How to cut your risk of bowel cancer

It’s frighteningly common and the second leading cause of cancer death, primarily because it causes few symptoms until the disease becomes advanced.

Last week, in our special supplement, I brought you the advice of Britain’s top experts about how to cut the risk of breast and prostate cancer. Today we bring you the same cutting edge advice on the third most-common – bowel cancer.

The good news is that new figures, published in August by Cancer Research UK, showed the rate of people dying from this has fallen by more than 30 per cent in the last 20 years.

That’s an amazing achievement, which is down to screening and improvements in treatment.

But I want to see it fall further, not least because I lost a good friend to bowel cancer last year.

More than half of cases are preventable – there are positive steps we can all take to improve our daily lifestyle and reduce our chances of developing the disease. 

And by knowing other personal risk factors and taking part in the national bowel cancer screening programme available to those over the age of 60, we can further make sure that even if the worst does happen, we have the best chances of being well again.

From what to eat and what foods to avoid to myth busting and other tips, here’s all you need to know to protect yourself and your family… 

It’s frighteningly common and the second leading cause of cancer death, primarily because it causes few symptoms until the disease becomes advanced, writes Dr Ellie Cannon (above) 

The simple rules that EVERYONE should follow  

1. Know what is ‘normal’ for you

Bowel habits are almost as individual as our signatures. For some people, it is normal to go to the toilet every few days, at no set time. Others are regular as clockwork, going twice a day.

What is important is recognising your own pattern and any sustained changes in that.

There are also dozens of other bowel issues, problems, conditions and diseases which have absolutely nothing to do with cancer but are just as life-changing for the person affected by them. That’s why it is important to get anything you feel is not quite right for you checked out.

2. Don’t ignore the symptoms

The warning signs, apart from a change in bowel habits, include:

Bleeding from the back passage or blood in your stool is the most commonly experienced colon cancer symptom. As a tumour grows larger, passing waste can cause it to bleed. You may notice it in the toilet bowl or on the toilet paper.

Pain in the abdomen or back passage. Cancers obstructing the bowel can cause constipation – which itself cantrigger abdominal cramps, gas and bloating – but these may also happen without you struggling to pass stools.

The pain and discomfort caused by a tumour can lead to loss of appetite and, in turn, unintentional weight loss.

A constant feeling of wanting to empty your bowels. A tumour that grows toward the end of the colon or in the rectum may cause this sense of ‘fullness’.

Significant tiredness. This can be the result of blood loss, caused by a tumour bleeding. Because the signs of bowel cancer can mimic other conditions, it is likely with any of these symptoms that your doctor will need to perform a rectal examination (yes, this is the dreaded rubber glove procedure, but GPs honestly do this all the time – and most importantly, it could save your life), followed by blood tests and a stool test before arranging a specialist referral within two weeks.

3. Take part in screening

Of the 41,265 new bowel cancer cases in 2014, just over half will survive for ten years or more. This figure is low and makes another statistic even more disappointing – fewer than 60 per cent of people take up the offer of bowel screening within six months of invitation.

Potentially, this means that if further investigations or treatment are needed, valuable time has been lost.

The NHS Bowel Cancer Screening Programme offers screening every two years to everyone aged 60 to 69 and is currently being extended to 74. It begins at 50 in Scotland.

About the time you turn 60 a self-test stool kit will be sent to your home. Don’t put it in a drawer and forget about it. The kit contains a little card with three fold-back perforated flaps. Under each flap are two little ‘windows’ – recesses in the card.

One each of three days, you tear back a flap and place a couple of smears of stool sample on the two windows. The flap then seals back down securely, so it’s not dirty or messy.

Once all three days are done, you pop the kit into a sealed bag which will be stamped and addressed back to your GP. Post it off. The kit looks for hidden blood in stool, which might not be visible to the naked eye, and can be a sign of bowel cancer. If there is a positive result, you will be called in for further investigation.

After completing your first screening, you’ll automatically be sent another screening kit every two years until you reach 69 or 74.

If you are over invitation age range you can request a screening test every two years by calling 0800 707 6060.

Six steps to cut your risk of bowel cancer 

1. Ration those sausage butties 

The problem: It is estimated that around one in five cases of bowel cancer in the UK are linked to eating red and processed meats. The World Health Organisation has warned that 50g of processed meat a day – just one sausage – increases the chance of developing bowel cancer by 18 per cent. And don’t think because it’s a fancy deli salami, prosciutto or Parma ham that it doesn’t count. All of these have been processed in some way, even if it’s just to preserve them.

The solution: Swap red meat for turkey or chicken, or choose vegetarian options for all your favourite foods, whether it’s curry or a pie. Can you give up a bacon sandwich? Try an avocado, turkey and tomato club – and see if you still miss it.

You also need to fill up on fibre, a lack of which has been linked with bowel cancer. Swap your morning fry-up with bacon for a bowl of porridge oats. 

You need to fill up on fibre, a lack of which has been linked with bowel cancer. Swap your morning fry-up with bacon for a bowl of porridge oats

2. Limit your booze intake               

The problem: Around ten per cent of bowel cancer cases in the UK are linked to drinking alcohol. And it’s not just binge drinking that’s harmful – any amount can cause damage. According to Cancer Research UK, the less alcohol you drink, the lower your risk of cancer.

No type of alcohol is better or worse than another, it is the alcohol itself that leads to the damage, regardless of whether it is in wine, beer or spirits.

The culprit seems to be a product created when alcohol is digested – a very toxic chemical called acetaldehyde. A build-up of this can cause significant damage to DNA, and prevent our cells from repairing the damage. There are also other ways in which alcohol is thought to increase the risk of cancer, such as increasing the levels of some hormones.

The solution: It is important to say that not everyone who drinks alcohol will get cancer – of course not – but it is a risk and we have to weigh up that risk.

Ask yourself what’s best for you and how can you cut back without compromise – ideally, try to make drinking a treat rather than a habit.

Make sure you stick within the chief medical officer’s guidelines of 14 units of alcohol a week for men and women.

Experts believe any weight loss is seriously advantageous – if only for better general health

3. Lose those excess pounds 

The problem: Excess weight is linked to approximately 13 per cent of British bowel cancer cases. And recent research suggests bowel cancer risk is 46 per cent higher in people with the largest waist circumference, compared with those with the smallest. 

Extra fat in the body can have harmful effects, such as producing hormones that affect the way our cells work, raising the risk of several diseases, including cancer.

Overall, experts believe any weight loss is seriously advantageous – if only for better general health.

The solution: Speak to a health professional, such as a GP, nurse or pharmacist, to find out if you are overweight or obese, then take a look at the NHS 12-week weight loss plan. Visit nhs.uk and search for ‘weight loss guide’.

Ask yourself what’s best for you and how can you cut back without compromise – ideally, try to make drinking a treat rather than a habit

4. Get yourself moving 

The problem: The link between bowel cancer and exercise has been examined many times and a review of 52 studies found the most physically active people had a 24 per cent lower risk of the disease than those who were least active. Exercise is also linked to a lower risk of polyps developing in the bowel.

Being active has long been known to help keep your bowels functioning regularly each day: in fact, I recommend exercise to adults and children with constipation for this reason. It is perhaps this effect that allows exercise to reduce the risk of bowel cancer.

Some research has suggested that constipation on a long-term basis can expose the lining of the colon to potentially carcinogenic substances in the stool, which might increase the risk of cancer.

The solution: Move! Make movement a part of your day. Whether it’s getting up from your desk every hour to walking the dog – right through to running, swimming, playing golf or taking part in team sports – move that body.

Where possible, stick to a consistent regime of at least seven hours’ sleep a night. If you struggle with this, speak to your GP

5. Smoker? Stub it out for good 

The problem: About one in ten bowel cancers in the UK are linked to smoking, and the risk increases with the number smoked each day.

The solution: Ask your GP or pharmacist for help quitting, not only to reduce your risk of bowel cancer but to protect your lung and heart

6. Get seven hours’ sleep every night 

The problem: It’s widely accepted that a lack of sleep – or interrupted slumber – can wreak havoc with our blood sugar and appetite control, compromise our immune system and increase our risk of conditions such as diabetes or cancer. For example, a study published in the journal Cancer found that adults at risk of bowel cancer who have less than six hours of sleep a night have a higher chance of developing growths in the bowel that can develop into cancer.

The solution: Where possible, stick to a consistent regime of at least seven hours’ sleep a night. If you struggle with this, speak to your GP.

YOU CAN EAT TO BEAT BOWEL CANCER – HERE’S HOW  

Oily fish supplies vitamin D which is needed for the immune system

FABULOUS FISH  

Oily fish such as canned sardines or canned and fresh salmon provide omega-3 fats that are antiinflammatory and have been shown to suppress the development of cancer cells.

Oily fish also supplies vitamin D, which is needed for the immune system and is independently protective.

In one analysis, published in the American Journal of Preventive Medicine, it was estimated that raising the blood serum level of vitamin D to 34 nanograms per ml, the incidence of colorectal cancer could be reduced by half. 

UK figures are hard to come by, but the example of the American population suggests that there’s still work to do. Over there, 60 per cent of people have a level lower than

DEVOUR MORE DAIRY  

Researchers in 2013 reported that each 400 gram per day intake of dairy products was associated with a 14 per cent reduction in the risk of bowel cancer, and for every 200 grams of milk consumed per day, risk was reduced by seven per cent.

Filling up on fibre: Worryingly, we eat on average only about 18g a day 

It did not matter if the milk was full fat or skimmed, and yogurt and cheese were not associated with colorectal cancer risk. The chief theory is that the calcium in dairy milk is the protective ingredient, which among other things may suppress proliferation of rogue cells. 

However, in dairy products that haven’t had all the fat removed, butyrate and conjugated linoleic acid – types of healthy fat – may also play a beneficial role.

FILL UP ON FIBRE 

About 12 per cent of bowel cancer cases are linked to eating less than 23g of fibre a day, says Cancer Research UK. Worryingly, we eat on average only about 18g a day.

One way fibre is thought to help reduce bowel cancer risk is because it speeds up gut transit time, lessening the time that potentially cancer-causing substances are in contact with the gut.

To reach 23 grams of fibre (or, more ideally, the 30 grams that the Government’s Scientific Advisory Committee on Nutrition recommends is the optimal daily intake) requires basing meals largely around whole grains, fruit, vegetables and pulses, as well as consuming high-fibre foods for snacks. 

‘I know I’m at high risk… so meat is off the menu’: Why youth worker, 29, avoids all things animal  

Matthew Barnes-Smith, 29, is a part-time youth worker from Hitchin, Hertfordshire.

He says: ‘I used to love bacon – and as a 6ft-tall former rugby player, I’d eat meat most days. 

‘But in the past few years I’ve really changed what I eat – these days I cook mainly vegetarian or vegan meals. And no more bacon.

‘I made the decision because there is a strong history of bowel cancer in my family, and I want to reduce my risk as much as possible.

Matthew Barnes-Smith, 29, is a part-time youth worker from Hitchin, Hertfordshire

‘Diet is key to doing that – in particular steering clear of processed and red meat.

‘My grandfather, John, died in his early 30s from the disease in the late 1960s, leaving my grandmother with four children under the age of seven.

‘My mum, who is in her 50s, began having colonoscopies in her mid-20s to check for early signs of the disease, as did her siblings. She had a DNA test organised by the bowel clinic last year, which flagged-up an anomaly.

‘Research into genes for bowel cancer is at an early stage, so they don’t know how significant these anomalies are, but she’s now been told to have a colonoscopy every year, rather than every five years as she did before.

‘I had my first colonoscopy a month ago. It didn’t show anything of concern and I have an appointment mid-October when I’ll find out how often I’ll need to be checked out.

‘The actual feeling of the colonoscopy was pretty uncomfortable at times, however I chose not to have any sedation because I was driving myself home, and just

used oxygen.

‘All the staff were amazing though, and made me feel at ease.

‘I’ve mentioned it to a few of my friends that I’ve had one. I have no fear of talking about cancer or colonoscopies.

‘Most people you speak to theses days have had some sort of contact with cancer so are able to talk about their experiences quite openly.

‘I also do lots of exercise, including indoor rock climbing once a week, yoga three times a week and running at least twice a week.

‘And this week, I took part in a sponsored 30-mile walk for the charity Bowel And Cancer Research to raise money for vital research.

‘So far, I have been lucky enough to remain cancer-free, and I’m determined to keep living life to the full.’   

KNOW THE SIGNS: ARE YOU AT RISK? 

There is strong evidence that lifestyle plays a role in bowel cancer, but there are other risk factors that we can do little about. That doesn’t mean you should put your head in the sand, though. 

Knowing your family history and whether or not you’ve had other illnesses that raise the risk of the disease are key to vigilance.

• Be aware of any family history of bowel cancer. Your risk is doubled if one of your parents, a sibling or one of your children has had the disease – and is four times higher if at least two first degree relatives has received a diagnosis. A close family member being diagnosed under the age of 45 also ups your chance of the disease, and if you tick these boxes you should be referred to bowel cancer family clinic for advice and monitoring.

People with type 2 diabetes are also at an increased risk, although we don’t know why

• If there is a history of endometrial (womb), ovarian, stomach, pancreas and bladder cancers, then you should discuss this with your GP who may again refer you to a specialist as above. 
• As with many cancers, the older you are, the higher your risk of bowel cancer – especially if you are over 50. While around one in 20 people develop bowel cancer, 90 per cent of these cases are in those aged over 60. Cancer is caused when damaged cells multiply out of control. As we get older our cells are more likely to become damaged which is why the chance of getting cancer in general increases as you get older.
• If you are one of the 300,000 in the UK with inflammatory bowel disease, which covers the chronic conditions Crohn’s disease and ulcerative colitis, then you are at higher risk of developing bowel cancer after having it for a number of years.
• Around four per cent of bowel cancers are caused by a inherited disorder called Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), which significantly increases the risk of developing colorectal and other cancers.
• Suffering from other forms of cancer previously, such as prostate, breast, bladder, womb, oesophageal, cervical, kidney, head and neck or lymphoma, increases your risk.
• People with type 2 diabetes are also at an increased risk, although we don’t know why. 
• Those who are Afro-Caribbean have a high incidence rate while Ashkenazi Jews have one of the highest bowel cancer risks of any ethnic group in the world.