Dr. Alessandro Fichera: We have all seen significantly higher incidence of rectal cancer in the younger age group, which a few years ago was unheard of. My personal belief is that the poor diet over the last several decades is finally catching up with us.
Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.
Over the past three decades, cases of colorectal cancer in those under 50 have increased by 2.4%. So what’s behind this rise?
March is Colorectal Cancer Awareness Month, and we spoke with Dr. Alessandro Fichera, Chief of Colon and Rectal Surgery at NewYork-Presbyterian and Weill Cornell Medicine, to discuss how diet could be a factor in these rising rates.
We talk about healthy eating, exercise, and screenings, breaking down how lifestyle choices—and the food we eat—can help reduce the risk of colorectal cancer.
Dr. Fichera offers simple steps we can all take to give our hard-working guts the support they need, and explains some of the science behind the time-honored advice to eat your vegetables.
Courtney: Hi, Dr. Fichera. Welcome to Health Matters.
Dr. Alessandro Fichera: Thank you. Thank you.
Courtney: So, to get us started, let’s talk about the rise of colorectal cancer in people under 50. Why do doctors think this is happening?
Dr. Alessandro Fichera: That is a great question. We have seen a spike in the 20, 30, 40 year old individuals. And because it’s so unusual and people don’t think about colorectal cancer in somebody that young, oftentimes they are diagnosed at a late stage. So, I think obviously diet has made an impact on that. This is real. We have all seen significantly higher incidence of specifically rectal cancer in the younger age group, which, when I was in training, was unheard of. Those are not patients with colorectal cancer syndrome, but rather sporadic cancers, in just younger patient population. My personal belief is that the poor diet over the last several decades is finally catching up with us.
Courtney: What’s wrong with the Western diet that might be contributing to these rising cancer rates?
Dr. Alessandro Fichera: The high content of animal fat or trans fat in the diet that is also associated with a low fiber intake. So we have this pro-inflammatory diet that because of the lack of fiber sits in our colon for a longer period of time, having a chance of really doing some damage on the lining of the intestine over time. That diet is often associated with a higher alcohol intake. Alcohol has been associated with a higher risk of colorectal cancer, especially in smokers.
So if you put all of this together: high calorie, high trans fat, high animal fat, low fiber, higher alcohol intake and we’re still smoking, despite the evidence that that is very detrimental on so many levels. And you put all of that together, I think that is what is driving this higher incidence in the younger patient population.
Courtney: In the big picture, is colorectal cancer a rare cancer or a common one?
Dr. Alessandro Fichera: No, it’s not a rare cancer at all. It’s up there and obviously the statistics do change year after year, but it’s up there in the top three, in terms of incidence and also in terms of mortality. And it’s a cancer that doesn’t discriminate between men and women.
So we have pretty much the same risk in both men and women. And where the incidence was very low, let’s say 40, 50 years ago, like in Africa and some parts of Asia, they are now catching up with us. So it’s all over the world. It’s all over the age groups and genders. So it’s a real health problem.
Courtney: Absolutely. So you mentioned a few foods that increase this risk. What specifically are these foods?
Dr. Alessandro Fichera: So we have identified a group of what are called pro-inflammatory foods. At the top of the list are foods rich in animal fat. So cold cuts, bacon, beef, processed food, high sugar content. It is well known fact that high processed food, that oftentimes are associated with either high sodium content and high sugar content, all are involved with this pro-inflammatory state.
And then there is a big group of anti-inflammatory foods that include vegetables, of course, greens and fish. Fish oil is an anti-inflammatory, pretty strong anti-inflammatory. So there is a balance that we should maintain. This balance between pro-inflammatory and anti-inflammatory foods that unfortunately is lost in a Western diet.
Courtney: Let’s talk more about sugar. I feel like sugar has a bad reputation. Can you talk about its relationship with colorectal cancer?
Dr. Alessandro Fichera: Pure sugar is not good and for a variety of reasons. Risk of obesity, pro-inflammatory activity. It’s the type of sugar, the amount of sugar, and the balance with the rest of the diet. People that drink soda, they don’t drink a can, they drink several. You know, you don’t need that amount of sugar in something you drink multiple times a day, right? Definitely a glass of water is significantly better. So it’s important to read the label, right? We have labels for a reason.
It’s balance, it’s portion control, it’s quantity. A diet, personally, without good bread and pasta, it’s not for me, not compatible with life. But, it’s the amount and it’s the balance with the rest of your food pyramid.
Courtney: That’s a good point and a recent warning from the Surgeon General said alcohol can increase the risk of cancer. Why is that, and can you discuss the role of alcohol on colorectal cancer?
Dr. Alessandro Fichera: So again, the same thing: the amount and obviously alcohol is very different if you’re drinking shots or a glass of wine or a beer. So we need to keep that into consideration. But definitely excessive drinking, for a variety of reasons. Pro-inflammatory. Those are empty calories that you don’t really benefit from it. And they have gone further to say that if you drink and smoke your risk of cancer goes up. So all of those are not individual factors, but together they work to create this perfect storm. To me, it goes again to moderation. Anything with moderation is, it’s better than just going wild.
Courtney: Let’s talk more about what we can do.
Dr. Alessandro Fichera: Yes. Right. So, my first recommendation is to increase natural fiber intake. I’d always recommend to my patients just natural fibers. No, you don’t have to go to the store and buy fiber supplements if you can have your servings of fruits and vegetables. And, you know, fruits and vegetables require some time to prepare, although it’s time well spent if you ask me. And, now you can buy salad made already for you at the store. So you go and buy your salad and add a little protein and have a healthy lunch. It’s critical: start with natural fibers, and then drink a lot of fluids. And when I say fluids, I mean water, as we said earlier. Water, it’s delicious, if you ask me.
Courtney: Can you give some more examples of specific foods someone might try to include in their diet to help reduce cancer risk?
Dr. Alessandro Fichera: Yeah. All the greens are great for fiber intakes. There are also some fruit that are higher in fiber content and some you don’t expect. You know, if you eat an apple with the skin, there is fiber in there. If you eat blueberries, if you eat mangoes, if you, if you eat celery. You know, celery is a great source of fibers and you can have a little cheese with it. So you can, you know, make it tasty if you really don’t like, don’t like celery. Fruits and vegetables, you really cannot go wrong,
Courtney: That’s great to hear. I’ve actually been trying more to build my plate more around a vegetable. And there’s so much you can do with that. So how about something like omega 3 fatty acids—how important are those?
Dr. Alessandro Fichera: Those are anti-inflammatory component of our cells. In the structure of the cells. There are, they’re part of it and they work on as anti-inflammatory in the big scheme of things. Obviously, you find it in fish and fish tastes great.
As I said earlier, though, there is not a silver bullet. There is not one, you know, if I load up on fish oil or omega 3 or I’ll be, I’ll be okay. No, it’s a combination of things and a balance of things.
Courtney: What else beyond diet is important for reducing your risk of colorectal cancer?
Dr. Alessandro Fichera: So, there are simple things: stay active, exercise, stay hydrated, staying hydrated helps with colonic transit time and bowel movements and, obviously, don’t smoke. And then get your screening. We have ways to prevent colorectal cancer. We have ways to detect it early. Just stay on top of your screening modalities. It gives you a peace of mind, knowing that your colon is clean. So, I can’t stress enough the importance of getting your screening done.
Courtney: When should someone get their first colonoscopy?
Dr. Alessandro Fichera: For average risk patients is 45, age 45. And that was before we realized that we had a problem with younger folks. So I wouldn’t be surprised if the American Cancer Society or the American Society of Colorectal Surgeons will come up with revised guidelines.
Obviously, if you have risks like family history, if you have a hereditary colorectal cancer syndrome, like familial polyposis or Lynch syndrome, the guidelines are different. If you have inflammatory bowel disease, the guidelines are different. So, but in general, since the majority of individuals have an average risk, 45 years is when you need a colonoscopy. When somebody, no matter how young they are, have symptoms, they’re bleeding, just get a colonoscopy. Because it’s devastating when those hemorrhoids are not hemorrhoids and then the cancer is advanced.
Courtney: And you touched on this, but how important is it to know family cancer history?
Dr. Alessandro Fichera: Very important. You know, first degree relatives, parents and siblings. It’s critical because it puts you at a higher risk and it’s not just first degree relatives with cancer, it’s first degree relatives with polyps as well. So people with advanced polyps should share that diagnosis with their family members. I know it’s not easy sometimes, but it’s important. And then your children. If you have a polyp or cancer, your siblings, your first degree relative should have a colonoscopy at age 40 or 10 years younger than the index individual. So if you had, if you get diagnosed at age 50, your first degree relative should have a colonoscopy at age 40 and so on and so forth.
Courtney: Thank you so, so much for being here and sharing all your amazing expertise.
Dr. Alessandro Fichera: Thank you for having me. And, let’s get our colonoscopies.
Our many thanks to Dr. Alessandro Fichera. I’m Courtney Allison.
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