Exercise Can Lower Your Risk of Colorectal Cancer

Getting active to stay healthy

Studies cited by the National Cancer Institute have found adults who increase their physical activity can reduce their risk of developing colorectal cancer by 30 to 40 percent compared to people who don’t exercise. But how much exercise do you need?  Fortunately, even a little exercise every week can help lower your risk.

“I tell patients that if they’re breaking a sweat for about 20 minutes at a time two to three times a week, that seems to be enough,” says Dr. James FitzGerald, a colon and rectal surgeon at MedStar Washington Hospital Center.  “You don’t have to live at the gym or train for marathons. Take a brisk walk around the block once a day, or watch your favorite TV show while you walk on the treadmill.”

Some other examples of moderate exercise, according to the Centers for Disease Control and Prevention (CDC), include: aerobics, biking, climbing stairs or using a stair climber, dancing, playing basketball, swimming and yoga.  Just be sure to consult with your doctor prior to starting any new exercise plan, especially if you have conditions like heart disease, lung disease, diabetes or other serious conditions.

Exercise even helps after a patient has had surgery to treat colorectal cancer. The American Cancer Society notes that people who exercise regularly after being treated for colorectal cancer have a lower chance of the disease coming back, as well as a lower chance of dying from the disease. In addition, exercise has been linked to an improved quality of life and less fatigue after colorectal surgery.

But what about if you have never exercised before?  For older adults, making that sort of lifestyle change isn’t always easy.

“It can be intimidating to walk into the local gym and get started on a fitness plan, but I encourage my patients to do what they can,” says Dr. FitzGerald. “Even little changes in their activities or walking just a little bit can benefit them in the long term.”

Other steps you can take in addition to exercise

And exercise isn’t the only thing you can do to lower your risk for colorectal cancer.  Certain lifestyle and dietary modifications can also help.

“You should try to eat a low-glycemic-index diet with more fruits, vegetables and whole grains, and don’t eat as many red and processed meats like beef, pork, hot dogs and bologna,” says Dr. FitzGerald.  “Try to quit smoking and avoid excess alcohol usage as well.”

As colorectal cancer tends to affect people in older age groups, it is also recommended that people over 50 get a colonoscopy on a regular basis to lower their risk for colorectal cancer.  As always, be sure to consult with your doctor, as your needs might be different.

Our specialists are experts in the diagnosis and treatment of colon and rectal cancer. Ready to schedule an appointment? Call us at

202-877-3627

 

Dr. James FitzGerald, MD
MedStar Washington Hospital Center

 

 

For an appointment, call 202-877-3627.

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Walk away from colorectal cancer: Exercise can lower risk

In January 2017, researchers reported that exercise is associated with a lower risk of death from metastatic colorectal cancer. Metastatic colorectal cancer is cancer of the colon or rectum that has spread to other areas of the body. This study found people who were physically active for four or more hours per week reduced their risk by 20 percent. People who exercised for at least five hours per week lowered their risk by 25 percent.  

These results reinforce other data researchers have collected on how exercise affects the risk of colorectal cancer. Though we don’t fully understand why, exercise plays a role in the development of colorectal cancer—for people who may be at risk for the disease, people who already have it and people who have been treated for it.

Who’s at risk for colorectal cancer?

Several lifestyle factors can increase the risk for colorectal cancer, including:

  • Diets high in red meat, such as beef and pork
  • Diets high in processed meats, such as hot dogs and bologna
  • Heavy alcohol use
  • Obesity, particularly excess belly fat
  • Smoking

Other factors can also increase the risk of developing colorectal cancer. These include:  

  • A history of inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
  • Family history of colorectal cancer or colon polyps (growths in the colon)
  • Being African-American
  • Having type 2 diabetes

Colorectal cancer tends to affect people in older age groups. That’s why we recommend people over 50 get a colonoscopy on a regular basis to lower their risk for colorectal cancer. Your doctor may recommend starting earlier if you have one or more of the above risk factors. For instance, we recommend African-Americans start getting regular colonoscopies at age 45. Though there are other tests available to screen for colorectal cancer, colonoscopy is still the best option for finding and treating the disease as early as possible. 

Getting active to stay healthy

As we age, we tend to be less active and at higher risk for conditions like heart disease and diabetes, which can further limit our activity levels. But even a little exercise every week can lower your risk of colorectal cancer. Studies cited by the National Cancer Institute have found adults who increase their physical activity can reduce their risk of developing colorectal cancer by 30 to 40 percent compared to people who don’t exercise. That’s on top of the benefit researchers have found exercise has in people whose cancer has spread.  

Modest amounts of moderate exercise can help. I tell patients that if they’re breaking a sweat for about 20 minutes at a time two to three times a week, that seems to be enough. Walking is a great way to do this. Some other examples of moderate exercise, according to the Centers for Disease Control and Prevention (CDC), include:

  • Aerobics
  • Biking
  • Climbing stairs or using a stair climber
  • Dancing
  • Playing basketball
  • Swimming
  • Yoga 

Research shows that people don’t have to do intense exercises to get these survival benefits. When it comes to lowering your risk of colorectal cancer, just getting up and doing something is important. If you can do more, that’s great! If you can’t, do what you can. Just make sure you’re doing something. And talk to your doctor about starting any new exercise plan, especially if you have conditions like heart disease, lung disease, diabetes or other serious conditions.

Exercise even helps after a patient has had surgery to treat colorectal cancer. The American Cancer Society notes that people who exercise regularly after being treated for colorectal cancer have a lower chance of the disease coming back, as well as a lower chance of dying from the disease. In addition, exercise has been linked to an improved quality of life and less fatigue after colorectal surgery. If you’re starting or resuming an exercise routine after colorectal surgery, be sure to talk to your doctor beforehand about the types of exercise you can do safely. 

Controlling your colon cancer risk

I realize that getting active is easier for some people than others. By the time people are in their 60s and 70s, if they haven’t exercised regularly before, making that sort of lifestyle change can be tough. But I encourage my patients to do what they can to lower their risk for colorectal cancer. I let them know that even little changes in their activities or walking just a little bit can benefit them in the long term.  

Older adults who have never exercised before may not know where to start. It can be intimidating to walk into the local gym and get started on a fitness plan. The National Institute on Aging has examples of sample exercises for older adults based on four key fitness areas: endurance, strength, balance and flexibility. Your doctor can also provide guidance on the types and amount of exercise you should do.  

And exercise isn’t the only thing I advise people do to lower their risk. Other ways you may be able to reduce the risk of colorectal cancer include:

Take the first step

We need more research in this area of medicine to find out exactly why exercise lowers the risk of death from colorectal cancer and the risk of developing it in the first place. For now, though, the data show a clear link between the disease and activity levels.

 You don’t have to live at the gym or train for marathons to reduce your risk for colorectal cancer. Take a brisk walk around the block once a day, or watch your favorite TV show while you walk on the treadmill. Every step is one you’re taking to live a healthier, more active life—and one free from colorectal cancer. 

How do colorectal cancer screenings measure up?

Colorectal cancer is the third most common cancer diagnosed in the United States, according to the American Cancer Society (ACS). Colorectal cancer includes both cancer of the colon and cancer of the rectum. But it doesn’t just appear overnight. It starts as a small growth called a colon polyp and develops into cancer. This process can take 5 to 10 years to happen.  

We tend to start seeing colorectal cancer in people who are 60 and older, so we recommend people start getting screened for colon polyps at age 50. Your doctor may recommend starting earlier if you have certain risk factors, including a family history of colon cancer. Because of their increased risk, we also recommend African-Americans start getting regular colonoscopies at age 45. The idea is to find colon polyps early and remove them before they have a chance to develop into cancer. 

The gold standard for colorectal cancer screening is the colonoscopy. It’s an accurate, effective test that lets us check patients for colon polyps and colorectal cancer. People who have regular colonoscopies may reduce their risk for getting colorectal cancer by 40 percent. But getting ready for a colonoscopy can be a hassle, and some patients would rather have an alternative to this test.  

There are additional tests available for colorectal cancer. One that’s been getting some attention recently is Cologuard, which is a test people can take at home with a doctor’s prescription.  

Though some say these alternative tests are just as effective as colonoscopies, I want to emphasize one important fact: These alternative tests look at different factors than what colonoscopies look at. That’s why it’s important to follow your doctor’s advice and get screened for colorectal cancer according to the current medical guidelines. 

How a colonoscopy works

Before someone has a colonoscopy, we first have to prepare the colon for the procedure. This involves the person having the test limiting their diet to clear liquids the day before the test. The person also has to clear the bowels before the test by taking special laxatives.  

The test itself is fairly simple. We pass a thin, flexible tube called a colonoscope through the rectum so we can see the inside of the colon on a monitor. The patient is usually asleep during the test. For some patients, we use conscious sedation, which relaxes the patient but allows us to give the patient instructions during the test.  

The test itself usually takes about 20 minutes to complete, but preparing for it and recovering afterward could mean the patient has to take a day or two off work. Missing work is one of the complaints I hear about colonoscopies most frequently, along with the bowel preparation. Most people don’t mind the colonoscopy procedure itself. In fact, because of the sedation we use, most people don’t remember the test at all. Most people only need a colonoscopy every 10 years. 

Other tests for colorectal cancer

Most other types of tests for colorectal cancer are what we call stool tests. Rather than looking directly at the colon for evidence of colorectal cancer, stool tests use a stool sample the patient provides. Stool tests have a higher sensitivity for finding colorectal cancer that has already developed. They aren’t as good as colonoscopy for finding colon polyps. There are several types of stool tests, including:

  • Hemoccult test
  • Fecal immunochemical test
  • Cologuard  

Hemoccult test

In a hemoccult test, a doctor gives the patient six cards that the patient uses to collect three stool samples. The patient mails these cards to the doctor, who checks the samples for a molecule in blood called heme. Heme is a component of hemoglobin, which carries oxygen in the blood. Finding heme in a hemoccult test is a possible red flag for colon cancer.  

Hemoccult tests have a few problems. They’re not very sensitive, so they can miss some conditions. And they can result in false positive results, or results that identify a condition that doesn’t actually exist, if there’s any bleeding in the digestive system. 

Fecal immunochemical test

A fecal immunochemical test, or FIT, uses a chemical protein to detect hemoglobin in a stool sample. FIT is a much more sensitive test than the home hemoccult test. One reason for this is that hemoglobin molecules are broken down by the body during digestion. This means that if FIT detects hemoglobin in a stool sample, it’s easier for us to eliminate the stomach or other areas of the digestive system as sources for the blood.

 FIT is typically done on an annual basis. Doctors in some areas without ready access to colonoscopy technology might use FIT as an alternative to patients getting regular colonoscopies.  

Cologuard test

Cologuard is one of the newest tests developed for colorectal cancer. It’s approved by the Food and Drug Administration (FDA) for people who don’t want other forms of colorectal cancer screening.  

Cologuard combines FIT with a test for DNA markers. These markers can get mixed in with stool as it moves through the colon. When a patient sends a stool sample to a lab for a Cologuard test, the lab looks for mutations in the DNA that happen in cases of colorectal cancer. If the test is positive for these mutations, the lab recommends that the patient get further testing for colorectal cancer. Unlike the annual FIT, patients only need to retake the Cologuard test every three years. 

The problem with alternatives to colonoscopy

Because of how these alternative tests work, they may find colon problems that are more advanced than we would find if we had done a colonoscopy earlier in the process. Early detection is key to surviving colorectal cancer.  

As the ACS notes, about 92 percent of people with stage I colon cancer survive at least five years. For stage IV cancer, that rate drops to about 11 percent. And, of course, our ideal goal is to catch colon polyps before they ever turn into colorectal cancer in the first place.  

Another issue with alternative tests is that they may not be effective in helping people avoid colonoscopies—which is a primary goal for many patients. If any of these tests yields a suspicious result, the next step is for the doctor to order a colonoscopy to see if the test’s result was accurate. So avoiding a colonoscopy with one of these tests could just lead to needing a colonoscopy anyway. If that’s the case, why not just have the colonoscopy to begin with? 

Practical realities of colorectal cancer screening

I know not everyone who should have a colonoscopy is going to have one. The American Society for Gastrointestinal Endoscopy notes that more than 60 percent of Americans age 50 or older haven’t been screened at all for colorectal cancer. And that number is probably higher in some areas and parts of the population.  

In D.C. for example, we discovered a high instance of late-stage colon cancer exists among African-Americans in Ward 5. To help combat this, we launched the “Colon Cancer Prevention in the Neighborhood” program. Part of the former Vice President Joe Biden’s Cancer Moonshot, we’re working to increase colon cancer education in Ward 5, perform risk assessments and distribute fecal immunochemical tests that residents can do at home.  

Most people go with their doctors’ recommendations for screening. But some people, for various reasons, just refuse to have a colonoscopy. In that sense, the best screening available for colorectal cancer is one that a person will have. If one of the alternative tests finds something that motivates a patient to get a colonoscopy, and we’re able to detect and treat that person’s condition, then that’s what I care about. 

Personally, I’m going to continue recommending that my patients get regular colonoscopies according to the standards of care. But if the alternative tests lead to more people getting screened and treated for colorectal cancer, that would be a great thing in my opinion.