Study shows US colorectal cancer rates are rising again in almost all age groups after 20+ years of decline. NEJM Evidence study finds rates climbing in every age group even when screening is high.
Just a random thought, but has there been any research into dishwasher tablets/cleaning agents used in dishwashers? People are ingesting that, everywhere, all of the time
This includes only diagnosed cases of colon cancer, so if India has much less screening and fewer diagnostic opportunities, that will greatly reduce its score. But it is still a striking number!!
What data? The article only seems to be about the US?
Indian diets are very different from the average American diet. Loads of vegetables. Even non-vegetarians get tons of fibre and are often eating 20-30 different plants in a day. Most of it fresh too.
"The data showed that the age-adjusted incidence rate fell from 55.2 per 100,000 in 2000 to 36.7 in 2022, then rose to 38.3 in 2023."
If you would like to advance a theory that this is because of a specific environmental change, your theory should cope with the fact that the rate was MUCH higher in 2000 and the rise described here is is 2023. Increased screening is said to be a likely culprit in this case for middle-aged adult prevalence but not for older adult prevalence, because screening has increased somewhat in the middle aged groups.
I am personally dealing with colon cancer, and one of the incredibly annoying things about the awful disease is the number of truly clueless people who use it to advance some culinary agenda they believe in without evidence.
> If you would like to advance a theory that this is because of a specific environmental change
It probably is, but it could be anything. For all we know, (joke,) it could be a pesticide with traces present in pesticides, or exposure to a cleaning chemical in public transportation.
But the bigger issue is that the people pushing these theories are pushing them on moral reasons; IE, making an unfair claim that colon cancer is on the rise because people have immoral lifestyles. IE, from eating poorly or the multitude of other holier-than-thou lifestyle claims at the tip of their tongue.
Personally, my money is that we find out that regularly holding in farts increases the probability of colon cancer, and that we need a public health campaign to fart in public.
This one took a turn but point taken. You see similar arguments for a great many ailments (sperm count and carpets comes to mind). You can’t well run randomized control trials on every plastic, additive, or manufacturing process. It feels futile to even start.
I looked through your comment history to ensure you haven't already answered this. But what made you get tested ? Did you have risk factors ? No problem if you'd rather not share.
Related, I was told by a doctor to get screened after turning 50. But a reasonable self-estimate given all my risk factors puts my chances of having colon cancer at 1 in 10000. A colonoscopy has a false positive of ~2%[0] for my demographic. Meaning if I get a positive result, it's actually ~200 times more likely that I don't have cancer. It's hard to justify a screening given those odds and the 99%+ chance I will waste my time treating and worrying about a disease I don't have. My guess is an insurance company wouldn't cover a colonoscopy for those reasons.
I just had my first colonoscopy at 45 - they lowered the guideline recently, as the article mentioned.
The link you give is for colon cancer blood tests. Colonoscopies themself are basically definitive, because if they see something suspicious they will snip it and send it to the lab for biopsy. I had one such "suspicious polyp" and it turned out it wasn't a polyp at all, just normal intestinal tissue they mistook. There's your false positive. But the risks and long-term consequences are basically nil, the intestine heals itself in a week or two.
It's a very unpleasant procedure (the prep, not the procedure itself), but it's also very low risk and effective at catching colon cancer cases early when they can still be treated.
One thing I learned about colonoscopy is that it is not _only_ a test. I understand that the removal of polyps is a cancer-reducing mechanism in addition to being a diagnostic. Less invasive tests do not have this property.
Tested at 37, because occasional bloody stool. Found a few polyps but no cancer. Still had to fight with insurance to keep my costs below $2500 for the whole experience. Still upset the doctor thought I was joking when I requested a DVD or Memory stick with the tour of my insides on it.
You can do a comparison to the UK, which, as I understand it, does not give out routine colonoscopies as the first line of defense, as in US. I believe there are some preventable colorectal cancer deaths there for this reason.
I asked my doctor here in the Netherlands about a test (mid 40's male, my dad has had several polyps removed) and he said to come back when I was bleeding out of my ass...
So the processed meat -> colorectal cancer link is actually a textbook example for explaining what statistical & scientific concepts mean.
Processed meat is a known Group 1 carcinogen, in the same category as asbestos, tobacco smoke, and plutonium. Carcinogens are grouped by the strength of scientific evidence on them, not by how hazardous they are. In this case, there are abundant studies with solid methodology that show a link between consuming nitrites in processed meat and a higher risk of cancer, and we also understand how the process works at a molecular level.
This shows how well we understand the link, not how strong the link is. And it turns out that processed meat is a very minor carcinogen. When you average the studies together, the hazard ratio for someone eating 50g of processed meat per day, over an 85 year lifetime, over somebody who eats no processed meat is about 1.18. That means that folks in the former group are about 18% more likely to get colon cancer than folks in the latter group. By contrast, the hazard ratio for cigarette smoking is about 20x (smokers are 2000% more likely to get lung cancer than non-smokers), for asbestos exposure it's about 35-45x (industrial asbestos workers without PPA develop mesothelioma at a rate 3500-4500% greater than the general public), and plutonium exposure is about 7-50x for a single unprotected exposure.
There's a further piece to the statistical puzzle, and that's base rates. Colorectal cancer is relatively rare, with a lifetime incidence (again assuming an 85y lifespan) of about 7%. Combined with the 18% hazard ratio, that means a diet full of processed meats increases your lifetime risk of colon cancer by about 1%. There are far worse activities you could be doing.
A related concept is the Prop65 warning labels in California. If you've ever been to the restrooms in the SFO airport, you might notice that there's a warning label of "This restroom contains chemicals known to the State of California to cause cancer." These are pretty ubiquitous, you'll see them everywhere else in California too, like on new cars. Are you going to get cancer just because you transferred through SFO or LAX? No. But the list of chemicals that have scientifically demonstrated carcinogenicity is long, and the good people of California don't really make a distinction between minor risks and major risks.
Whether the known carcinogenicity of processed meats is behind the uptake in colon cancer rates is a separate scientific question. You would need data on processed meat consumption at a population level, over time, to see if that epidemiologically explains the increase we've been seeing. I don't know if this data exists and kinda suspect it would go the other way, but that's what the scientific method is for.
maybe it's meat overall, and not exclusively processed meat? i was vegetarian for many years though and don't trust myself to make guesses anymore on this. I do think there's gotta be a bunch of bad stuff that comes from eating all the unhappy animals/eggs from them/milk from them.
Absolutely. Animals are subjected to disgusting conditions.
Feed lots for cattle are very disgusting places and have been linked to a variety of illness in humans who live downwind(specifically airborne illness). Chicken farms have similar problems.
Featured article says they are looking into “environmental chemical exposures as a possible culprit”. A rise since 2019 due to “chemical exposure” make food and water pollution, and thus diet, plausible explanations no?
> I am personally dealing with colon cancer, and one of the incredibly annoying things about the awful disease is the number of truly clueless people who use it to advance some culinary agenda they believe in without evidence.
Sorry to hear this, and it's really a shame that whenever health and disease topics show up, every conspiracy theorist comes out from under their rock to try to explain their "theory" to you. Just look at the comment-trainwreck on this HN article. A significant percentage of the comments are "I have a theory that it's [....]" and it's always something mundane, untestable, and vaguely victim-blamey like diet.
This isn’t some mystery, this isn’t happening in a vacuum. There are correlated trends like rising profits of the food industry, food becoming plasticized
> I am personally dealing with colon cancer, and one of the incredibly annoying things about the awful disease is the number of truly clueless people who use it to advance some culinary agenda they believe in without evidence.
How do you square that with this quote in the article?
"The data showed that the age-adjusted incidence rate fell from 55.2 per 100,000 in 2000 to 36.7 in 2022, then rose to 38.3 in 2023."
Were more people fat back in 2000? Was the food worse? Though I don’t really doubt that the food industry and trends like you mentioned do contribute, that stat also seems to directly contradict the hypothesis.
I don't buy their explaining away the effects of COVID by excluding 2020-2021. It was incredibly difficult to access routine medical care (especially colonoscopies!) during COVID. A post-COVID bump should be expected in the 1-2 years after normalization of medical care, when many people had previously skipped screenings. Let's see if the rise continues in 2024+ before drawing any conclusions.
I'd expect increased colon cancer rates due to COVID for the rest of the 2020s, simply because screening is usually every 5-10 years and people probably just skipped their 2020-2022 appointment, giving more time for cancers to grow undetected. It's sorta like how measles is now epidemic because so many parents skipped their vaccinations from 2020-2022. It takes years for public health consequences of interruptions in medical care to show up.
And continue to get them as advised. I have had four and was told to return in three years. My wife and one of my sisters died of colon cancer. One of my sons just had his first colonoscopy at 32.
I turned 50 this month and after asking him to "please schedule me for a colonoscopy", my Primary Care Preventer is working hard to talk me out of it and into alternatives. Ones that I assume are cheaper for the Org and he gets to prolong the process by saying it's a loooooong time to schedule (which is why I reached out, duh?)
I intensely dislike American Healthcare. Every little damn thing is a fight.
Change doctors. If they don't listen and work with you tell them that. If you have valid reasons for requesting care and they try to convince you otherwise that isn't a good doctor.
Colorectal cancer rates are increasing globally, but the data in the older groups needs to take into account changes in screening ages
> The authors saw the sharpest increase in incidence rates among the 45-49-year-old age group, with an increase of 12.76% annually from 2019-2023. They said that this increase is likely driven by more people undergoing colorectal cancer screening after national recommendations lowered the age to begin screening from 50 to 45.
So the rates for 45-50 year olds can’t be directly compared in the US.
The strange part about the change in colorectal cancer rates around the world is that it’s showing a large increase in much younger people. I’ve read some studies where the sampled time period showed cancer rates declining for elderly people while they increased for very young people.
How are screening methods these days? As I understand it, colonoscopies care a small risk, which tends to cause doctors to not recommend them for fully asymptomatic individuals.
I’m starting to be convinced it’s due to 100 different reasons, but each of those reasons is due to people doing things the extreme.
Eating too much processed food? There are studies showing an increase in risk.
Sit too much every day? Ditto.
Long distance running? When taken to the extreme it increases colon cancer risk (recent research)
A measured, balanced lifestyle regarding your activity and habits is the best thing you can do to put yourself in a good position to avoid diseases or health complications.
My doctor’s favorite phrase :“Here is your prescription - Eat a little better and move around a little bit. You’ll outlive your enemies”
One key aspect that most people don't seem to be aware of is that there has been a lot of research in the cancer causing impacts of Covid infections. Its been implicated and mechanistically shown to cause a number of cancers and Covid hangs around in the gut for years/potentially ever we aren't yet sure in some people and it acts like a phage. As a phage it infects certain bacteria in our gut and drastically changes the microbiome, pushing it towards colonies of bacteria that are implicated in colon cancer.
The scientific evidence isn't there yet for colorectal cancer but its being investigated in studies at the moment and we are expecting a mass disabling event due to Covid and Long Covid and a big increase in a variety of conditions including cancer. Its one of the most studied viruses in human history and it does a lot of bad stuff and most people are catching 1.5 times a year.
52 comments
[ 0.25 ms ] story [ 12.6 ms ] threadI’m actually surprised by the placement of some of these countries. I assumed Japan would be much lower.
It's always a mix of the "true rate" vs screening/detection rates vs "dying of other things before detection" rate
So it's not really a surprise our food and drink quality and safety would suffer alongside that
It's probably going to get worse
From the abstract:
The alcohol ethoxylates present in the rinse aid were identified as the culprit component causing the epithelial inflammation and barrier damage.
Indian diets are very different from the average American diet. Loads of vegetables. Even non-vegetarians get tons of fibre and are often eating 20-30 different plants in a day. Most of it fresh too.
"The data showed that the age-adjusted incidence rate fell from 55.2 per 100,000 in 2000 to 36.7 in 2022, then rose to 38.3 in 2023."
If you would like to advance a theory that this is because of a specific environmental change, your theory should cope with the fact that the rate was MUCH higher in 2000 and the rise described here is is 2023. Increased screening is said to be a likely culprit in this case for middle-aged adult prevalence but not for older adult prevalence, because screening has increased somewhat in the middle aged groups.
I am personally dealing with colon cancer, and one of the incredibly annoying things about the awful disease is the number of truly clueless people who use it to advance some culinary agenda they believe in without evidence.
It probably is, but it could be anything. For all we know, (joke,) it could be a pesticide with traces present in pesticides, or exposure to a cleaning chemical in public transportation.
But the bigger issue is that the people pushing these theories are pushing them on moral reasons; IE, making an unfair claim that colon cancer is on the rise because people have immoral lifestyles. IE, from eating poorly or the multitude of other holier-than-thou lifestyle claims at the tip of their tongue.
Personally, my money is that we find out that regularly holding in farts increases the probability of colon cancer, and that we need a public health campaign to fart in public.
Related, I was told by a doctor to get screened after turning 50. But a reasonable self-estimate given all my risk factors puts my chances of having colon cancer at 1 in 10000. A colonoscopy has a false positive of ~2%[0] for my demographic. Meaning if I get a positive result, it's actually ~200 times more likely that I don't have cancer. It's hard to justify a screening given those odds and the 99%+ chance I will waste my time treating and worrying about a disease I don't have. My guess is an insurance company wouldn't cover a colonoscopy for those reasons.
[0]https://pmc.ncbi.nlm.nih.gov/articles/PMC7147410/
The link you give is for colon cancer blood tests. Colonoscopies themself are basically definitive, because if they see something suspicious they will snip it and send it to the lab for biopsy. I had one such "suspicious polyp" and it turned out it wasn't a polyp at all, just normal intestinal tissue they mistook. There's your false positive. But the risks and long-term consequences are basically nil, the intestine heals itself in a week or two.
It's a very unpleasant procedure (the prep, not the procedure itself), but it's also very low risk and effective at catching colon cancer cases early when they can still be treated.
Tested at 37, because occasional bloody stool. Found a few polyps but no cancer. Still had to fight with insurance to keep my costs below $2500 for the whole experience. Still upset the doctor thought I was joking when I requested a DVD or Memory stick with the tour of my insides on it.
Processed meat is a known Group 1 carcinogen, in the same category as asbestos, tobacco smoke, and plutonium. Carcinogens are grouped by the strength of scientific evidence on them, not by how hazardous they are. In this case, there are abundant studies with solid methodology that show a link between consuming nitrites in processed meat and a higher risk of cancer, and we also understand how the process works at a molecular level.
This shows how well we understand the link, not how strong the link is. And it turns out that processed meat is a very minor carcinogen. When you average the studies together, the hazard ratio for someone eating 50g of processed meat per day, over an 85 year lifetime, over somebody who eats no processed meat is about 1.18. That means that folks in the former group are about 18% more likely to get colon cancer than folks in the latter group. By contrast, the hazard ratio for cigarette smoking is about 20x (smokers are 2000% more likely to get lung cancer than non-smokers), for asbestos exposure it's about 35-45x (industrial asbestos workers without PPA develop mesothelioma at a rate 3500-4500% greater than the general public), and plutonium exposure is about 7-50x for a single unprotected exposure.
There's a further piece to the statistical puzzle, and that's base rates. Colorectal cancer is relatively rare, with a lifetime incidence (again assuming an 85y lifespan) of about 7%. Combined with the 18% hazard ratio, that means a diet full of processed meats increases your lifetime risk of colon cancer by about 1%. There are far worse activities you could be doing.
https://www.iarc.who.int/wp-content/uploads/2018/11/Monograp...
A related concept is the Prop65 warning labels in California. If you've ever been to the restrooms in the SFO airport, you might notice that there's a warning label of "This restroom contains chemicals known to the State of California to cause cancer." These are pretty ubiquitous, you'll see them everywhere else in California too, like on new cars. Are you going to get cancer just because you transferred through SFO or LAX? No. But the list of chemicals that have scientifically demonstrated carcinogenicity is long, and the good people of California don't really make a distinction between minor risks and major risks.
Whether the known carcinogenicity of processed meats is behind the uptake in colon cancer rates is a separate scientific question. You would need data on processed meat consumption at a population level, over time, to see if that epidemiologically explains the increase we've been seeing. I don't know if this data exists and kinda suspect it would go the other way, but that's what the scientific method is for.
Feed lots for cattle are very disgusting places and have been linked to a variety of illness in humans who live downwind(specifically airborne illness). Chicken farms have similar problems.
what counts as "processed meat"? any processes? specific ones?
Sorry to hear this, and it's really a shame that whenever health and disease topics show up, every conspiracy theorist comes out from under their rock to try to explain their "theory" to you. Just look at the comment-trainwreck on this HN article. A significant percentage of the comments are "I have a theory that it's [....]" and it's always something mundane, untestable, and vaguely victim-blamey like diet.
This isn’t some mystery, this isn’t happening in a vacuum. There are correlated trends like rising profits of the food industry, food becoming plasticized
Your sibling comment from 1 minute earlier:
> I am personally dealing with colon cancer, and one of the incredibly annoying things about the awful disease is the number of truly clueless people who use it to advance some culinary agenda they believe in without evidence.
"The data showed that the age-adjusted incidence rate fell from 55.2 per 100,000 in 2000 to 36.7 in 2022, then rose to 38.3 in 2023."
Were more people fat back in 2000? Was the food worse? Though I don’t really doubt that the food industry and trends like you mentioned do contribute, that stat also seems to directly contradict the hypothesis.
https://mfelix.org/stories/just-get-the-colonoscopy
I intensely dislike American Healthcare. Every little damn thing is a fight.
Change doctors. If they don't listen and work with you tell them that. If you have valid reasons for requesting care and they try to convince you otherwise that isn't a good doctor.
> The authors saw the sharpest increase in incidence rates among the 45-49-year-old age group, with an increase of 12.76% annually from 2019-2023. They said that this increase is likely driven by more people undergoing colorectal cancer screening after national recommendations lowered the age to begin screening from 50 to 45.
So the rates for 45-50 year olds can’t be directly compared in the US.
The strange part about the change in colorectal cancer rates around the world is that it’s showing a large increase in much younger people. I’ve read some studies where the sampled time period showed cancer rates declining for elderly people while they increased for very young people.
Eating too much processed food? There are studies showing an increase in risk. Sit too much every day? Ditto. Long distance running? When taken to the extreme it increases colon cancer risk (recent research)
A measured, balanced lifestyle regarding your activity and habits is the best thing you can do to put yourself in a good position to avoid diseases or health complications.
My doctor’s favorite phrase :“Here is your prescription - Eat a little better and move around a little bit. You’ll outlive your enemies”
"milk" is a cow eating soy and grain, intended for a baby cow, but it's mostly made out of the same plant that the cow ate.
"meat" is cooked animal muscle that has been built more slowly than milk, but is also built out of the plants ingested by that baby animal.
virtually all 'meat' is made out of animals that could be easily considered to be babies of that kind of animal. :(
anyway, that doing bad things like this is bad for everyone who does it is not surprising.
What terms do you propose? What adjudication?
The scientific evidence isn't there yet for colorectal cancer but its being investigated in studies at the moment and we are expecting a mass disabling event due to Covid and Long Covid and a big increase in a variety of conditions including cancer. Its one of the most studied viruses in human history and it does a lot of bad stuff and most people are catching 1.5 times a year.