal cancer. Indeed, the earlier colorectal cancer is identified, the higher the likelihood of successful treatment.
Johnson & Johnson is committed to driving forward a new era in colorectal cancer treatment, focusing on innovative science that aims to expand options for patients and give people with colorectal cancer improved outcomes and more time with the people they love.
For Colorectal Cancer Awareness Month, we rounded up the latest science-backed information on who’s most at risk, how best to prevent the disease and why there’s growing hope for people who receive a diagnosis.
1.
The honest answer from researchers: We don’t know yet. Lifestyle and metabolic factors likely play a role, but they don’t fully account for the sharp, rapid increase. That’s why teams are exploring tumor biology, environmental exposures and the gut microbiome for answers, while health systems, nonprofits and the healthcare industry accelerate research to detect risk earlier and target disease more precisely.
All of the unknowns underscore the need to double down on research, symptom awareness and destigmatizing discussions about bowel health among younger adults.
2.
It’s never too early to watch out for symptoms
Colorectal cancer is generally first spotted in the form of polyps, or abnormal growths, on the inner lining of the colon or rectum; these polyps may eventually turn into cancer.
The American Cancer Society recommends that all adults begin screening for colon cancer at age 45. The gold standard is a colonoscopy, during which your doctor uses a flexible lighted tube to check for polyps in your rectum and colon while you’re under sedation. During a colonoscopy, doctors can remove any precancerous polyps that are spotted before they turn into cancer.
This screening should be repeated at least once every 10 years if no abnormal findings are discovered. If polyps are found, you’ll need to go in for colonoscopies at shorter intervals. Depending upon your family history, your doctor may also recommend additional screening tests, such as stool tests.
According to one study published in the Journal of the National Cancer Institute, adults born around 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to those born around 1950.
If you’re younger than 45, it’s still important to be watchful for symptoms that may indicate colon cancer. These include rectal bleeding or blood in your stool; persistent changes in bowel habits, including constipation or diarrhea; stomach pains, aches or cramps; or unexplained weight loss.
In fact, according to one study published in the Journal of the National Cancer Institute (NCI), adults born around 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer compared to those born around 1950.
The NCI study found that people younger than 55 are nearly 60% more likely to be diagnosed with late-stage disease than older adults, often because they aren’t aware of the symptoms. If you have any concerning signs of illness like the ones mentioned, don’t delay in getting them checked out.
3.
Certain diseases can raise your risk—as can your family tree
Almost one-third of all people with colorectal cancer have a family history of the disease. And about 5% have inherited gene syndromes that can lead them to develop the disease.
The most common of these are Lynch syndrome, historically known as hereditary non-polyposis colorectal cancer (HNPCC), and familial adenomatous polyposis (FAP). If colorectal cancer runs in your family, talk to your doctor about whether genetic testing might make sense for you.
You also have an increased risk of developing colorectal cancer if you’re overweight or have type 2 diabetes; high levels of insulin in your body may, over time, speed up the production of precancerous colon cancer cells, according to one theory.
Inflammatory diseases of the colon, such as ulcerative colitis and Crohn’s disease, can raise your risk, too, says David Pocalyko, Ph.D., Discovery Lead, Bladder and Colorectal Cancer, Johnson & Johnson Innovative Medicine. This is because chronic inflammation causes DNA damage and the cells in the intestinal lining to continuously turn over, increasing the chances you’ll develop a mutation that could potentially become cancer.
Doctors recommend that anyone who has had an inflammatory bowel disease for more than eight years undergo a colonoscopy every year or two, so any suspicious polyps that have developed can be removed before they could potentially turn cancerous.
4.
Lifestyle changes have great potential to protect you
There are specific things you can do to help lower your odds of developing colorectal cancer, which isn’t true of all types of cancer, says Eduardo Vilar-Sanchez, M.D., Ph.D., associate professor of cancer prevention and population sciences at The University of Texas MD Anderson Cancer Center in Houston. A few tips:
Try to maintain a healthy weight. Women who are overweight or obese have up to twice the risk of developing colorectal cancer before age 50 compared to women who are at a normal BMI, according to one study.
Women who are overweight or obese have up to twice the risk of developing colorectal cancer before age 50 compared to women who are at a normal BMI.
Eat a fiber-rich diet. The more fiber the better—for each 10 grams you consume daily (the equivalent of a cup of beans), you can help reduce your risk of colon cancer by 10%, according to research. For extra credit, sub out deli meat sandwiches for hummus or peanut butter between bread instead. Processed meat has been linked to an increased risk of colon cancer, while fish and plant-based proteins appear to be protective.
Break a sweat. The more active you are, the greater the benefits: One analysis of over 50 studies found that the most physically active folks had a 24% lower risk of colon cancer than the least active.
Cut back on cigarettes and alcohol. Women who have smoked (even if they’ve since quit) have an almost 20% increased risk for colon cancer, compared to those who’ve never taken a puff, according to one study. And people who have more than three drinks a day have a 50% increased risk of developing colon cancer, while a drink or two daily carries a 20% increased risk, according to a French study published in the Annals of Oncology.
5.
There are better treatments now than ever before
Despite the news about younger demographics being diagnosed with the disease in increasing numbers, rates of colorectal cancer deaths overall have been declining for decades, thanks to an uptick in screening. But innovations in treatment have helped, too.
Product innovations, like those Johnson & Johnson MedTech is pioneering, are crucial in helping to ensure that patients who receive colon resection—a surgical procedure used to treat colon cancer—have a reduced risk for potential complications, like surgical site infection, bowel content leaks or postoperative bowel obstruction.
“Surgical resection is a curative modality for localized colon cancer"—in other words, a way to treat it, explains Raymond S. Fryrear II, M.D., Vice President and Integrated Leader, Preclinical, Clinical & Medical Affairs, Johnson & johnson MedTech. “Our goal is to optimize outcomes and help reduce the risk of complications at every critical moment during surgery through tools like the Echelon CircularTM Powered Stapler.” (Shown above)
6.
New ways to treat, and even catch, the disease before it progresses are also on the horizon
One advance in the treatment of colon cancer is related to the discovery of biomarkers, which include DNA, proteins and genetic mutations. These biomarkers can be used to help diagnose colorectal cancer and guide treatment decisions..
A study published in Science found that two types of bacteria commonly found in the gut—Bacteroides fragilis and E. coli—release toxins that can damage cell DNA, making polyps found in the colon more likely to turn precancerous. These bacteria are often found in people with FAP, which can lead to cancer.
“Eventually, we hope to be able to use some of these gut bacteria as biomarkers “either to help project who may be at higher risk to go on to develop colorectal cancer or to determine who may respond better to certain types of treatment,” says Dr. Vilar-Sanchez.
Advanced and metastatic colorectal cancer—that is, when the cancer has spread to other parts of the body—is also an area where Johnson & Johnson is focusing its research efforts. The 5-year survival rate is less than 20% when disease progresses to metastatic disease, and there is an urgent need to improve outcomes for these patients.
“With each successive line of therapy, the likelihood of survival and achieving a response decreases,” says Mahadi Baig, M.D., Global Medical Head, Johnson & Johnson Innovative Medicine. “Johnson & Johnson is committed to investigating innovative therapies in the metastatic setting as well as in earlier stages of disease, with the ultimate goal of helping more patients live longer and better.”
This is a revision to a story originally published on March 1, 2020
