Childhood obesity is a significant global public health concern that has escalated since the late 20th century. In 2022, an estimated 37 million children under the age of 5 were overweight and over 390 million children and adolescents aged 5-19 were also overweight, of which 160 million were obese. Significant research has identified the association between obesity and increased cancer risk, including a study that has specifically found a correlation between high early-life body-mass index (BMI) and an increased risk of colorectal cancer (CRC) in adulthood.

Obesity can have detrimental effects on nearly every organ in a child’s body. The CDC reports that approximately 14.7 million children and adolescents in the U.S. were obese during the period 2017-2020.

Risk Factors of Childhood Obesity

Childhood obesity is a condition in which a child has a significantly higher weight than what is typically expected for their age and height within a specific age range. Since children are continuously growing, the ranges of height, weight, and BMI vary based on age and sex-specific percentiles rather than the BMI cut-points used in adults. However, severe obesity in children can be classified into two classes:

– Class 2 obesity: BMI range between >120% to <140% of the 95th percentile for BMI >35 kg/m2 to <40 kg/m2, based on age and sex.
– Class 3 obesity: BMI >140% of the 95th percentile or BMI >40 kg/m2, based on age and sex.

Several risk factors may contribute to childhood obesity, including:

1. Genetic factors: Both common and rare genetic variants that affect gene expression or function can contribute to obesity. Genetic factors are considered responsible for 40% to 70% of an individual’s obesity risk.

2. Diet: Young people are more likely to consume fast food, processed snacks, and foods rich in processed sugar. These foods often contain higher levels of carcinogens and mutagens, as well as being high in calorie count. California has taken measures to ban four additives commonly used in foods, particularly snacks for children, that have a strong correlation with cancer: brominated vegetable oil, potassium bromate, propylparaben, and Red dye 3. 

3. Sedentary lifestyle: Play is a crucial aspect of child development, affecting physical, mental, and social development. The prevalence of video games and the virtual world among children and adolescents has led to a decrease in outdoor play. A study found that over 90% of children over 2 years old play video games, with many spending 1.5 to 2 hours per day gaming. This can contribute to health problems, including obesity.

CRC and Obesity 

 A meta-analysis study in the U.S. involving over 4.7 million participants (3.2 million men and 1.5 million women) found that individuals who were obese in their early life had an increased risk of CRC as adults. The study demonstrated a 39% increase in CRC risk for obese males in early-life and a 19% increase for obese females in early-life, compared to controls. For men, an obese BMI in early life was more strongly associated with distal colon and rectal cancer. In women, the association was stronger for rectal cancer. 

Additional studies are needed to fully understand the association between early childhood obesity and CRC risk to prevent cancer in adulthood.

 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Image by kalhh from Pixabay

A 20-year Danish cohort study was recently published in the Journal of the National Cancer Institute, and was an accumulation of really surprising data from nationwide registries in regard to aspirin’s impact on the prevention of colorectal cancer (CRC).

This study followed 1,909,532 individuals for 18.2 years. The individuals, who were between 40-70 years old and had no cancer at baseline, were split into two main groups:

  • Those who use low-dose aspirin (as measured by having at least one prescription and nonuse of no prescriptions since baseline) 
  • Those who use high-dose aspirin (as measured by having at least two prescriptions and nonuse as less than two prescriptions since baseline)

Researchers then used the Cancer Registry to determine which individuals had been diagnosed with cancer during the 18.2-year follow-up period. Additionally, using the Prescription Registry, researchers were also able to keep track of individuals in the study who had refilled their aspirin prescriptions, and were able to further see the approximate dosage that each individual was taking. 

What Were the Study Findings?

Among all of the individuals who were accounted for during the approximate 18.2 years, 422,778 were diagnosed with cancer. While low-dose aspirin usage during a short period of time (<5 years) did not show statistical significance in preventing cancer, long-term use (5+ or 10+ years) was associated with at least a 10% reductions in risk for several cancer sites throughout the body (including the colon, rectum, esophagus, stomach, liver, pancreas, etc.). Additionally, high-dose usage was associated with an even higher percentage of risk reductions for developing these cancers.

Overall, this study found that individuals who took aspirin had less spread of cancer to their lymph nodes as compared to those who did not take aspirin. The study also found an association between aspirin usage and a reduction in the risk of CRC.

Unpacking the Study Findings: What Does This Mean? 

Aspirin’s role in preventing various cancers is surprising because one wouldn’t typically think there was a connection between the two. However, aspirin actually has capabilities of adjusting the immune system function, inherently allowing it to function better when it comes to fighting cancer cells. 

Though this seems like an exciting preventative measure, researchers insist that the increased-usage of this medication should not be encouraged. Aspirin raises the risk of serious bleeding, and could even be lethal if too much of the medication is consumed. However, this study really is interesting as it makes us wonder what other parts of daily life could unknowingly be helping us reduce the risk of cancer and other diseases. Additionally, it also raises questions on further research that could be done on the impact of medications on the immune system along with ways to strengthen the immune system to prevent various cancers. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Photo credit: Dan Smedley on Unsplash

CCCF Research

There is growing concern about the increasing rate of colorectal cancer (CRC) among younger people. As a result, the recommended age for screening has been lowered to 45 years. The American Cancer Society estimates that there will be approximately 106,590 new cases of colon cancer in the United States, with 54,210 cases in men and 52,380 cases in women. Additionally, there will be about 46,220 new cases of rectal cancer, with 27,330 cases in men and 18,890 cases in women. Since the mid-1990s, there has been a 1% to 2% increase in the number of CRC cases in people younger than 55 years of age. A study has shown that millennials (those born between the early 80s and late 90s) are twice as likely to develop CRC compared to those born in 1950. Furthermore, millennials are less likely to undergo early screening for CRC.

Genetics and Poor Health Outcomes

Various factors contribute to poor health outcomes. Common risk factors for disease include:

  • Diet 
  • Environment
  • Socioeconomic status
  • Education
  • Lifestyle and,
  • Genetics

Genetics is a significant risk factor for many diseases, including CRC. According to one study, about 30% of CRC cases are inherited, with Lynch Syndrome being the most common cause of hereditary CRC.

 Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer or HNPCC, is an inherited disorder that elevates the risk of several types of cancer, including colorectal and uterine cancers. Approximately 4,300 colorectal and 1,800 uterine cancers per year are attributed to Lynch syndrome. It is estimated that 1 in 279 individuals in the United States have a variant associated with Lynch syndrome. Lynch syndrome raises the risk of developing cancer before the age of 50.

Early detection of Lynch syndrome through genetic testing can help identify CRC at an early stage. While genetic testing may not determine the cause of hereditary CRC, it can indicate if an individual has polyps and is at risk of developing CRC. This information allows for early colonoscopy and lifestyle changes that may reduce the risk and prevent late recognition of CRC.

Barriers to Genetic Testing

Common types of genetic testing includes;

  • Single gene testing, which examines changes in only one gene
  • Panel testing, which examines changes in many genes in one test
  • Large scale testing: this could be genome sequencing (which examines a person’s entire DNA) or exome sequencing (which focuses solely on the genes associated with medical conditions).

There are various reasons why people may be hesitant to undergo genetic testing:

1. Concerns about privacy breaches, stigmatization, and discrimination by healthcare providers.

2. Lack of trust in the healthcare system, particularly among Black Americans, due to historical instances of unethical research targeted at Black individuals.

3. Limited awareness or knowledge about the benefits of genetic testing.

4. Worries about potential health insurance discrimination based on genetic testing results.

These concerns act as barriers that prevent individuals from receiving necessary help and contribute to mortality rates related to CRC.
Genetic testing is recommended in the following situations:

1. If you have had CRC.
2. If you have a family member with Lynch syndrome or a history of CRC.
3. If you have had uterine cancer before the age of 50.
4. If your tumor screening results show abnormalities.

It is advisable to undergo genetic screening as soon as possible if there is a family history of cancer, regardless of your age. In addition, couples planning to have children should consider getting screened to identify potential health risks for future generations. As always, consult with your doctor for guidance.

 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

In the late 1800s/early 1900s, there was a desperate need for researchers to develop medications that could kill bacteria. Pneumonia and diarrhea (conditions that seem quite easy to treat today) were killing people left and right. After years of experiments and studies, manufacturers began mass-producing an antibiotic called penicillin in 1944, a medication that they called the “wonder drug”. 

Antibiotics can clear a vast assortment of bacterial infections, ease symptoms, speed up the recovery process, prevent the spread of ailments from one individual to another, etc. It really is no surprise that physicians were thrilled about this medication and began widely prescribing it even if it wasn’t entirely necessary.

Dangers of the “Wonder Drug”

Despite all of the incredibly healing properties of antibiotics, there is also a lot of damage that they can do as well. For instance, in our bodies, the microbiome in the gut is vital to the food digestion process, breaking down toxic chemicals in the body, and assisting with the regulation of the immune system. When a person consumes antibiotics, however, the gut microbiome can be heavily disrupted, which leads to the over- or underproduction of certain chemicals that are an integral part of the immune system. This imbalance can be quite dangerous, and can actually lead to the development of various cancers. 

Study Linking Antibiotic Use to CRC

In 2022, researchers wanted to see if there was a specific link to antibiotic usage (particularly among younger individuals) and the development of colorectal cancer (CRC). Using census data between the years 2000 to 2011, scientists analyzed 7,903 Scottish individuals who had an official CRC diagnosis, and split them into two comparative groups: 

  • 445 early onset individuals (those who had received a diagnosis at under 50 years) 
  • 7,458 regular onset individuals (those who had received a diagnosis at over 50 years)

While comparing both groups, researchers separately analyzed antibiotic usage to see if there was a positive relationship between increased antibiotic usage and CRC development. 

And what did they find?

Antibiotic usage was associated with an estimated 49% higher risk of CRC in the early onset group compared to a 9% higher risk in the regular onset group. However, a statistically-significant link was not confirmed between the two variables, meaning that a causal relationship cannot be established between antibiotic use and development of CRC. 

Though researchers cannot explicitly define antibiotics as being contributors to CRC or other cancers, there is a link between the two. In terms of moving forward, more research must be conducted on this specific relationship, though researchers and physicians recommend the usual: healthy lifestyle choices to prevent CRC, regardless of antibiotic usage. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Cases of colorectal cancer (CRC) are increasing among young people at an alarming rate, prompting the recommended age for screening to be lowered to 45 years. While several risk factors for developing CRC have already been identified, a surprising one has recently been linked to bad breath.

A recent study has shed light on a specific oral organism that may be responsible for CRC. Fusobacterium nucleatum (Fn), a bacterium normally found in the human oral cavity and rarely in the lower gastrointestinal tract of healthy individuals, is found in high concentrations in CRC tumors. High levels of Fn within the tumor have been associated with higher rates of recurrence, metastasis, and poor patient prognosis.

The study examined approximately 200 CRC tumors and collected stool samples from 1,246 individuals in a case-control study. Two distinct subspecies of Fn bacteria were identified: Fna C1 and Fna C2. Of these two, Fna C2 was found to dominate the CRC tumors and provide protection against cancer-fighting drugs. This means that patients with high levels of Fna C2 in the gastrointestinal tract have a worse prognosis and do not respond well to treatment, resulting in an increased risk of recurrence. Fna C2 was present in 50% of the CRC tumors analyzed in the study. Interestingly, Fna C2 is able to withstand high levels of stomach acid, allowing it to travel from the oral cavity through the stomach, while Fna C1 is limited to the oral cavity.

Researchers worldwide are only beginning to scratch the surface of understanding cancer and developing effective treatments. However, this study provides valuable insight into the connection between oral health and CRC, potentially leading to the development of antibiotics specifically designed to target these bacteria at an early stage, thereby preventing CRC or improving treatment outcomes. In the meantime, the best approach is to maintain proper oral hygiene and regularly visit the dentist to prevent CRC.

 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

At the beginning of the year the American Cancer Society released the Cancer statistics for the year 2024 in its journal and the numbers are quite intriguing. 

Here are some key statistics:2,001,140 new cancer cases and 611,720 cancer deaths are projected in the U.S. in 2024.

Colorectal cancer (CRC) is projected to have 152,810 new cases in the U.S. (106,590 new cases of colon cancer and 46,220 new cases of rectal cancer).

In 2024, CRC is projected to be the third leading cause of cancer-related death in men and the fourth leading cause in women. Lung cancer is projected to be the overall leading cause of cancer-related deaths in the U.S in 2024. However, CRC is projected to be the leading cause of deaths from digestive system cancer in the U.S in 2024, with 53,010 projected deaths.

 

Much has been achieved in the past, however a lot more needs to be done in raising awareness about cancer and ensuring access to care for everyone irrespective of race, gender or socio-economic status.

 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

By Parker Lynch

According to the Mayo Clinic, cystic fibrosis (CF) is a disorder in which there is severe damage to the lungs and other organs in the body. This condition presents itself differently in each patient when comparing manifestations of symptoms; however, wheezing, difficulty breathing, exercise intolerance, constant lung infections, and recurrent sinusitis are all very common among individuals with CF. People with cystic fibrosis are very strong and admirable, as their condition can be very arduous in terms of treatment and monitoring: the need for consistent medication (bronchodilators, mucus thinners), using special devices and techniques to assist with breathing, monitoring what they eat, etc. 

Though it seems like CF and colorectal cancer (CRC) wouldn’t even be remotely related, adults with CF actually have a 5-10 times higher risk of developing CRC as opposed to adults without CF. On top of this, individuals with CF who receive lung transplants (or any other solid organ transplant, for that matter) are 20 times more likely to develop CRC, which requires them to complete their preventative screenings at the age of thirty rather than the standardly-recommended age of forty-five.

You can read about a CF patient’s experience with her surprise diagnosis of CRC. 

Where is This Connection Coming From?

As with any other condition or diagnosis, researchers aren’t completely certain of what the singular cause is of a CF patient’s higher chance of developing CRC. However, it is believed that mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene may have a role to play. Mutation in the CFTR gene not only leads to the development of CF, but can also lead to the development of CRC, though more research needs to be done on this topic to be able to analyze the strength of the correlation between the two. 

Moving Forward With This Information

Patients with CF are recommended to receive regular colonoscopies beginning at the age of 40 (which is five years younger than typically recommended among the adult population). Those who have received lung transplants are recommended to get their screenings at the age of 30, due to the aforementioned risks that come with organ transplantation and CRC development. 

Outside of preventative screenings, monitoring CF and CRC requires collaborative efforts among different healthcare providers as well as the individual themselves. The important factor here is that CF patients are made aware of their increased risk of getting CRC, and have a support system in navigating appointments, physician communication, screenings, etc. 

Monitoring one condition alone is extremely stressful and taxing on an individual, let alone having to deal with two. The American Cancer Society has a list of psychosocial resources for individuals who need support with navigating their healthcare, while also helping provide financial assistance, individual therapy, and group therapy. Health concerns are never easy to deal with, and it is always okay to reach out for help. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Image credit: Gordon Johnson from Pixabay

Breathe out into an airtight bag and take a whiff. How unpleasant is the odor? Now, consider this: what if the intensity of your breath’s scent could indicate your likelihood of developing colorectal cancer (CRC)? 

Bad breath, or halitosis, is a fairly common problem. The root cause of bad breath could be poor oral hygiene, certain foods, smoking, or underlying health conditions such as gum disease or dry mouth. It could also be an indicator of diseases such as diabetes. A study conducted in South Korea has discovered a potential connection between oral health and colorectal adenoma. Colorectal adenoma is a non-malignant growth that develops on the inner lining of the colon or rectum and is a significant risk factor for CRC. This finding is supported by other studies that have established a correlation between oral health and gastrointestinal disorders.

How Was the Study Done?

The cross-sectional study involved 42,871 eligible patients. The median age of the participants was 39 years, with a majority (70.4%) being men. In the sample population, adenoma was found in 12% of cases. Factors associated with a higher risk of adenoma included:

  • BMI of 25.0 kg/m2 or more 
  • Periodontitis (gum disease)
  • Moderate alcohol intake 
  • Heavy alcohol intake 
  • Tooth loss

Being male or a former or current smoker, having an alcohol intake above a moderate level, and experiencing periodontitis and tooth loss all increase the risk of colorectal adenoma. Any form of gum disease is a leading cause of bad breath.

Your breath has a lot to say about your health. By paying attention to the quality of your breath and any changes you notice, you can potentially catch early signs of certain health conditions. It is important to listen to what your breath is telling you. Now, take another deep breath and exhale into an airtight bag. Take a sniff and decide whether you should schedule an appointment with your dentist or your gastroenterologist.

 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Picture credit: Bruno from Pixabay.

By Anna Payne

Thank you to the Cystic Fibrosis Research Institute for letting us share this blog with our audience!

Last year, at the age of 34, I was living in a place of hope. I was thriving on Trikafta, working full time, serving as elected Supervisor for Middletown Township in Bucks County Pennsylvania, and acting as Vice-Chair of the Pennsylvania Rare Disease Advisory Council. For the first time in a long time, I had hope for a future of a “healthy” life. I had big dreams and a lot of things I wanted to accomplish. But then I found a mass in my groin, and after a long, painful and circuitous diagnostic journey, that included numerous invasive tests and long waits between them, I received the news no one wants to hear. “You have Stage 4 colon cancer.”

Known as the “silent cancer,” colorectal cancer remains the third leading cause of cancer-related deaths in the U.S. among the general population. Those with cystic fibrosis have a significantly higher risk of colon cancer than the general population. For those with CF who have not had a transplant, their risk of colon cancer is five to ten times higher, while individuals with CF post-lung transplant have twenty times the risk as the general population.

What makes us especially vulnerable is that colon cancer symptoms can and often do mimic issues that we CF survivors experience daily. More research is needed to determine exactly why we’re at such elevated risk for the disease, but it’s believed to be linked to a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.

The most effective tool for preventing this silent disease is a colonoscopy. Colon cancer always starts in the form of polyps, which if found early can be removed prior to becoming malignant. Colonoscopies are recommended for the general population at 45, yet despite our highly elevated risk, the current recommendation for a first screening colonoscopy for a person with CF is 40. That’s too late and must change. Screenings can prevent about 60 percent of colorectal cancer deaths.

I was 34 years old when diagnosed; I had few symptoms and no known family history. Colon cancer grows slowly, and it’s possible it’s been in me for years. I initially sensed that something was wrong when I had minor digestive issues. They persisted, but I second-guessed myself. Then I found a mass in my groin about the size of a dime.

After an inconclusive ultrasound, and while waiting for an appointment with a general surgeon, the lump grew to the size of a walnut. I went to my CF team for help. They found a bowel blockage, a common condition for those with cystic fibrosis known as Distal Intestinal Obstruction Syndrome, or DIOS. We hoped a colon cleanse would clear the blockage, but deep down I knew it was something more serious.

After a CAT scan and a biopsy of the groin mass, came the bad news. Cancer. I burst into tears. A PET scan then revealed the cancer had spread to other organs, including my ovaries, liver – which had 14 lesions – and lymph nodes.

After thriving on modulators, I have been transformed by cancer back into that sick, little vulnerable girl with CF who spent many nights curled up in a hospital bed, unsure of her future. I am now undergoing aggressive chemotherapy, requiring me to be outfitted with a take-home pump. Five times a week, I’m hooked up to an IV pole at home, on fluids to help me re-hydrate. Chemotherapy leaves me fatigued and immunocompromised, susceptible to infections and viruses that can be deadly.

Naturally, that’s required me to adjust my social life, relying on a network of friends. Work has taken a backseat to the battle at hand, but my supportive employer allows me to work remotely — as much as I’m able. My wonderful colleagues have carried the load in my absence. I miss them. I’ve even come to miss the 45-minute commute to my office with a stop to get a hot tea at Dunkin’.

Simple joys like eating — which most of us take for granted — are now a chore. I eat for calories, not pleasure. My diet changed drastically, and I no longer enjoy foods I’d grown up eating, such as macaroni and cheese and steak. If you looked in my cabinets now, you’d mainly find massive amounts of Fruit Loops and Apple Jacks.

I was shocked when my platinum blonde hair – with blue streaks – fell out in clumps. Losing hair is traumatic – it’s about body image, one’s sense of self, and feeling normal. Many have told me not to worry, that it will grow back, but I have no idea how long I will be on chemo, and whether that is true. While I have multiple wigs that allow me to feel like a different superstar each day, and a wide array of knitted hats, I often scrap these so I can emulate my idol, the Rock.

As a little girl, I spent a lot of time inpatient at St. Christopher’s Hospital for Children in Philadelphia. Watching the Rock on the weekly Smackdown was a great escape. Amazingly, the Rock learned about my diagnosis and sent me a heartfelt video wishing me luck in my fight. It’s been viewed millions of times on his Instagram page, and has allowed me to feel less isolated, with a virtual connection to countless people who channel their positivity toward me.

Prior to my diagnosis with colon cancer, I planned to travel across the globe. I wanted to hold a koala bear in Australia and visit Costa Rica. I planned to run for higher elected office. I had hopes and dreams that have been put on pause. I live in a world of uncertainty. Once again, I am learning to be comfortable living in the uncomfortable.

As science improves and evolves, so should our thinking. Cancer screenings must become a normal routine for cystic fibrosis adults, and the sooner the better. My hope is that the recommended age for a first colonoscopy will be lowered to 25 years for those with CF.

But you don’t have to wait for that to happen. If you have symptoms, don’t write them off as the usual CF GI issues. Go and get screened. You may end up saving your own life.

 

Image credit: David Sánchez-Medina Calderón from Pixabay

By Laiba Ahmad

Once upon a time, in a community served by a Federally Qualified Health Center (FQHC) clinic, a group of researchers embarked on a mission to enhance colorectal cancer (CRC) screening among a unique demographic—those aged 45 to 49. Using the U.S. Preventive Services Task Force screening recommendations as their guiding light, the researchers started their journey of measuring the impact of a mailed fecal immunochemical test (FIT) intervention.

The journey began in February 2022 when 316 eligible individuals in this age group received a mysterious package in the mail—a FIT, the key to unlocking early detection of CRC. This diverse group included 57% females, 58% non-Hispanic Blacks, and 50% commercially insured individuals. The researchers eagerly awaited the outcome of their intervention.

A Surprise Finding

The randomized trial discovered the difference between an improved mailing envelope and a plain one. The enhanced envelope, with a tracking label and a splash of colored messaging stickers, aimed to captivate the recipients.

As the days unfolded, the results emerged. A total of 54 out of 316 individuals (17.1%) observed the call, completing the FIT within 60 days. The enhanced envelope wielded a stronger enchantment, with 21.5% of recipients returning the test, compared to 12.7% from the plain envelope group—a significant difference of 8.9%. The researchers extended their gaze to the entire clinic population in the 45-49 age group, observing the collective transformation in CRC screening over the span of six months. The clinic-level screening soared, rising by a remarkable 16.6%, from a baseline of 26.7% to a triumphant 43.3%. 

A New Strategy to Increase Screening Compliance 

As the researchers concluded their quest, they discovered a promising path forward. The mailed FIT intervention had cast a spell of increased CRC screening among the vibrant 45-49-year-old FQHC patients. They recognized that this was just the beginning of the story. Larger studies would be needed to unravel the mysteries of acceptability and completion rates in this younger population. 

The story of enhanced mailers and CRC screening echoed through the halls of healthcare, reminding all that visually appealing enchantments can indeed pave the way for a healthier tomorrow.

Laiba Ahmad is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.