Rising rates of colorectal cancer found in nearly all age groups
uchicagomedicine.org52 points by randycupertino 3 hours ago
52 points by randycupertino 3 hours ago
Important context in the article:
"The data showed that the age-adjusted incidence rate fell from 55.2 per 100,000 in 2000 to 36.7 in 2022, then rose to 38.3 in 2023."
If you would like to advance a theory that this is because of a specific environmental change, your theory should cope with the fact that the rate was MUCH higher in 2000 and the rise described here is is 2023. Increased screening is said to be a likely culprit in this case for middle-aged adult prevalence but not for older adult prevalence, because screening has increased somewhat in the middle aged groups.
I am personally dealing with colon cancer, and one of the incredibly annoying things about the awful disease is the number of truly clueless people who use it to advance some culinary agenda they believe in without evidence.
I looked through your comment history to ensure you haven't already answered this. But what made you get tested ? Did you have risk factors ? No problem if you'd rather not share.
Related, I was told by a doctor to get screened after turning 50. But a reasonable self-estimate given all my risk factors puts my chances of having colon cancer at 1 in 10000. A colonoscopy has a false positive of ~2%[0] for my demographic. Meaning if I get a positive result, it's actually ~200 times more likely that I don't have cancer. It's hard to justify a screening given those odds and the 99%+ chance I will waste my time treating and worrying about a disease I don't have. My guess is an insurance company wouldn't cover a colonoscopy for those reasons.
I just had my first colonoscopy at 45 - they lowered the guideline recently, as the article mentioned.
The link you give is for colon cancer blood tests. Colonoscopies themself are basically definitive, because if they see something suspicious they will snip it and send it to the lab for biopsy. I had one such "suspicious polyp" and it turned out it wasn't a polyp at all, just normal intestinal tissue they mistook. There's your false positive. But the risks and long-term consequences are basically nil, the intestine heals itself in a week or two.
It's a very unpleasant procedure (the prep, not the procedure itself), but it's also very low risk and effective at catching colon cancer cases early when they can still be treated.
>But what made you get tested ?
Tested at 37, because occasional bloody stool. Found a few polyps but no cancer. Still had to fight with insurance to keep my costs below $2500 for the whole experience. Still upset the doctor thought I was joking when I requested a DVD or Memory stick with the tour of my insides on it.
You can do a comparison to the UK, which, as I understand it, does not give out routine colonoscopies as the first line of defense, as in US. I believe there are some preventable colorectal cancer deaths there for this reason.
I asked my doctor here in the Netherlands about a test (mid 40's male, my dad has had several polyps removed) and he said to come back when I was bleeding out of my ass...
One thing I learned about colonoscopy is that it is not _only_ a test. I understand that the removal of polyps is a cancer-reducing mechanism in addition to being a diagnostic. Less invasive tests do not have this property.
Featured article says they are looking into “environmental chemical exposures as a possible culprit”. A rise since 2019 due to “chemical exposure” make food and water pollution, and thus diet, plausible explanations no?
So the processed meat -> colorectal cancer link is actually a textbook example for explaining what statistical & scientific concepts mean.
Processed meat is a known Group 1 carcinogen, in the same category as asbestos, tobacco smoke, and plutonium. Carcinogens are grouped by the strength of scientific evidence on them, not by how hazardous they are. In this case, there are abundant studies with solid methodology that show a link between consuming nitrites in processed meat and a higher risk of cancer, and we also understand how the process works at a molecular level.
This shows how well we understand the link, not how strong the link is. And it turns out that processed meat is a very minor carcinogen. When you average the studies together, the hazard ratio for someone eating 50g of processed meat per day, over an 85 year lifetime, over somebody who eats no processed meat is about 1.18. That means that folks in the former group are about 18% more likely to get colon cancer than folks in the latter group. By contrast, the hazard ratio for cigarette smoking is about 20x (smokers are 2000% more likely to get lung cancer than non-smokers), for asbestos exposure it's about 35-45x (industrial asbestos workers without PPA develop mesothelioma at a rate 3500-4500% greater than the general public), and plutonium exposure is about 7-50x for a single unprotected exposure.
There's a further piece to the statistical puzzle, and that's base rates. Colorectal cancer is relatively rare, with a lifetime incidence (again assuming an 85y lifespan) of about 7%. Combined with the 18% hazard ratio, that means a diet full of processed meats increases your lifetime risk of colon cancer by about 1%. There are far worse activities you could be doing.
https://www.iarc.who.int/wp-content/uploads/2018/11/Monograp...
A related concept is the Prop65 warning labels in California. If you've ever been to the restrooms in the SFO airport, you might notice that there's a warning label of "This restroom contains chemicals known to the State of California to cause cancer." These are pretty ubiquitous, you'll see them everywhere else in California too, like on new cars. Are you going to get cancer just because you transferred through SFO or LAX? No. But the list of chemicals that have scientifically demonstrated carcinogenicity is long, and the good people of California don't really make a distinction between minor risks and major risks.
Whether the known carcinogenicity of processed meats is behind the uptake in colon cancer rates is a separate scientific question. You would need data on processed meat consumption at a population level, over time, to see if that epidemiologically explains the increase we've been seeing. I don't know if this data exists and kinda suspect it would go the other way, but that's what the scientific method is for.
maybe it's meat overall, and not exclusively processed meat? i was vegetarian for many years though and don't trust myself to make guesses anymore on this. I do think there's gotta be a bunch of bad stuff that comes from eating all the unhappy animals/eggs from them/milk from them.
> I am personally dealing with colon cancer, and one of the incredibly annoying things about the awful disease is the number of truly clueless people who use it to advance some culinary agenda they believe in without evidence.
Sorry to hear this, and it's really a shame that whenever health and disease topics show up, every conspiracy theorist comes out from under their rock to try to explain their "theory" to you. Just look at the comment-trainwreck on this HN article. A significant percentage of the comments are "I have a theory that it's [....]" and it's always something mundane, untestable, and vaguely victim-blamey like diet.
> If you would like to advance a theory that this is because of a specific environmental change
It probably is, but it could be anything. For all we know, (joke,) it could be a pesticide with traces present in salads and fresh fruit, or exposure to a cleaning chemical in public transportation.
But the bigger issue is that the people pushing these theories are pushing them on moral reasons; IE, making an unfair claim that colon cancer is on the rise because people have immoral lifestyles. IE, from eating poorly or the multitude of other holier-than-thou lifestyle claims at the tip of their tongue.
Personally, my money is that we find out that regularly holding in farts increases the probability of colon cancer, and that we need a public health campaign to fart in public.
This one took a turn but point taken. You see similar arguments for a great many ailments (sperm count and carpets comes to mind). You can’t well run randomized control trials on every plastic, additive, or manufacturing process. It feels futile to even start.
I don't buy their explaining away the effects of COVID by excluding 2020-2021. It was incredibly difficult to access routine medical care (especially colonoscopies!) during COVID. A post-COVID bump should be expected in the 1-2 years after normalization of medical care, when many people had previously skipped screenings. Let's see if the rise continues in 2024+ before drawing any conclusions.
(It doesn’t change your point, but amusingly) I’m 97% sure I caught my first COVID infection from… the admin/consenting clinic visit prior to a colonoscopy. :)
I'd expect increased colon cancer rates due to COVID for the rest of the 2020s, simply because screening is usually every 5-10 years and people probably just skipped their 2020-2022 appointment, giving more time for cancers to grow undetected. It's sorta like how measles is now epidemic because so many parents skipped their vaccinations from 2020-2022. It takes years for public health consequences of interruptions in medical care to show up.
Yes. Also exercise reduces the risk, and COVID has plausibly caused a long-term reduction in exercise levels.
One key aspect that most people don't seem to be aware of is that there has been a lot of research in the cancer causing impacts of Covid infections. Its been implicated and mechanistically shown to cause a number of cancers and Covid hangs around in the gut for years/potentially ever we aren't yet sure in some people and it acts like a phage. As a phage it infects certain bacteria in our gut and drastically changes the microbiome, pushing it towards colonies of bacteria that are implicated in colon cancer.
The scientific evidence isn't there yet for colorectal cancer but its being investigated in studies at the moment and we are expecting a mass disabling event due to Covid and Long Covid and a big increase in a variety of conditions including cancer. Its one of the most studied viruses in human history and it does a lot of bad stuff and most people are catching 1.5 times a year.
just get the colonoscopy, it's really not that bad. if ya haven't had one yet, i wrote this for u (30 second read of my experience):
I had the colonoscopy without anasthesia, it was over in 5 minutes with less pain than almost any visit to the dentist. The experience made me baffled at the insistence on total anasthesia, and the assumption the unanasthesized procedure is harrowing, that is often reported by people in private-insurance countries like the USA. So, I agree, if you need the procedure because of age or family history, just get it done.
I will say, the drink prescribed by my own GP tasted just fine, like any electrolyte sports drink in powdered form, so I think you were unlucky there!
I asked, but the clinic that I went to did not offer the option. They cited safety as the reason. e.g. any movement by me could risk intestinal damage.
Presumably they still used a nerve block or some sort of local anasthetic on you. How was the recovery?
No, no local anasthetic at all . A lack of anasthesia seems usual for public healthcare in multiple EU countries; if you want anasthesia, you go to a private clinic and pay.
Recovery? The procedure left no lingering feeling at all except for a little gas; it was as if I had never had the procedure at all. The sole discomfort, when air is blown into the colon to inflate it for inspection, abated as soon as air was no longer being blown.
>I will say, the drink prescribed by my own GP tasted just fine, like any electrolyte sports drink in powdered form, so I think you were unlucky there!
Mine was so bad I almost vomited it all up immediately from the taste. Would very much like your option next time.
I would also like to do it without the anesthesia next time to save $1500.
I turned 50 this month and after asking him to "please schedule me for a colonoscopy", my Primary Care Preventer is working hard to talk me out of it and into alternatives. Ones that I assume are cheaper for the Org and he gets to prolong the process by saying it's a loooooong time to schedule (which is why I reached out, duh?)
I intensely dislike American Healthcare. Every little damn thing is a fight.
Good piece, and ditto. Really the worst part for me was just not being able to eat for 24 hours before; the actual procedure was painless.
Seconded.
Although everyone’s experience varies a little - for me, the prep is quite miserable, not because of the obvious, but because I feel very dehydrated/hung over for hours during it. Conversely, a friend who has relatively regular colonoscopies doesn’t share this at all.
And continue to get them as advised. I have had four and was told to return in three years. My wife and one of my sisters died of colon cancer. One of my sons just had his first colonoscopy at 32.
Study shows US colorectal cancer rates are rising again in almost all age groups after 20+ years of decline. NEJM Evidence study finds rates climbing in every age group even when screening is high.
The US also happens to be a country with a notoriously poor lifestyle and equally poor diet involving foods full of additives either not used or banned elsewhere.
And that's before we get to the subject of the US healthcare system.
Of course colorectal cancer has numerous causes but it is worth considering that when reading the somewhat clickbaity headline.
That's not necessarily the cause here.
While rates in the US may be rising, they are still below countries like Japan, Italy, France, and the UK.
All of those countries (except the UK) have a ton of people who are cigarette smokers. For comparison, a third of french adults smoke tobacco. Most US adults who use nicotine don't do so via tobacco, with Japan (the third lowest in the group) having double the cigarette smokers than the US and France having 3-4 times as many.
> While rates in the US may be rising, they are still below countries like Japan, Italy, France, and the UK.
Average life expectancy in Japan is 85 with average 88 female and 82 male.
Meanwhile US is 79 (avg), 81 (f), 76 (m).
So I suspect diet and lifestyle is still more likely to kill you in the US.
Deaths from opioids over the last 10+ years has really affected the life expectancy in the US. But no doubt that Japanese lifestyle is much better than the American lifestyle overall, especially at the older ages.
If the rates went down from 2000 to 2022 and then had a small bump into 2023 isn't that just statistical noise?
> The US…
Rates are rising in other countries, too. Global phenomenon.
The rate of cancer deaths is actually growing faster in several other regions like the UK
That is the most factually correct and constrained headline and GP comment I've seen in a while. Both are literally true as written, and contain no anecdotal, cautionary, or extrapolated suggestions.
Happening in the UK too though.
If poor nutrition is the cause (not obviously the case) then it's fair to say our diet in the UK is not so far behind the USA in terms of the availability of unhealthy foods. We maybe eat a bit less of it, but we have rising obesity levels. We don't have anywhere near the same number of morbidly obese or super-obese people, but towards the merely very overweight end of the scale we've probably caught up.
Probably catching more cases in screening, though.
There is an obvious factor for cases in 2023, which is that a lot of backlogged cases from 2021 and 2022 will be turning up, and the mere presence of a backlog means delayed diagnosis of newer cases. Even if COVID itself doesn't cause cancers or make them worse (and that's being studied), the pandemic did.
> a country with a notoriously poor lifestyle and equally poor diet involving foods full of additives
Is mostly true for the UK too
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I saw a 'diabetes isn't your fault' campaign poster at my GP surgery today. I shook my head! (no mentioning T1 vs T2, so the message is obvious)
You're third sentence is funny in contrast with the first two.
The "notoriously poor lifestyle" is a oft repeated meme and you're blanket implications of "additives" being causal without naming anything specific or having any sort of evidence supplied. Relying, instead, on the common "knowledge" that's memed around the internet as being self-evident.
The US also has the best healthcare in the world, it's just expensive. People from all over the world come here for treatment.
The food theory doesn't align with the fact that it declined from 2000 - 2022...
“The data showed that the age-adjusted incidence rate fell from 55.2 per 100,000 in 2000 to 36.7 in 2022, then rose to 38.3 in 2023.
This is the first time that we have seen an increase in the overall rate since in more than 20 years,”
Please for the love of all things, stop the kneejerk attribution... or at least read the article first.
I’m starting to be convinced it’s due to 100 different reasons, but each of those reasons is due to people doing things the extreme.
Eating too much processed food? There are studies showing an increase in risk. Sit too much every day? Ditto. Long distance running? When taken to the extreme it increases colon cancer risk (recent research)
A measured, balanced lifestyle regarding your activity and habits is the best thing you can do to put yourself in a good position to avoid diseases or health complications.
My doctor’s favorite phrase :“Here is your prescription - Eat a little better and move around a little bit. You’ll outlive your enemies”
Colorectal cancer rates are increasing globally, but the data in the older groups needs to take into account changes in screening ages
> The authors saw the sharpest increase in incidence rates among the 45-49-year-old age group, with an increase of 12.76% annually from 2019-2023. They said that this increase is likely driven by more people undergoing colorectal cancer screening after national recommendations lowered the age to begin screening from 50 to 45.
So the rates for 45-50 year olds can’t be directly compared in the US.
The strange part about the change in colorectal cancer rates around the world is that it’s showing a large increase in much younger people. I’ve read some studies where the sampled time period showed cancer rates declining for elderly people while they increased for very young people.
How are screening methods these days? As I understand it, colonoscopies care a small risk, which tends to cause doctors to not recommend them for fully asymptomatic individuals.
Only 5% of American adults meet the U.S. daily RDAs for fiber.
i bet it'll end up that eating animal flesh or drinking their secretions messes with the body quickly, compared to eating the plant proteins directly.
"milk" is a cow eating soy and grain, intended for a baby cow, but it's mostly made out of the same plant that the cow ate.
"meat" is cooked animal muscle that has been built more slowly than milk, but is also built out of the plants ingested by that baby animal.
virtually all 'meat' is made out of animals that could be easily considered to be babies of that kind of animal. :(
anyway, that doing bad things like this is bad for everyone who does it is not surprising.
Just a random thought, but has there been any research into dishwasher tablets/cleaning agents used in dishwashers? People are ingesting that, everywhere, all of the time
I stopped using rinse aid in my dishwasher after seeing this or a similar study: https://www.jacionline.org/article/S0091-6749(22)01477-4/ful...
Thanks for the reference.
From the abstract:
The alcohol ethoxylates present in the rinse aid were identified as the culprit component causing the epithelial inflammation and barrier damage.
My theory is PFAS. https://research.uky.edu/news/markey-study-links-forever-che...
My theory is energy drinks which contain taurine that actually promotes cancer growth.
Dishwashers are not a new thing, so there should not be a correlation.
Perhaps it is the new detergents? I don't know.
The popular brands have extremely strong smell and I assume very strong chemicals. We use "Attitude" that supposed to be milder.
"Should not be a correlation" is a weird thing to say. A quick glance shows dishwasher use has been steadily increasing over time.
Some of these conspiracy theories you’re all coming up with are too whack even for me. Video game controllers near groins? Really? Come on.
The most striking thing in that data for me is how low India is.
This includes only diagnosed cases of colon cancer, so if India has much less screening and fewer diagnostic opportunities, that will greatly reduce its score. But it is still a striking number!!
I have no idea if it makes a difference in reference to the study, but plant based diets are significantly more common there.
What data? The article only seems to be about the US?
Indian diets are very different from the average American diet. Loads of vegetables. Even non-vegetarians get tons of fibre and are often eating 20-30 different plants in a day. Most of it fresh too.
Baseless conspiracy theory; its because we are keeping our phones in our pockets and worse, holding game controllers etc near that area.
*In the US
https://www.wcrf.org/preventing-cancer/cancer-statistics/col...
I’m actually surprised by the placement of some of these countries. I assumed Japan would be much lower.
> I assumed Japan would be much lower.
Maybe it is per-se. Overall the Japanese diet is substantially more healthy than the US one. However Japan is also quite a white rice heavy diet on average, so comparable to the US's preponderance for processed bread. So if you're not careful in Japan you can quite easily go days without much fibre – it is much easier to get a healthy meal in Japan, but its also easy to get poor meals in Japan (e.g. 7-11 snacks) !
However the thing about Japan is they have an aggressive annual health screening programme which is mandated by law for all employed individuals (twice per year for those working in hazardous environment).
So the more interesting question for Japan might be in relation to early diagnosis and associated outcomes. I suspect both would be materially better than in the US but I haven't gone looking for the data.
Measured rates are not as straightforward as they seem
It's always a mix of the "true rate" vs screening/detection rates vs "dying of other things before detection" rate
U.S. is runaway corruption
So it's not really a surprise our food and drink quality and safety would suffer alongside that
It's probably going to get worse
To be fair, food quality standards in the US have lagged places like Europe for many years. This is certainly not a new problem.
Also the rates are rising globally. This isn't an exclusive US problem.
It’s the food
This isn’t some mystery, this isn’t happening in a vacuum. There are correlated trends like rising profits of the food industry, food becoming plasticized. Everyone’s fat now
How do you square that with this quote in the article?
"The data showed that the age-adjusted incidence rate fell from 55.2 per 100,000 in 2000 to 36.7 in 2022, then rose to 38.3 in 2023."
Were more people fat back in 2000? Was the food worse? Though I don’t really doubt that the food industry and trends like you mentioned do contribute, that stat also seems to directly contradict the hypothesis.
You and orangecat are using a false binary
That’s not how science works
Show me correlating graphs to the rise in colorectal cancer. There has to be a meta-analysis about this, my money is on food being a major contributing factor
It's milk consumption:
https://tylervigen.com/spurious/custom_correlation/757_new-c...
No wait it's GMO use in corn grown in Texas:
https://tylervigen.com/spurious/custom_correlation/758_new-c...
No wait it's the popularity of the first name Devon:
https://tylervigen.com/spurious/custom_correlation/759_new-c...
No wait it's the number of postal service machine operators in Texas:
https://tylervigen.com/spurious/custom_correlation/760_new-c...
Pretty certain this isn't how science works either. Be careful mistaking correlation for causation, and in relying on intuitive hunches.
> my money is on food being a major contributing factor
That's not how science works either.
So the food got better from 2000 to 2022 and only since then has gotten worse?
> It’s the food
Your sibling comment from 1 minute earlier:
> I am personally dealing with colon cancer, and one of the incredibly annoying things about the awful disease is the number of truly clueless people who use it to advance some culinary agenda they believe in without evidence.
The need to eat more fiber, and the dearth of fiber in most processed food, is something always mentioned in writing on colon cancer incidence by actual researchers. I could understand your post if one were posting in defence of some particular fad diet versus another fad diet, but saying merely "Its the food" is not in any way controversial.
There’s a lack of fiber
There’s an overconsumption of sugar
Sugar is awesome for cancer