Pediatricians play a crucial role in preventing early-onset colorectal cancer by promoting healthy diets and fiber intake among children.
Addressing early-onset colorectal cancer in pediatric practice: Prevention starts now | Image Credit: © photka - stock.adobe.com.
Colorectal cancer was once considered a disease of aging, but not anymore. Although screening has driven down rates in adults older than 50 years, the opposite is true for younger populations. By 2030, early-onset colorectal cancer (EOCRC) could account for up to 11% of colon cancers and 24% of rectal cancers, with rates in 20- to 34-year-olds expected to surge by more than 90%.1 These cancers often present at more advanced stages, with a higher risk of metastasis and poorer outcomes.
Although some cases are tied to hereditary syndromes or family history, most are not. This raises the question: Could childhood dietary choices play a role? Pediatricians don’t screen for colon cancer, but they are often the first—and sometimes only—touchpoint in shaping a child’s long-term eating habits. In this article, we examine the dietary risk factors driving this alarming trend, explore how fiber and other protective foods can reduce cancer risk, and provide practical strategies for assessing and improving your patients’ long-term colon health.
Rising rates of pediatric obesity, poor diet quality, and sedentary lifestyles may be fueling the surge in EOCRC. Excess weight in adolescence is linked to long-term inflammation, insulin resistance, and microbiome disruption, all of which contribute to carcinogenesis.2 The traditional Western diet, rich in red meat, sugar, and ultraprocessed, high-fat foods, compounds these risks. Data from one study revealed that high-fat diets nearly doubled the risk of EOCRC, and frequent fast-food consumption was tied to a 10-fold increase in risk.1
Particularly concerning is the high consumption of sugary drinks during adolescence, especially when paired with low fruit intake. Findings from one longitudinal study showed that high school students with the highest intake of sugary drinks had a greater risk of developing colorectal adenomas before 50 years of age, especially when fruit intake was low.3
Eating fiber is one of the most powerful means of supporting long-term colon health, yet it is drastically underconsumed. Results of a 2017 analysis showed that 95% of Americans, including children, fall short on its intake, with fiber being recognized as a “nutrient of concern” in the Dietary Guidelines for Americans.4,5 Young children in the United States average only 7 g to 9 g of fiber per day for toddlers and 10 g to 11.5 g for preschoolers, which is far below the recommended levels.6
Current fiber recommendations by age: The Institute of Medicine’s Dietary Reference Intake for dietary fiber is 14 g fiber/1000 kcal7:
A quick clinical shortcut: “Age + 5” provides a reasonable estimate of a child’s daily fiber needs.
Fiber classification can be complicated, but for practical purposes, focus on 2 main types: soluble and insoluble. Soluble fiber (eg, oats, beans, apples, and many vegetables) dissolves in water and forms a gel-like substance in the gut. It is easily fermented by gut bacteria and produces short-chain fatty acids, such as butyrate, which strengthen the gut lining, reduce inflammation, and help regulate immune function.8 Insoluble fiber (eg, whole grains, fibrous vegetables) adds bulk and promotes regularity.8
Together, both types promote gut motility, relieve constipation, feed beneficial bacteria, support blood glucose regulation, shorten gut transit time, and modulate inflammation.8-10 In one large prospective study, investigators found that participants who ate the most whole grains had a 16% lower risk of colorectal cancer.²
Although much of the conversation focuses on what to limit, it is equally important to highlight what to increase. A high intake of whole fruits, vegetables, legumes, whole grains, and nuts and seeds has been associated with a lower cancer risk.3 These foods are rich in anti-inflammatory and antioxidant compounds, such as β-carotene, vitamin C, vitamin E, and folate, which help regulate cell turnover and may slow cancer progression.
Translating fiber recommendations into real food can feel daunting for families. Here are 5 fiber-rich foods that are typically well accepted by children:
The rise in EOCRC is not happening in isolation; it reflects broader trends such as rising pediatric obesity, ultraprocessed diets, sugary beverage intake, and sedentary lifestyles. Because risk accumulates long before screening age, pediatricians have a unique window to intervene early. Here are a few practical questions you can weave into routine visits:
When you identify areas for improvement, focus on small, achievable changes, such as swapping 1 sugary drink for water daily, adding berries to cereal, and choosing nuts instead of chips. These conversations plant seeds that can grow into lifelong habits.
Preventing EOCRC shouldn’t start at age 45 in the gastroenterology office. It begins in the pediatrics office, where pediatricians play a key role in addressing obesity, promoting healthier diets, and encouraging greater fiber intake—one conversation at a time.
References
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