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.

By Parker Lynch

According to the national census data for 2020, Kentucky was found to have the highest incidence of colorectal cancer (CRC) in the country—41.2 new cases of CRC per 100,000 people in the state  that year. This number is concerning, especially when comparing it to other states with significantly lower rates: Utah, Colorado, Delaware, Arizona, and Vermont (about 20 new cases per 100,000 in 2020). 

Why Is CRC Incidence High in Kentucky?

There are several risk factors associated with CRC: tobacco use, poor dietary habits, lack of exercise, genetic predispositions, etc. Unfortunately, the residents of Kentucky exhibit each of these poor lifestyle habits much more than other states. Two-thirds of adults in Kentucky are overweight, less than a tenth eat a sufficient amount of fruits and vegetables, and more than a third are not getting enough exercise. On top of these, family history of CRC is common among many families in the state, making it much more likely for individuals to develop the disease. 

On a national level, Kentucky is known for having some of the poorest diets, which includes a regular consumption of fried foods, meats, and bread. Fried foods and over-processed meats, in particular, can expose one’s body to carcinogens that have been linked to CRC as well as various other cancers. 

Kentucky Culture 

Born out of Corbin, Kentucky, Colonel Sanders’ fried chicken restaurant quickly grew to become a very popular and profitable chain of fast food spots. Known for serving bowls, pot pies, mashed potatoes, and loads of fried chicken, KFC has been a hot-spot since the 1940s. It might seem like an easy fix to tell residents to just “eat healthier”, but unhealthy diets that are deeply ingrained in a state’s culture and history are very hard to just simply eradicate. 

Telling residents of Kentucky to stop eating their fried foods is like telling residents of New York to stop drinking coffee; they may just laugh in your face. Changing the standard American diet and encouraging healthy eating habits remains a challenging endeavor for healthcare workers, researchers, community educators, and the population itself. 

Educating Communities

For starters, access to dietary and lifestyle counseling should be expanded throughout all states in America. In doing so, people would inherently have the opportunity to reflect on their own eating habits, and create plans to maximize their nutrient intake, while also learning how to be financially feasible in doing so. Many people may not even be aware of the significant health consequences of their dietary habits, and they will never know unless people are intentionally educating communities about these crises. 

People don’t need to entirely restrict certain foods in order to avoid CRC, but a gradual decrease of the consumption of fried/heavily processed foods while simultaneously increasing the consumption of vegetables, fruits, and leaner meats will lead to a new culture: one where CRC is not a common disease in one’s community or town. 

 

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

Picture credit Larry White from Pixabay.

By Parker Lynch

The Colon Cancer Foundation (CCF) has an incredible internship program that encourages interns to review journal articles on healthcare and colorectal cancer (CRC), raises their awareness on CRC, provides a platform for interns to connect with other researchers/students interested in the same field, attend research conferences, among other things! Additionally, interns frequently write articles and create infographics on the latest developments in the CRC space. 

This blog post is dedicated to introducing some of the faces behind all of these articles, and taking a look at what they are doing now in their academic and professional careers.

Emily Edwards (they/them) 

Emily Edwards

After working with CCF, Emily is currently serving as an Infection Prevention Specialist for the CDC Foundation in conjunction with the North Carolina Division of Public Health. Their primary focus is to prevent the transmission of sexually transmitted diseases across 27 counties located in Western North Carolina. They are also responsible for connecting individuals with the necessary healthcare services while simultaneously reaching out to their partners to curb the further spread of the disease. According to Emily, “The skills I acquired during my time as an intern with the Colon Cancer Foundation equipped me with the expertise to communicate intricate scientific data to diverse audiences, which I use in my current role”.

 

 

 

 

Shachi Patel

Shachi Patel (she/her) 

Shachi is currently a second-year physician assistant student. Since September 2023, she has completed her pediatric and surgery rotations and is currently on her OBGYN rotation in Philadelphia. Shachi has loved all of them so far, and is excited for the rest of her rotations and to see what specialty she ends up in as a PA. 

 

 

 

 

Sahar Alam (she/her)

Sahar Alam

Sahar joined the Colon Cancer Foundation (CCF) as a Colorectal Cancer (CRC) Prevention intern while she completed her Master of Public Health with a concentration in Epidemiology from New York University. She was drawn to CCF’s mission because one of her close family members was diagnosed and treated for colorectal cancer in 2019. During her internship, Sahar interviewed researchers about their recent work and notable research findings, wrote blog

posts about CRC research, developed infographics, and coordinated with other interns to raise

awareness about CRC. Sahar says that she is very grateful to have worked with Dr. Surabhi Dangi-Garimella, who mentored and guided her throughout her internship. Currently, Sahar works as a Manager of Scientific and Health Policy Initiatives at ISPOR—The Professional Society for Health Economics and Outcomes Research.

 

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

Picture credit: Gerd Altmann from Pixabay.

Often, colorectal cancer (CRC) doesn’t cause symptoms until it grows or spreads. It is often harder to detect in the younger population who might ignore symptoms due to lack of insurance coverage, and because they are not yet eligible for screening because of their younger age. However, findings from a recent study might provide some clues to identifying the early onset of CRC among young adults not old enough to qualify for CRC screening. 

Those under 45 may not have insurance coverage for any form of CRC screening—colonoscopy, FIT, or FOBT—because the recommended age to start screening for CRC is 45 years. According to the American Cancer Society, 2,001,140 new cases of cancer are projected in the U.S. in 2024,152, 810 of which may be CRC. Another concerning statistic is the 2% rise in the annual CRC incidence rate among young adults (ages <55 years). 

Paying Attention to The Early Signs

The study identified 4 red-flag signs and symptoms occurring at least three months before diagnosis that were associated with a subsequent risk of early-onset CRC:

  • Abdominal pain 
  • Rectal bleeding 
  • Diarrhea
  • Iron deficiency anemia 

A total of 5,075 early-onset CRC cases and 22,378 controls were included in the study. 63% of the cases were diagnosed with CRC. The authors found that in the study population:

  • Abdominal pain and rectal bleeding were the most common symptoms
  • Abdominal pain was associated with a 34% higher risk of early-onset CRC 
  • Signs of rectal bleeding had the greatest association with developing CRC 

Diarrhea and iron deficiency anemia were also identified as a common symptom but did not have a high association with CRC.

Having one, two, or three of these warning signs and symptoms were linked to a 1.9-, 3.6-, and 6.5-fold higher risk of developing CRC, respectively. These correlations were stronger for rectal cancer and young-onset cases (average 43 years).

Despite the possibility that this study helped focus on the early warning signs and symptoms of CRC, it is crucial to remember that the signs and symptoms described above can also be the result of other health conditions such as inflammatory bowel disease, hemorrhoids, irritable bowel syndrome, or infections. In order to properly identify and treat the condition, it is important to see a doctor and get screened if you are experiencing any of those symptoms.

 

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

Picture credit: Muhammad Daudy on Unsplash

By Alexa Kanbergs, MD-ScM, MS

What is IGNITE-TX?

Have you been diagnosed with Lynch Syndrome or a BRCA1 or BRCA2 genetic mutation? Do you have family members who have not yet undergone genetic testing? If yes, then this study may be for you! The IGNITE-TX study explores ways to increase genetic testing for family members of those diagnosed with Lynch Syndrome or a BRCA1 or BRCA2 genetic mutation. This is also known as cascade genetic testing.

What the Study Involves

Individuals eligible for the study will be granted access to the IGNITE-TX website. The website contains information about their genetic mutation and how to share information with family members. Participants and their family members will be placed at random into four groups:

  • Group 1: Standard of care, which is receiving a letter with information on their specific hereditary cancer syndrome that they can share with their relatives
  • Group 2: Free genetic counseling and testing
  • Group 3: The IGNITE-TX intervention, which gives family members access to the website and education modules as well as access to a study navigator
  • Group 4: The IGNITE-TX intervention and free genetic counseling and testing.

All participants (including family members enrolled in the study) will be asked to complete a baseline survey and then follow-up surveys at 6 and 12 months. Participants will receive a $10 gift card after completion of each survey.

Why Should I Enroll? 

There are good reasons to join the IGNITE-TX Study. First, you get to help others. By joining, you can help test your family members, and it also helps us learn better ways to conduct genetic testing for people whose family has a history of cancer. Additionally, everyone who takes part in the study will be compensated for their time.

How Do I Know if I am Eligible to Enroll?

You are eligible to participate in this trial if:

  • You are 18 years of age or older
  • You or your family member has a positive genetic test result  for the BRCA1/BRCA2 mutation or Lynch syndrome (MLH1, MSH2, MSH6, PMS2, EPCAM mutation)
  • You have an email address and/or a U.S. cell phone number
  • You speak English or Spanish

You are not eligible to participate if:

  • You do not have any relatives
  • You do not have one of the genetic conditions listed above or only have been told you have a variant of uncertain significance

Study Locations

We are targeting enrolling patients throughout the U.S.

Study Contact Information

J. Alejandro Rauh-Hain, PI

Heidy Bosch Study Coordinator

Study specific contact information: Ignitiestudy@mdanderson.org, Phone: 713 792 9155

 

Clinicaltrials.gov identifier:

NCT05677048 (https://clinicaltrials.gov/show/NCT05677048)

 

Alexa Kanbergs, MD-ScM, MS, is a Gynecologic Oncology Fellow, MD Anderson Cancer Center.

Photo credit: Rajiv Perera on Unsplash