Here’s a stunning new statistic in the ongoing war on cancer: The number of adults under 55 diagnosed with colorectal cancer (CRC) has nearly doubled from a decade ago, according to a recent report by the American Cancer Society. The ACS reported that the number of advanced-stage CRC diagnoses in all age groups increased by 8%, and those diagnosed in the under-55 age group jumped from 11% to 20%.(1)
The Common Threads of Insulin Resistance and Inflammation
This jump is suspected to be due to lifestyle and environmental influences: diet, lack of physical activity, exposure to carcinogens, and increasing rates of various inflammatory bowel diseases.
Sugar plays an influential role. According to the Prospective Nurses' Health Study II from 1991–2015, the intake of sugar-sweetened beverages during adolescence and young adulthood was associated with a significantly increased risk: 2 servings of sugar-sweetened beverages per day during adulthood doubled the risk of early-onset colorectal cancer compared to those who reported consuming less than one serving per week. When the data was all tallied up, the authors concluded that each sugar drink serving daily increased risk by 16%.
Physical activity also appears to be highly influential in CRC prevention and those currently diagnosed with CRC. Two prospective observational studies reported more than a 50% reduction in recurrence and mortality in early-stage colorectal cancer with increased physical activity.(2,3) Remarkably, the studies reported that the benefit of exercise was much greater than that of the accompanying adjuvant chemotherapy.
This type of data supports a common theme to the readers of this blog – the importance of lifestyle, supplements, and some medications that target insulin resistance and inflammation, for both prevention and treatment. To be sure, both are well-established risk factors for cancer and other chronic diseases. Indeed, diet and exercise are the low-hanging fruit to prevent and reverse insulin resistance and inflammation.
Repurposed Medications for CRC Prevention and Treatment
Metformin is a commonly prescribed medication to treat insulin resistance. To follow up on decades of epidemiological evidence suggesting that metformin users had reduced rates of CRC compared to non-users, a prospective 2016 trial was designed to bring the often-grainy resolution of epidemiological studies into sharp resolution. The trial design was gold standard: a double-blinded, randomized, placebo-controlled phase 3 trial of 151 patients. The inclusion criteria were patients who had undergone removal of colorectal polyps. The patients were then randomized into a group given metformin (250 mg per day) and a group given a placebo. Both groups were then followed for a year. In the end, the metformin group experienced a significantly reduced prevalence of total new polyps compared to the placebo group.(4)
Similarly, epidemiological studies have reported significant reductions in the risk of CRC for statin users. Statins fall into a class of drugs known as small molecules – promiscuous drugs that affect six molecularly relevant cellular pathways on average. In addition to targeting cholesterol synthesis, statins target inflammatory pathways. A 2004 study published in the New England Journal of Medicine reported a 47% reduction in CRC risk for users of statins compared to nonusers.(5) In 2020, ASCO reported on the most recent metanalysis of statins in CRC prevention. The study filtered through a massive collection of retrospective analyses and summarized the key points in the findings.(6)
KEY POINTS
A meta-analysis evaluated statins as a means of preventing colorectal cancer.
The analysis included 52 studies involving more than 11 million individuals.
Statin users had a 20% reduced risk for colorectal cancer.
In persons with inflammatory bowel disease, the risk was reduced by 60% with the use of statins.
In addition to prevention, people newly diagnosed with cancer appear to have better survival and recurrence rates when targeting insulin resistance and inflammation. In an extensive systematic review and meta-analysis, for example, researchers showed that patients who took statins before their cancer diagnosis had a 21% lower risk of all-cause mortality and a 31% lower risk of cancer-specific mortality.(7) The addition of metformin to the active treatment of CRC patients has also demonstrated promise. Results of phase II clinical trials have revealed that metformin can enhance the anti-cancer effects of chemotherapeutic agents, such as 5-Fluorouracil (5-FU) and Irinotecan on refractory CRC.(8)
While CRC rates in young adults are experiencing a dramatic rise, there are active steps in reducing your risk. MMC specializes in the steps that can be taken to reduce the risk of cancer and other chronic diseases through the MOP program. For those diagnosed with CRC, MMC specializes in adjunctive therapies that complement the standard of care.
Article Summary:
The number of adults under 55 diagnosed with colorectal cancer (CRC) has nearly doubled in the past decade.
Lifestyle and environmental factors, such as diet, lack of physical activity, and exposure to carcinogens, are believed to contribute to this increase.
Sugar-sweetened beverage consumption is associated with a higher risk of early-onset colorectal cancer.
Regular physical activity can significantly reduce the risk of recurrence and mortality in early-stage colorectal cancer.
Medications like metformin and statins that target insulin resistance and inflammation, have shown promise in preventing and treating CRC.
Statin users have a 20% reduced risk of colorectal cancer, and individuals with inflammatory bowel disease experience a 60% risk reduction through statin use.
MeaakinMetabolicCare.com offers solutions to help prevent CRC and improve outcomes with standard of care for those diagnosed with this malady.
Stay Strong and Curious,
Charles Meakin MD, MS, MHA
Travis Christofferson MS
Meakin Metabolic Care Website
Meakin Metabolic Care Service Plans
CoachItForwardChuck.com - Questions from the Clinic (rationally researched for you)
Chronic Disease Prevention Program- Metabolic Optimization Protocol (MOP)
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Disclaimer: This information is not meant as direct medical advice. Readers should always review options with their local medical team. This is the sole opinion of Dr. Meakin based on a literature review at the time of the blog and may change as new evidence evolves.
Meyerhardt JA, Giovannucci, EL, Holmes, MD, et al. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol. 2006;24:3527-3534.
Meyerhardt, JA, Heseltine D, Niedzwiecki D, et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Cin Oncol. 2006;24(22):3535-3541.
Higurashi T, Hosono K, Takahashi H, et al. Metformin for chemoprevention of metachronous colorectal adenoma or polyps in post-polypectomy patients without diabetes: a multicentre, double-blind, placebo-controlled, randomized phase 3 trial. Lancet Oncol 2016;17:475-83.
Poynter J, et al. Statins and the Risk of Colorectal Cancer. N Engl J Med 2005; 352:2184-2192
Ala M. The Emerging Role of Metformin in the Prevention and Treatment of Colorectal Cancer: A Game Changer for the Management of Colorectal Cancer. Curr Diabetes Rev. 2022;18(8):e051121197762.