Breaking News: Colorectal Cancer Rates In Young People Have Doubled

haidut

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I don't know which is sadder - this front page news reported today on CNN, or the fact that the pharma/medical press continues to call colorectal cancer largely a "genetic" phenomenon. Surely, there must be an evil gene that swept through the population in just 2 decades and targeted the young the most.
But, at least this study is calling B.S. on the genetic or even lifestyle rationalizations. Well, if we remove these two then what else is left other than diet??
I would strongly recommend that anybody who has a conversation with their doctor about cancer risk and its genetic causes, to show their doctor this research and the explanation even mainstream news are starting to pick up on - genetics or "eating too much, moving too little" cannot explain a change that occurred in just 10 - 20 years. Unless of course, your doctor wants to admit that Lamarck was right and thus call into question the Central Dogma underlying most of medicine for the last century. Either choice is not a pleasant one for our dear doctors, but the truth is hard to ignore. Quack, quack doctor!

Colorectal Cancer Incidence Patterns in the United States, 1974–2013 | JNCI: Journal of the National Cancer Institute | Oxford Academic
Colorectal cancers on the rise in younger adults - CNN.com

"...Colon and rectal cancer rates are rising sharply for Americans under 55, according to a study published today. Someone born in 1990 would have twice the risk of colon cancer and four times the risk of rectal cancer at the same age had they been born in 1950, according to researchers at the American Cancer Society and the National Cancer Institute. Because routine screening is generally not recommended for most people under 50, these cancers are often found in more advanced stages, too. "What we found was pretty surprising," said Rebecca Siegel, an epidemiologist at the American Cancer Society and the lead author of the study. Siegel added that the surge of younger diagnoses contrasts with the overall trend of colorectal cancer, which has been dropping for several decades. However, this progress is driven by older adults who have benefited from regular screenings, including colonoscopies, that may pick up growths before they become cancerous, she said."

"...Though no one knows exactly why colorectal cancers are increasing among the younger age groups, researchers say that it's probably not driven primarily by our genes. "It would be hard to speculate that we are fundamentally so different genetically between 1950 and today," said Chang. "What's really changed more are our environmental exposures, our lifestyles and our behaviors." Siegel said that the rise of obesity, for example, has closely mirrored the trends in colorectal cancer. Obesity may not be a direct cause of colorectal cancer, Siegel said, though it may share common risks -- such as sedentary lifestyles and unhealthy diets. If obesity were the primary cause, Siegel said, "you wouldn't expect to see (an increase in colorectal cancer) for 10 or 20 years."
 
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Regina

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I don't know which is sadder - this front page news reported today on CNN, or the fact that the pharma/medical press continues to call colorectal cancer largely a "genetic" phenomenon. Surely, there must be an evil gene that swept through the population in just 2 decades and targeted the young the most.
But, at least this study is calling B.S. on the genetic or even lifestyle rationalizations. Well, if we remove these two then what else is left other than diet??
I would strongly recommend that anybody who has a conversation with their doctor about cancer risk and its genetic causes, to show their doctor this research and the explanation even mainstream news are starting to pick up on - genetics or "eating too much, moving too little" cannot explain a change that occurred in just 10 - 20 years. Unless of course, your doctor wants to admit that Lamarck was right and thus call into question the Central Dogma underlying most of medicine for the last century. Either choice is not a pleasant one for our dear doctors, but the truth is hard to ignore. Quack, quack doctor!

Colorectal Cancer Incidence Patterns in the United States, 1974–2013 | JNCI: Journal of the National Cancer Institute | Oxford Academic
Colorectal cancers on the rise in younger adults - CNN.com

"...Colon and rectal cancer rates are rising sharply for Americans under 55, according to a study published today. Someone born in 1990 would have twice the risk of colon cancer and four times the risk of rectal cancer at the same age had they been born in 1950, according to researchers at the American Cancer Society and the National Cancer Institute. Because routine screening is generally not recommended for most people under 50, these cancers are often found in more advanced stages, too. "What we found was pretty surprising," said Rebecca Siegel, an epidemiologist at the American Cancer Society and the lead author of the study. Siegel added that the surge of younger diagnoses contrasts with the overall trend of colorectal cancer, which has been dropping for several decades. However, this progress is driven by older adults who have benefited from regular screenings, including colonoscopies, that may pick up growths before they become cancerous, she said."

"...Though no one knows exactly why colorectal cancers are increasing among the younger age groups, researchers say that it's probably not driven primarily by our genes. "It would be hard to speculate that we are fundamentally so different genetically between 1950 and today," said Chang. "What's really changed more are our environmental exposures, our lifestyles and our behaviors." Siegel said that the rise of obesity, for example, has closely mirrored the trends in colorectal cancer. Obesity may not be a direct cause of colorectal cancer, Siegel said, though it may share common risks -- such as sedentary lifestyles and unhealthy diets. If obesity were the primary cause, Siegel said, "you wouldn't expect to see (an increase in colorectal cancer) for 10 or 20 years."
Sadly, I have a friend with CRC. A really good aikidoist with two little daughters. He's gone through chemo and has just passed the one year mark. He's probably late 30's. (Recently, I lost another friend in her mid-20's to liver cancer. She was a runner). In both cases, diet is largely home-baked goodies (cookies, cakes, cupcakes) combined with take-out (PUFA) meals. You can't really say anything. :-(
 

tankasnowgod

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Since 1990, huh? Hey! That's right around the time that Iron in the US food supply (a known potent carcinogen) soared to all time heights, of about 23mg per person per day, according to FDA data (chart attached).

I believe the rise is primarily due to inorganic iron (from fortification and supplements), which doesn't carry the natural plant or animal protections that come from organic iron (be it heme or non-heme). I suspect this would make the colon very susceptible to this iron excess.
 

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Regina

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Since 1990, huh? Hey! That's right around the time that Iron in the US food supply (a known potent carcinogen) soared to all time heights, of about 23mg per person per day, according to FDA data (chart attached).

I believe the rise is primarily due to inorganic iron (from fortification and supplements), which doesn't carry the natural plant or animal protections that come from organic iron (be it heme or non-heme). I suspect this would make the colon very susceptible to this iron excess.
Combined with PUFA. You make a good point though. Back when my friends first were hospitalized, friends and family would constantly bring them baked-goods, so they wouldn't have to do without their favorite cakes. Everyone did so lovingly and post all the photos. At the time, I thought diet was the problem -- but I was thinking may be they shouldn't have so much gluten. Nah, it's the iron and PUFA.
 

misery guts

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Since 1990, huh? Hey! That's right around the time that Iron in the US food supply (a known potent carcinogen) soared to all time heights, of about 23mg per person per day, according to FDA data (chart attached).

I believe the rise is primarily due to inorganic iron (from fortification and supplements), which doesn't carry the natural plant or animal protections that come from organic iron (be it heme or non-heme). I suspect this would make the colon very susceptible to this iron excess.

Cooling Inflammation: Cure for Inflammatory Diseases

And according to Dr Ayer's response to that comment, perhaps a formula fed gut (which I imagine to have only become more common since 1990) and the subsequent pathogenic biofilm/flora created probably only serves to lessen our ability to deal with that increased iron :(
 
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Trimethylamine N-oxide (TMAO) is getting some attention now:

"Gut microbial metabolism of choline results in the production of trimethylamine (TMA), which upon absorption by the host is converted in the liver to trimethylamine-N-oxide (TMAO). Recent studies revealed that TMAO exacerbates atherosclerosis in mice and positively correlates with the severity of this disease in humans."

Intestinal Microbiota Composition Modulates Choline Bioavailability from Diet and Accumulation of the Proatherogenic Metabolite Trimethylamine-N-Oxide

A genome-wide systems analysis reveals strong link between colorectal cancer and trimethylamine N-oxide (TMAO), a gut microbial metabolite of dietary meat and fat

Serum Trimethylamine N-Oxide (TMAO), Diet, and Colorectal Cancer Risk
 

Mito

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Ray talks about the main benefit of raw carrots (or carrot salad) being the reduction of endotoxin in the small intestine. Do they also provide any health benefits for the colon?
 
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Trimethylamine N-oxide (TMAO) is getting some attention now:

"Gut microbial metabolism of choline results in the production of trimethylamine (TMA), which upon absorption by the host is converted in the liver to trimethylamine-N-oxide (TMAO). Recent studies revealed that TMAO exacerbates atherosclerosis in mice and positively correlates with the severity of this disease in humans."

Intestinal Microbiota Composition Modulates Choline Bioavailability from Diet and Accumulation of the Proatherogenic Metabolite Trimethylamine-N-Oxide

A genome-wide systems analysis reveals strong link between colorectal cancer and trimethylamine N-oxide (TMAO), a gut microbial metabolite of dietary meat and fat

Serum Trimethylamine N-Oxide (TMAO), Diet, and Colorectal Cancer Risk

I've been part of the TMAU community for ages. TMAU is an odor condition caused by a malfunction in the liver enzyme that metabolizes choline. In the last few years there's been a large spike in TMAU sufferers. Specifically young people, teens and early 20s.

Lots of members had commented on it but we assumed it was an increase in social media usage.
 

Queequeg

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wow those cancer maps in the CNN article are crazy. Besides the lower Mississippi being a mess I was surprised that Los Angeles is ground zero for testicular cancer. Blue balls from all the hot chicks I imagine.
 
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"Rates of colon cancer are much higher in African Americans (65:100,000) than in rural South Africans (<5:100,000). The higher rates are associated with higher animal protein and fat, and lower fibre consumption, higher colonic secondary bile acids, lower colonic short-chain fatty acid quantities and higher mucosal proliferative biomarkers of cancer risk in otherwise healthy middle-aged volunteers. Here we investigate further the role of fat and fibre in this association. We performed 2-week food exchanges in subjects from the same populations, where African Americans were fed a high-fibre, low-fat African-style diet and rural Africans a high-fat, low-fibre western-style diet, under close supervision. In comparison with their usual diets, the food changes resulted in remarkable reciprocal changes in mucosal biomarkers of cancer risk and in aspects of the microbiota and metabolome known to affect cancer risk, best illustrated by increased saccharolytic fermentation and butyrogenesis, and suppressed secondary bile acid synthesis in the African Americans."

http://www.nature.com/articles/ncomms7342

.
 

tankasnowgod

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Cooling Inflammation: Cure for Inflammatory Diseases

And according to Dr Ayer's response to that comment, perhaps a formula fed gut (which I imagine to have only become more common since 1990) and the subsequent pathogenic biofilm/flora created probably only serves to lessen our ability to deal with that increased iron :(

Welp, most formula's on the market contain added iron. Iron is also a potent stimulator of bacterial growth. If you read "Exposing the Hidden Danger's of Iron," E.D. Weinberg conducted an experiment where he found that iron had the ability to completely neutralize an antibiotic in a petri dish. This experiment is what lead him to focus on iron research.

When formula is compared to breastmilk (or even regular milk), it's likely higher in iron, and lower in iron binding compounds like lactoferrin (which happens to be used as a biofilm disruptor).
 

haidut

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Iron is also a potent stimulator of bacterial growth

Yes, and as an interesting side note this is why we have fever when there is bacterial infection - i.e. fever depletes both serum iron and serum tryptophan, both of which are absolutely crucial for bacteria replication. Pyrogenic substances in general do the same - lower serum iron and tryptophan, which may explain why things like aspirin, progesterone, thyroid, etc are helpful for infectious conditions.
 

fradon

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Combined with PUFA. You make a good point though. Back when my friends first were hospitalized, friends and family would constantly bring them baked-goods, so they wouldn't have to do without their favorite cakes. Everyone did so lovingly and post all the photos. At the time, I thought diet was the problem -- but I was thinking may be they shouldn't have so much gluten. Nah, it's the iron and PUFA.
you might have to add synthetic fortified folic acid too as it is said to increase homocysteine.
 

haidut

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Mito

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Original Investigation
October 11, 2018
Association of Obesity With Risk of Early-Onset Colorectal Cancer Among Women
Po-Hong Liu, MD, MPH1; Kana Wu, MD, MPH, PhD2; Kimmie Ng, MD, MPH3; Ann G. Zauber, PhD4; Long H. Nguyen, MD, MS1,5; Mingyang Song, MD, ScD1,2; Xiaosheng He, MD1; Charles S. Fuchs, MD, MPH6; Shuji Ogino, MD, PhD, MS7,8,9,10; Walter C. Willett, MD, DrPH2,11; Andrew T. Chan, MD, MPH1,5,10,11,12; Edward L. Giovannucci, MD, ScD2,7; Yin Cao, MPH, ScD1,13,14
Author Affiliations

Key Points
Question Is obesity associated with early-onset colorectal cancer, which may have etiologic differences from late-onset colorectal cancer?

Findings In a prospective cohort study of 85 256 women, those with obesity (body mass index ≥30) had a nearly doubled risk of early-onset colorectal cancer compared with women with a body mass index of 18.5 to 22.9.

Meaning The findings suggest that obesity is associated with an increased risk of early-onset colorectal cancer; further investigations are needed to identify whether this association is causal.

Abstract
Importance Colorectal cancer (CRC) incidence and mortality among individuals younger than 50 years (early-onset CRC) are increasing. The reasons for such increases are largely unknown, although the increasing prevalence of obesity may be partially responsible.

Objective To investigate prospectively the association between obesity and weight gain since early adulthood with the risk of early-onset CRC.

Design, Setting, and Participants The Nurses’ Health Study II is a prospective, ongoing cohort study of US female nurses aged 25 to 42 years at study enrollment (1989). A total of 85 256 women free of cancer and inflammatory bowel disease at enrollment were included in this analysis, with follow-up through December 31, 2011. Validated anthropomorphic measures and lifestyle information were self-reported biennially. Statistical analysis was performed from June 12, 2017, to June 28, 2018.

Exposures Current body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared), BMI at 18 years of age, and weight gain since 18 years of age.

Main Outcomes and Measures Relative risk (RR) for incident early-onset CRC.

Results Among the 85 256 women studied, 114 cases of early-onset CRC were documented (median age at diagnosis, 45 years; interquartile range, 41-47 years) during 1 196 452 person-years of follow-up. Compared with women with a BMI of 18.5 to 22.9, the multivariable RR was 1.37 (95% CI, 0.81-2.30) for overweight women (BMI, 25.0-29.9) and 1.93 (95% CI, 1.15-3.25) for obese women (BMI, ≥30.0). The RR for each 5-unit increment in BMI was 1.20 (95% CI, 1.05-1.38; P = .01 for trend). Similar associations were observed among women without a family history of CRC and without lower endoscopy within the past 10 years. Both BMI at 18 years of age and weight gain since 18 years of age contributed to this observation. Compared with women with a BMI of 18.5 to 20.9 at 18 years of age, the RR of early-onset CRC was 1.32 (95% CI, 0.80-2.16) for women with a BMI of 21.0 to 22.9 and 1.63 (95% CI, 1.01-2.61) for women with a BMI of 23.0 or greater at 18 years of age (P = .66 for trend). Compared with women who had gained less than 5.0 kg or had lost weight, the RR of early-onset CRC was 1.65 (95% CI, 0.96-2.81) for women gaining 20.0 to 39.9 kg and 2.15 (95% CI, 1.01-4.55) for women gaining 40.0 kg or more (P = .007 for trend).

Conclusions and Relevance Obesity was associated with an increased risk of early-onset CRC among women. Further investigations among men and to elucidate the underlying biological mechanisms are warranted.


Association of Obesity With Risk of Early-Onset Colorectal Cancer Among Women
 
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