Most colorectal cancers should be preventable, through increased surveillance, improved lifestyle, and, probably, the use of dietary chemopreventative agents.

1.) Lifestyle

Current dietary recommendations to prevent colorectal cancer include increasing the consumption of whole grains, fruits and vegetables, and reducing the intake of red meat. The evidence for fiber and fruits and vegetables however is poor. Physical activity can moderately reduce the risk of colorectal cancer.

2.) Medication

Aspirin and celecoxib appear to decrease the risk of colorectal cancer in those at high risk. However it is not recommended in those at average risk. There is tentative evidence for calcium supplementation but it is not sufficient to make a recommendation. Vitamin D intake and blood levels are associated with a lower risk of colon cancer.

3.) Screening

More than 80% colorectal cancers arise from adenomatous polyps making this cancer amenable to screening. The three main screening tests are fecal occult blood testing, flexible sigmoidoscopy and colonoscopy. Fecal occult blood testing of the stool is typically recommended every two years and can be either guaiac based or immunochemical. In the United States screening is recommended between the age of 50 and 75 years with sigmoidoscopy every 5 years and colonoscopy every 10 years. For those at high risk, screenings usually begin at around 40. Virtual colonoscopy via a CT scan appears as good as standard colonoscopy but is expensive and associated with radiation exposure. It is believed that screening has the potential to reduce colorectal cancer deaths by 60%. For people over 75 or those with a life expectancy of less than 10 years screening is not recommended.

 

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