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Seven major risk factors predict colorectal cancer in men

A study published in the journal Cancer Prevention Research is shedding new light on the risk factors that contribute to early onset of colorectal cancer in males. 

The research may revolutionize the way healthcare professionals approach early screening, especially in younger individuals who traditionally fall below the recommended screening age.

Focus of the study

Colorectal cancer has been seeing a decrease in incidence and death rates for individuals aged 50 and older. However, alarmingly, the rates are increasing for those under 50. 

This concerning trend prompted researcher-clinician Dr. Thomas Imperiale of the U.S. Department of Veterans Affairs, Regenstrief Institute, and Indiana University School of Medicine to lead a study into the risk factors for early onset colorectal cancer in males.

Seven risk factors

Dr. Imperiale’s study has identified seven risk factors that can help in targeting 45- to 49-year-olds for adherence to new national screening recommendations. Additionally, the findings may aid in recognizing younger men who could benefit from earlier screening.

The seven identified risk factors that convey a higher-than-average risk for early onset colorectal cancer in males include older age within the specified range, lack of regular use of non-steroidal anti-inflammatory drugs or statins, current alcohol use, family history of colorectal cancer, a higher disease burden, and a marker for socio-economic status known as service-connection/copay variable. 

Significance of the research 

“This study is important because it puts whether, and possibly how, to screen people who are younger than age 45 — below the age for recommended colorectal cancer screening and have some of the risk factors we identify — on the table for consideration for screening,” said Dr. Imperiale.

“We know that colon cancer at younger ages is on the rise, although the absolute risk is still much lower than even in the 45- to 54-year-old age group. Nonetheless, that doesn’t mean that we shouldn’t be trying to identify younger people at higher risk to screen them with some modality.”

Study implications 

Clinicians can engage in an individualized conversation about risk factors, and Dr. Imperiale suggests that it doesn’t necessarily require a colonoscopy. For men younger than 45 who are at higher-than-average risk, noninvasive screening tests such as fecal occult blood testing or multi-target stool DNA testing are viable options.

A particularly intriguing part of the study was the discovery that the set of risk factors for older individuals was not wholly applicable to younger ones.

“We found that while the weights assigned to some factors, such as family history and alcohol use, were about the same for men older and younger than 50, others, such as high body mass index (BMI) were risk factors for older but not younger men,” said Dr. Imperiale.

“We don’t believe that any of these risk factors are unique or specific to the veteran population,” with the exception of the socio-economic marker, explained Dr. Imperiale.

The comprehensive study involved 600 individuals with non-hereditary colon or rectal cancer and 2,400 control patients from VA medical centers across the U.S., all male veterans between the ages of 35 and 49.

Future research

Dr. Imperiale is currently analyzing data on risk factors for early onset colorectal cancer in female veterans, acknowledging that the risk is twice as high for men in any age category.

As the medical community and the public wrestle with a disease that does not discriminate by age, this pioneering research opens a new chapter in understanding, diagnosing, and potentially preventing colorectal cancer in an age group previously overlooked. 

With these insights, clinicians can more effectively tailor their screening and preventative measures, offering hope and potentially saving lives in the process.

More about colorectal cancer 

Colorectal cancer, often collectively referred to as colon cancer, involves the growth of malignant tumors in the colon or rectum, parts of the large intestine. It is a significant global health concern and is one of the leading causes of cancer-related deaths. 

Causes and risk factors

Most cases of colorectal cancer are diagnosed in individuals over 50. Having close relatives with the disease can increase this risk.

Certain types, like adenomatous polyps, can develop into cancer. A diet high in red meats and processed meats is also associated with an increased risk of colon cancer.

Both smoking and alcohol use are significant risk factors, as well as sedentary behavior and conditions like ulcerative colitis and Crohn’s disease.


Early stages of colorectal cancer often present no symptoms, which underscores the importance of regular screening. When symptoms appear, they may include changes in bowel habits, including diarrhea or constipation; rectal bleeding or blood in stool; persistent abdominal discomfort; weakness or fatigue; and unexplained weight loss.

In recent years, there has been growing concern about the rise in cases of colorectal cancer in younger individuals, making awareness, early diagnosis, and prevention even more crucial. Regular screenings remain the most effective way to detect early-stage colorectal cancer when it’s most treatable.


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