KEY POINTS

● Colorectal cancer (CRC) is the third most risk

common for CRC.
cancer and the third most common cause of
cancer ● A higher incidence of CRC is found among
blacks
death in the United States. than among other races.
● Over the past 20 years, the incidence of CRC ● Men have a slightly higher risk of developing
has CRC
declined.
than do women.
● Developed countries have a higher incidence of ● Known risk factors for CRC include family
CRC history,
than do developing countries. obesity, poor diet, alcohol and cigarette use, and
● Adenocarcinoma is the most common type of lack
CRC. of exercise.
● Persons over 50 years of age have the greatest
Personal or Family History of Colorectal Cancer

A family history of CRC increases the likelihood that an individual will develop CRC. A prospective study
of 119,116 individuals examined the relative risk of developing CRC for those with a first -degree relative
with a history of CRC compared with those with unaffected relatives. The age -adjusted relative risk of
CRC was 1.7. The relative risk among individuals with two or more affected fi rst-degree relatives was
2.7. For those younger than 45 years who had one or more affected fi rst-degree relatives, the relative
risk was 5.4.13 Most patients with CRC who also have a family history of CRC do not have a genetically
inherited syndrome. Overall, genetically inherited syndromes that cause CRC such as hereditary
nonpolyposis colon cancer (HNPCC) and familial adenomatous polyposis (FAP) are rare (5% to 10%)
(Fig. 1-7). These syndromes are discussed in Chapter 3, Hereditary Cancer Syndromes. A personal
history of CRC increases a person’s risk of developing another CRC.

Personal History of Infl ammatory Bowel Disease

A personal history of infl ammatory bowel disease (ulcerative colitis or Crohn’s disease) increases a person’s
risk of CRC. Individuals with primary sclerosing cholangitis, severe longstanding disease, and young age at
diagnosis have the highest risk.15 –17 In a meta-analysis of 19 studies, the cumulative risk of CRC for those
with ulcerative colitis was 2% at 10 years, 8% at 20 years, and 18% at 30 years.18 The extent of disease is
also associated with an increased risk of CRC. In a population -based cohort study of 3117 persons in Sweden
with ulcerative colitis, the odds of developing CRC for isolated proctitis was 1.7 compared with 2.8 for left -
sided colitis and 14.8 for pancolitis. Moreover, for those with pancolitis of more than 35 years’ duration, the
risk of CRC was 30%. For those with pancolitis for more than 35 years, which was diagnosed before the age of
15 years, the risk was 40%.
• Diet

Consumption of animal fat is associated with CRC. In the U.S. Nurses Health Study,

88,751 women were prospectively followed up for 512,488 person -years. W omen who

consumed beef, pork, or lamb more than once per month were 2.5 times more likely to

develop CRC compared with women who consumed meat less than once per month. No

increased risk was found with consumption of vegetable fat.25 The protective effect of fi

ber on CRC is controversial.26 Recent meta -analyses have demonstrated that those in

the highest quartile of fi ber consumption had a decreased risk of CRC compared with

those who were in the lowest quartile of fi ber consumption. However, when controlling

for other dietary factors, high fi ber failed to demonstrate any protective effect.

Exercise
Physical activity is inversely correlated with CRC. In a prospective
study of 45,906 Swedish men, even moderate physical activity was
associated with a 32% decreased risk of CRC.29 This relation is
stronger in men than in women.
• Smoking, Alcohol, Obesity, and Diabetes

CRC has been linked to long -term smoking and alcohol

consumption of more than two drinks per day.4 Obesity is

associated with an increased risk of CRC. A study from

Framingham, Massachusetts, demonstrated that individuals

with a body mass index (BMI) of more than 30 have a 1.5 to

2.4 times increased risk of CRC.31 Furthermore, centripetal

obesity is signifi cantly associated with CRC.32 Those with

type 2 non–insulin-dependent diabetes have an increased risk

of developing CRC and a poorer prognosis for survival than

those without diabetes.