The patient described in the clinical scenario has already developed colorectal cancer and is therefore in a high risk category. He has a sedentary occupation, a poor diet, and lifestyle factors that place him at higher risk for future colorectal adenomas and cancer. He should be advised to stop smoking and limit or eliminate alcohol. He should increase his physical activity to include 30 minutes of moderate activity each day. He should also limit his calories in order to reduce his body mass index and abdominal girth to normal. Dietary recommendations would limit red meat, especially processed and charred red meat. He should increase his dietary fiber from diet to improve his constipation. This might lower his risk for colorectal neoplasia although the information is equivocal. His intake of calcium should be increased to at least the recommended daily allowance for men, namely 1200 mg per day. This could be achieved using a supplement that also contains vitamin D. The patient should be strongly encouraged to return in 1 year for a follow-up colonoscopy. However, our responsibility as physicians extends beyond reminding the patient to return for a colonoscopy. We should make sure that the patient understands that maintaining ideal body weight, exercising, and stopping smoking are important to promote good general health. These interventions can lower the risk of heart disease, stroke, and diabetes, as well as colorectal cancer. It would be unfortunate if we cured his colorectal cancer but ignored risk factors for other important and potentially fatal chronic diseases. © 2010 AGA Institute.
Sandler, R. S. (2010). Dietary and Lifestyle Measures to Lower Colorectal Cancer Risk. Clinical Gastroenterology and Hepatology, 8(4), 329–332. https://doi.org/10.1016/j.cgh.2009.10.031