Why Is Colon Cancer on the Rise Among Younger Adults?

Rates of colon cancer among Americans under 50 years old have been on the rise in recent years, even as incidences among those 50 and over have been falling since a peak in 1985. It’s a public-health dilemma that’s become a personal concern for functional-medicine physician Gregory Plotnikoff, MD, MTS, FACP, who recently lost one of his young staff members to the disease. We asked him about this troubling trend and about preventive measures people of all ages can take.

Experience Life | Colorectal-cancer diagnoses have been rising among Americans younger than 50 years old — the American Cancer Society projected a 9 percent increase in diagnoses in 2023 compared with 2020. How would you explain these trends?

Gregory Plotnikoff | Colorectal cancer is already known to have strong genetic and epigenetic/environmental determinants. Our genes have not changed but our environment has. We need to ask tough questions about what we are doing to ourselves.

EL | Are there particular symptoms or chronic conditions that raise the risk of developing colorectal cancer at a younger age?

GP | Vitamin D deficiency is an important and easily addressed risk factor. The data also argues against a diet high in fats, processed meat, sugar, and alcohol. Not so easily addressed are the multiple new dietary exposures like microplastics and endocrine-disrupting chemicals.

EL | What role do lifestyle choices and environmental conditions play in the risk of developing colorectal cancer at a younger age?

GP | Body size and metabolic factors are important: Higher body-fat percentage, higher waist-to-hip ratio, higher waist circumference are all risks. An additional risk is insulin resistance, which is common now but was unheard of in young people even just a few decades ago. Less sleep and less high-quality sleep, including sleep–wake cycle disruptions and significantly more light exposure at night, are also concerns. Those risks are well established. Almost too painful to consider is what role EMF [electromagnetic fields], mold toxin exposure, and hormonal therapies (contraception, fertility) may play.

EL | What role does heredity play in raising or lowering these risks? Are there particular genes that signal the likelihood of developing the disease?

GP | Yes, there are genes strongly associated with increased risk that are easily screened by a family history review and follow-up genomic testing as well as colonoscopies. But genes are never destinies; they are only possibilities. It’s always genes and environment that matter.

EL | How effective are the various types of colorectal-cancer screenings, including in-home tests?

GP | The most effective screens are the ones that are actually done. Currently, there are no recommendations to screen people under age 45 who have an average risk. As we see more tragic cases, this recommendation will have to change. Home screening for blood in stools is easy and inexpensive and may be a great place to start on a yearly basis.

EL | What dietary and other lifestyle changes have you found to be most effective in reducing a patient’s risk of developing the disease?

GP | Aim for 30 different ingredients per day, serve meat as a condiment rather than as the majority of the meal, and avoid processed meat and highly processed foods. Specifically, increase your plant-based fiber, such as from beans, seeds, and nuts; resistant starch, such as from green bananas or cooked-then-refrigerated-overnight potatoes; inulin from onion, garlic, and asparagus; pectin from apples and citrus fruits; oligosaccharides [from foods] such as kale, garlic, broccoli, and blueberries.

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