Colorectal cancer is increasingly becoming a public health concern in India. It has steadily increased over the past two decades. Though the incidence of CRC is still much lower in India compared to the West, urban areas are increasingly seeing an alarming trend, particularly in people under 50 years. According to ICMR, colorectal cancer accounts for 7-8% of all cancer cases in India, with over 70,000 new cases being diagnosed every year. Unlike the Western world, where life-style factors- obesity and ready-to-eat food are high contributors, but genetic factors come into play alongside an increase of IBD. Low fiber consumption is also included in the disease. Late detections are a common problem because it is not the routine screening practices in India leading to low survival rates. This underscores the importance of early detection and lifestyle changes and increased awareness for a reduction in the mortality rate of CRC.

Know your colon cancer

The colon or the large intestine and the rectum are vital components of the digestive system because they absorb water and other nutrients and contain waste. Colorectal cancer typically begins as non-cancerous polyps that can develop into cancer over time. Early detection is crucial and makes the possibility of being effectively treated much higher.

Start recognizing signs:

Early-stage colorectal cancer usually has no obvious symptoms, so screenings should be part of one’s routine. As the disease progresses, a person may experience some of the following:

Prevention strategies
While some risk factors, such as age and family history, are non-modifiable, the role of lifestyle choices in prevention is paramount:
Routine check-ups
Due to the recent surge in young-onset cases of CRC among Indians, starting screening at a younger age could be beneficial. In October 2020, the U.S. Preventive Services Task Force recommended lowering the age for CRC screening to 45 years with the rise in young-onset CRC cases. However, in India, awareness and access to screening remain limited, especially in the rural regions. Experts recommend individuals with a family history of CRC, inflammatory bowel disease (IBD), or hereditary conditions such as Lynch syndrome to begin colonoscopy screenings earlier than the general public, possibly as early as 40 years, or even younger for those within high-risk groups. Annual stool-based test (FIT or FOBT), colonoscopy every 10 years in average-risk individuals. CRC is an avoidable and curable cancer when diagnosed early; however, many cases are detected in advanced stages in India because of the lack of an organized screening program.
Healthy diet
Diet plays a significant role in preventing CRC, with processed and red meats, low fiber intake, and high-fat diets significantly increasing the risk. In India, dietary habits are changing rapidly, especially in urban areas where people are adopting more Westernized diets, which contributes to a higher incidence of CRC. Studies have proven that diets high in fiber, particularly those with components of whole grains, legumes, green leafy vegetables, and fruits, are healthy for the gut and prevent polyps from forming inside the colon by promoting good bacteria in the intestines. The curcumin content in turmeric gives this spice anti-inflammatory properties that lower the risk for CRC. A diet for an Indian consisting of lentils, fresh fruits and vegetables, and fermented foods such as yogurt, which contain probiotics, supports gut health and reduces inflammation, thereby decreasing the risk for cancer. Secondly, a decrease in fried food, sugary drinks, and excessive dairy would improve digestive health and reduce factors.
Regular exercise
Sedentary lifestyles increase CRC significantly, especially for urban Indians with long hours at work sitting. Regular moderate-intensity exercise for at least 150 minutes a week is correlated with a 30-40% decreased risk of CRC. Physical activity will regulate bowel movements, reduce inflammatory episodes, maintain healthy weight levels, and increase the sensitivity of the body’s natural insulin, helping offset the risk of CRC. Yoga, brisk walking, and strength training are accessible and effective ways to maintain colon health. Even small changes, like choosing stairs over elevators, engaging in short walks after meals, and stretching frequently, can significantly contribute to better overall health and reduced CRC risk.
Limit alcohol and avoid tobacco
Excessive alcohol consumption and smoking are strongly linked to CRC. Studies Research indicates that long-term smoking raises the risk of colorectal cancer (CRC) by 18%, while heavy alcohol consumption can increase that risk by 50%. Alcohol may cause irritation of the colon’s lining, causing cellular damage and inflammation, leading to cancer. The Asian flush reaction, often seen in Indian and South Asian communities, suggests a genetic tendency for inefficient alcohol metabolism, which can heighten cancer risk. Smoking, on the other hand, accelerates the formation of polyps and causes mutational damage in the colon. Stopping smoking and reduction in alcohol can significantly reduce the risk of CRC. Quitting smoking may also help, to some extent, reverse some damage even among people who have smoked for years.
Increasing prevalence among younger generations
Colorectal cancer, a disease hitherto confined to older populations, is now increasingly affecting the Indian population between the ages of 30 and 40 years. Major contributors to this alarming trend are the increased prevalence of unhealthy diets, more ultra-processed foods consumption, low fiber consumption, high sugar levels, sedentary behavior, and growing obesity. Further, India has seen an increased incidence of IBD, specifically Crohn’s disease and ulcerative colitis, which is known to increase the risk for colorectal cancer. Excessive antibiotic use, imbalances in the gut microbiome, and chronic stress are also now being recognized as potential risks. Experts are stressing the need for early screening, preventive lifestyle changes, and enhancing awareness among young adults to fight this worrying trend.
Rising concern among younger populations
CRC is on the rise in India, and various lifestyle changes, dietary patterns, and urbanization are considered responsible. The consumption of processed and fast foods, rich in unhealthy fats and low in fiber, contributes to poor gut health and has been associated with an increased risk of CRC. Sedentary lifestyles, obesity, and rising inflammatory bowel disease (IBD) are additional factors. Unlike Western countries, where CRC is often associated with older individuals, India is experiencing a worrying increase in cases among younger adults. This is largely due to shifts in food habits, reduced physical activity, increased antibiotic use, and imbalances in the gut microbiome. The lack of regular screening programs and delays in diagnosis further complicate the issue, leading to more late-stage diagnoses and poorer survival outcomes.
Colorectal cancer is indeed a significant health challenge, but proactive steps, early detection, and well-informed lifestyle choices do reduce its impact. Regular screenings, paying attention to the changes in one’s body, and being committed to healthy living will be foundational steps to protecting oneself against this disease. We can work together to reduce the burden of colorectal cancer both in India and globally, if we all remain well-informed and vigilant.
Dr Rajesh Shinde, Consultant HPB, GI, Thoracic Oncology & Robotic Surgery, Apollo Hospitals Navi Mumbai