The first step in detection of all gynecologic cancers is a basic gynecologic exam.  Please join me in supporting #checkMeUp which simply asks that annual exams be available for all women.  Many countries might take this for granted but in the UK, we must fight for earlier cancer detection and regular basic exams.  Click on the image or link to be taken to the petition page, and hopefully also make a donation.  

Ovarian cancer is one example of why annual pelvic exams are important.  It's also important for endometrial and cervical cancers, as well as more common benign conditions like fibroids, ovarian cyst, endometriosis, and PCOS.  If there is any concern, transvaginal ultrasound can help (but not for cervical cancer). 

  Ovarian cancer is the sixth most common cancer among women after breast , bowel, lung,uterus (endometrium) and melanoma skin cancer.  There are more than 7,000 new cases of ovarian cancer diagnosed every year in the UK.    It is most common in post -menopausal women, although it can affect women of any age.    The earlier ovarian cancer is diagnosed and treated, the better the chance of a cure.  However,  it's often not recognised until it's already spread and a cure is not possible.   More than 70% of them are diagnosed at an advanced stage when the cancer has already spread.   

Ovarian cancer begins in the ovary or the fallopian tube.  The fallopian tube plays a very interesting role, probably in transport of inciting agents  originating from the outside world through the vagina, cervix and uterus

Your risk of developing ovarian cancer depends on many things including age, genetics, lifestyle and environmental factors.   Of interest, it appears that the environment of the vagina and vulva affect the risk of ovarian cancer (for example, talc powder, or unhealthy vaginal bacteria).   Inciting agents could travel through the cervix, uterus and fallopian tubes to reach the ovary or distal fallopian tube.  This suggests that the ascending pathway is an important conduit for ovarian cancer.   Conversely, tubal ligation (having tubes tied) or even hysterectomy may be protective by eliminating this potential path.   The following factors can increase the risk of ovarian cancer: 

As with most cancers, the risk of developing ovarian cancer increases with age. More than 80% of ovarian cancer occur in women who are over 50 years of age.

The risk of ovarian cancer increases with lifetime ovulation.   Every time an egg is released, the surface of the ovary ruptures to let it out. The surface of the ovary is damaged during this process and needs to be repaired. Each time this happens, there’s a greater chance of abnormal cell growth during the repair.   This incessant ovulation hypothesis proposes that repeated damage and repair to the ovarian surface increases ovarian cancer risk.  This may be why the risk of ovarian cancer decreases if you take the contraceptive pill, or have multiple pregnancies or periods of breastfeeding as eggs aren’t released during this time. Women reporting menstrual cycle length >35 days had decreased risk of invasive ovarian cancer compared with women reporting cycle length ≤35 days [OR = 0.70; 95% confidence interval (CI) = 0.58-0.84]. Decreased risk of invasive ovarian cancer was also observed among women who reported irregular menstrual cycles compared with women with regular cycles (OR = 0.83; 95% CI = 0.76-0.89)   However, other studies have observed increased risks of ovarian cancer among women with oligomenorrhea.  Hormonal alterations in women with oligomenorrhea including elevated androgen levels, a common characteristic of women with PCOS, have been hypothesized to explain this increased ovarian cancer risk.

Between 5 and 15 out of 100 ovarian cancers (5 to 15%) are caused by an inherited faulty gene. Inherited genes that increase the risk of ovarian cancer include faulty versions of BRCA1 and BRCA2 (see below). Faults in these genes also increase the risk of breast cancer.

You have an increased risk of ovarian cancer if you've had breast cancer in the past. The risk is higher in women diagnosed with breast cancer at a younger age, and those with oestrogen receptor negative (ER negative) breast cancer.Women who had bowel cancer at a young age have an increased risk of ovarian cancer compared to the general population.The increase in risk of ovarian cancer after previous cancer is likely to be partly due to inherited faulty genes such as BRCA 1 and 2, and Lynch syndrome.

Using HRT after the menopause increases the risk of ovarian cancer. In the UK, 4 in 100 (4%) ovarian cancers are linked to hormone replacement therapy (HRT) use. Remember that the increase in risk is small and HRT is helpful for many women with menopausal symptoms. Talk to your GP about the risks and benefits of taking HRT.

Recently, the type of bacteria in the vagina have been found to be associated with ovarian cancer.  Levels of the friendly bacteria Lactobacilli were significantly lower in women with ovarian cancer or with BRCA1 gene mutations. The investigators believe that the balance of bacteria (known as a microbiome) in the vagina could provide a protective barrier to infections, stopping harmful bacteria from reaching the fallopian tubes and ovaries.

Smoking can increase the risk of certain types of ovarian cancer such as mucinous ovarian cancer. The longer you have smoked, the greater the risk.

Interestingly, use of talc powder has also been associated with ovarian cancer.  

Studies have shown that women with endometriosis or diabetes have an increased risk of ovarian cancer.   Endometriosis may increase your risk of a rare sub- type of peritoneal cancer (a rare type of ovarian cancer).  

Having excess body fat is linked to an increase in risk of ovarian cancer.  In diabetics, the increase in risk might be higher in those that use insulin.

Taking the combined contraceptive pill at some point in your life reduces your risk of cancer of the ovary. Research has shown that the longer you take the pill, the more your risk is thought to be reduced. The reduction in risk lasts for tens of years after you stop taking the pill.

Having children seems to reduce the risk of ovarian cancer. The more children you have, the lower the risk. Breastfeeding also reduces the risk of ovarian cancer.This reduction in risk may be because while you are pregnant or breastfeeding you're not ovulating (releasing eggs). The fewer times you ovulate in your lifetime the lower the risk of ovarian cancer. 

Having your tubes tied is called tubal ligation.  Studies have found that tubal ligation substantially lowers a woman's risk of ovarian cancer. Some suspect the reason may be that tubal ligation cuts off the ovaries' exposure to outside environmental factors that may increase the risk of ovarian cancer.  

Until recently, most research has shown that having your womb removed (hysterectomy) may also reduce your risk of ovarian cancer. But this has become less clear in recent years and might depend on several factors including your age when you had the operation. Any reduction in risk may be greater for younger women. Researchers continue to study this area. 

Stories about potential causes are often in the media and it isn’t always clear which ideas are supported by evidence. There might be things you have heard of that we haven’t included here. This is because either there is no evidence about them or it is less clear.

 

If ovarian cancer symptoms are identified and the cancer diagnosed at an early stage, the outcome is more optimistic. However, because some of the symptoms of ovarian cancer are often the same as for other less serious conditions, such as irritable bowel syndrome (IBS) or pre-menstrual syndrome (PMS), it can be difficult to recognise the symptoms in the early stages – which is why most women are not diagnosed until the disease has spread.However, there are four main ovarian cancer symptoms that are more prevalent in women diagnosed with the condition. They are:

• increased abdominal size and persistent bloating (not bloating that comes and goes)
• persistent pelvic and abdominal pain
• unexplained change in bowel habits
• difficulty eating and feeling full quickly, or feeling nauseous

Other symptoms, such as back pain, needing to pass urine more frequently than usual, and pain during sex may be present in some women with the disease; however, it is most likely that these are not symptoms of ovarian cancer but may be the result of other conditions in the pelvic area.   .

Ultrasound and genetic markers remain the best hope for detection.  CA125 levels can also be followed but are considered less reliable than ultrasound. 

A BRCA mutation is a mutation in either of the BRCA1 and BRCA2 genes, which are tumour suppressor genes. Hundreds of different types of mutations in these genes have been identified, some of which have been determined to be harmful, while others have no proven impact.
Having relatives with ovarian cancer does not necessarily mean that you have a faulty inherited gene in the family. The cancers could have happened by chance. But women with a mother or sister diagnosed with ovarian cancer have around 3 times the risk of ovarian cancer compared to women without a family history.If you have two or more close relatives (mother, sister or daughter) who developed ovarian cancer or breast cancer, your risk of also developing the condition may be increased.If your relatives developed cancer before the age of 50, it’s more likely it was the result of an inherited faulty gene.You may be at a high risk of having a faulty gene if you have:

1. One relative diagnosed with ovarian cancer at any age and at least two close relatives with breast cancer whose average age is under 60; or alternatively at least one close relative with breast cancer under the age of 50. All of these relatives should be on the same side of your family (either your mother’s OR father’s side)
2. Two relatives from the same side of the family diagnosed with ovarian cancer at any age.

MYC gene

MYC proto-oncogene, bHLH transcription factorThis gene is a proto-oncogene and encodes a nuclear phosphoprotein that plays a role in cell cycle progression, apoptosis and cellular transformation. The encoded protein forms a heterodimer with the related transcription factor MAX. This complex binds to the E box DNA consensus sequence and regulates the transcription of specific target genes. Amplification of this gene is frequently observed in numerous human cancers 

The most common benign tumor of the ovary.  Not cancerous.

A dermoid, or dermoid cyst grows from primitive embryonal cells.  Most dermoids are entirely asymptomatic- women are not aware they have them.   They are usually discovered during a pelvic exam or a pelvic ultrasound performed for other reasons.  However, some tumors, like dermoids, may be associated with pelvic pain if they cause torsion, or partial torsion of the ovary.  

Mural nodules are very suspicious

  From TeachMeObgyn.com  Also see blog post 

Endometrial cancer is the fourth most common cancer affecting women in the UK, and the most common gynaecological cancer in the developed world.The incidence of this malignancy has risen by approximately 40% over the past 20 years – which has been attributed to an increase in obesity during this time period.In the UK, the peak incidence of endometrial cancer is between 65 and 75 years of age, although ~5% of women affected are under the age of 40.
The most common form of endometrial cancer is adenocarcinoma, a neoplasia of epithelial tissue that has glandular origin and/or glandular characteristics.Most cases of adenocarcinoma are caused by stimulation of the endometrium by oestrogen, without the protective effects of progesterone (termed ‘unopposed oestrogen’).Progesterone is produced by the corpus luteum after ovulation. Scenarios in which women may have experienced a longer period of anovulation are thought to predispose to developing malignancy.Unopposed oestrogen can also cause endometrial hyperplasia. This in itself is not malignancy, but can predispose to atypia, a precancerous state. 

Women who experience a prolonged period of anovulation – and therefore exposure to ‘unopposed’ oestrogen – are at a greater risk of developing endometrial cancer:

• Early menarche and/or late menopause– at the extremes of menstrual age, menstrual cycles are more likely to be anovulatory.
• Low parity – just under 1/3 of women developing endometrial cancer are nulliparous. With each pregnancy, the risk of endometrial cancer decreases.
• Polycystic ovarian syndrome – with oligomenorrhoea, cycles are more likely to be anovulatory.
• Hormone replacement therapy with oestrogen alone.
• Tamoxifen use

The peak incidence of endometrial cancer is between 65 and 75 years. Prior to the age of 45, the risk of endometrial cancer is low.

Approximately 40% of endometrial cancer cases are thought to be linked to obesity.The greater the amount of subcutaneous fat, the faster the rate of peripheral aromatisation of androgens to oestrogen – which increases unopposed oestrogen levels in post-menopausal women.

Genetic conditions that predispose to cancer, such as hereditary non-polyposis colorectal cancer (Lynch syndrome), are a risk factor for developing endometrial cancer.
 

 A transvaginal ultrasound scan is the most widely used first-line investigation. 96% of women with endometrial cancer will have an endometrial thickness of >5mm on ultrasound.If an endometrial thickness of >4mm in a postmenopausal woman is identified, an endometrial biopsy should be obtained. This can be performed at an outpatient appointment, often with a Pipelle biopsy. Histology from the biopsy can confirm the presence of hyperplasia, with or without atypia, or malignancy.If the gynaecologist deems the case high risk, such as with heavy bleeding, multiple risk factors or very thickened endometrium on ultrasound (or the patient is unable to tolerate outpatient sampling), hysteroscopy with biopsy may be performed – either as an outpatient or under anaesthetic.If the endometrium is <4mm and appears normal on ultrasound, it is reasonable to defer endometrial sampling as the risk of cancer is low. However, if they continue to have abnormal bleeding then sampling may be indicated.If malignancy is confirmed, an MRI or CT scan may be used for staging. 

Breast cancer is the most common type of cancer in the UK.

 Most women who get it (8 out of 10) are over 50, but younger women, and in rare cases, men, can also get breast cancer.

If it's treated early enough, breast cancer can be prevented from spreading to other parts of the body. 

Breast cancer is cancer that develops in breast cells. Typically, the cancer forms in either the lobules or the ducts of the breast. Lobules are the glands that produce milk, and ducts are the pathways that bring the milk from the glands to the nipple. Cancer can also occur in the fatty tissue or the fibrous connective tissue within your breast.

The uncontrolled cancer cells often invade other healthy breast tissue and can travel to the lymph nodes under the arms. The lymph nodes are a primary pathway that help the cancer cells move to other parts of the body.

In its early stages, breast cancer may not cause any symptoms. In many cases, a tumor may be too small to be felt, but an abnormality can still be seen on a mammogram. If a tumor can be felt, the first sign is usually a new lump in the breast that was not there before. However, not all lumps are cancer.

Each type of breast cancer can cause a variety of symptoms. Many of these symptoms are similar, but some can be different. Symptoms for the most common breast cancers include:

• a breast lump or tissue thickening that feels different than surrounding tissue and has developed recently
• breast pain
• red, pitted skin over your entire breast
• swelling in all or part of your breast
• a nipple discharge other than breast milk
• bloody discharge from your nipple
• peeling, scaling, or flaking of skin on your nipple or breast
• a sudden, unexplained change in the shape or size of your breast
• inverted nipple
• changes to the appearance of the skin on your breasts
• a lump or swelling under your arm

If you have any of these symptoms, it doesn’t necessarily mean you have breast cancer. For instance, pain in your breast or a breast lump can be caused by a benign cyst. Still, if you find a lump in your breast or have other symptoms, you should see your doctor for further examination and testing.

To determine if your symptoms are caused by breast cancer or a benign breast condition, your doctor will do a thorough physical exam in addition to a breast exam. They may also request one or more diagnostic tests to help understand what’s causing your symptoms.

Tests that can help diagnose breast cancer include:

• Mammogram. The most common way to see below the surface of your breast is with an imaging test called a mammogram. Many women aged 40 and older get annual mammograms to check for breast cancer. If your doctor suspects you may have a tumor or suspicious spot, they will also request a mammogram. If an abnormal area is seen on your mammogram, your doctor may request additional tests.
• Ultrasound. A breast ultrasound uses sound waves to create a picture of the tissues deep in your breast. An ultrasound can help your doctor distinguish between a solid mass, such as a tumor, and a benign cyst.

Your doctor may also suggest tests such as an MRI or a breast biopsy

From Johns Hopkins (USA) regarding 6 myths of mammograms 

Fact: The American College of Radiology recommends annual screening mammograms for all women over 40, regardless of symptoms or family history. “Early detection is critical,” says Dr. Sarah Zeb. “If you wait to have a mammogram until you have symptoms of breast cancer, such as a lump or discharge, at that point the cancer may be more advanced .” According to the American Cancer Society, early-stage breast cancer has a five-year survival rate of 99 percent. Later-stage cancer has a survival rates of 27 percent.More than 75 percent of women who have breast cancer have no family history.

Fact: “While a mammogram does use radiation, it is a very small amount and is within the medical guidelines,” says Dr. Zeb. Because mammography is a screening tool, it is highly regulated by the Food and Drug Administration, Mammography Quality and Standards Act and other governing organizations, like the American College of Radiology. A mammogram is safe as long as the facility you go to is certified by the regulating agencies. There is constant background radiation in the world that we are exposed to every day. The radiation dose from a mammogram is equal to about two months of background radiation for the average woman.

Fact: Three-dimensional mammography, or tomosynthesis, is the most modern screening and diagnostic tool available for early detection of breast cancer. Compared to a standard 2-D mammogram, a 3-D mammogram displays more images of the breast and in thin sections of breast tissue. “3-D mammograms provide us greater clarity and the ability to determine the difference between overlapping normal tissue and cancer,” says Dr. Zeb. “With 3-D mammography, the data show a 40 percent increase in detecting early cancer and a 40 percent decrease in false alarms or unnecessary recalls from screening.”

Fact: “While annual mammograms are very important for women, there are limitations,” says Dr. Zeb. This is mostly due to dense breast tissue — the denser the breast, the more likely it is that a cancer will be hidden by the tissue. “Normal breast tissue can both hide a cancer and mimic a cancer,” says Dr. Zeb. In addition to an annual mammogram other imaging methods including a breast ultrasound and a breast MRI can be used for women with dense breast tissue.

Fact: Mammography is detection, not prevention. “Having a normal mammogram is great news, but it does not guarantee that future mammograms will be normal,” says Dr. Zeb. "Having a mammogram every year increases the chance of detecting the cancer when it is small and when it is most easily treated which also improves survival."

Fact: You do not need your doctor to write you a prescription or complete an order form for you to have a screening mammogram. “The recommendation is that if you are a woman from age 40 on, you should have a mammogram every year, even if your doctor forgets to mention it,” says Dr. Zeb. Women can self-refer to make an appointment for their annual mammogram for earlier detection of breast cancer.

Breast BiopsyBreast ScanBreast Self-AwarenessBreast Ultrasound

Dr Nora Pashayan, from University College London, said: "Breast cancer screening prevents deaths from breast cancer in some women. On the other hand, not all cancers picked up by screening would result in death prevention and others won't be picked up by screening at all."  

NHS

 Screening for breast cancer with mammograms shows a big difference in the U.S. and U.K.  In the US, yearly screening is recommended after age 40.  In the UK, screening is recommended every 3 years for women age 50-70.

Prostate cancer on a site devoted to women?  This is for your partner or loved ones. 

The risk of developing prostate cancer increases with age, but that doesn’t mean it’s a disease that only affects old men. Prostate cancer is the second most common cancer in men worldwide. Men who are black, and men who have a family history (a brother or father with prostate cancer), are 2.5x more likely to get prostate cancer.

• A need to urinate frequently, especially at night
• Difficulty starting urination or holding back urine
• Weak or interrupted flow of urine
• Painful or burning urination
• Difficulty in having an erection
• Painful ejaculation
• Blood in urine or semen
• Frequent pain or stiffness in the lower back, hips, or upper thighs

When detected early, prostate cancer survival rates are better than 98%. Find it late, and those survival rates drop below 26%.

If you’re 50, you should be talking to your doctor about PSA testing. If you’re black, you need to start that conversation at 45. And if you have a brother or father with prostate cancer in their history, do it at 45.

The PSA test is a blood test used primarily to screen for prostate cancer.

The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below the bladder in men.

PSA is mostly found in semen, which also is produced in the prostate. Small amounts of PSA ordinarily circulate in the blood.

The PSA test can detect high levels of PSA that may indicate the presence of prostate cancer. However, many other conditions, such as an enlarged or inflamed prostate, can also increase PSA levels. Therefore, determining what a high PSA score means can be complicated.

There is a lot of conflicting advice about PSA testing. To decide whether to have a PSAtest, discuss the issue with your doctor, considering your risk factors and weighing your personal preferences.

Prostate cancer is common, and a frequent cause of cancer death. Early detection may be an important tool in getting appropriate and timely treatment.

Men with prostate cancer may have elevated levels of PSA. However, many noncancerous conditions also can increase the PSA level. The PSA test can detect high levels of PSA in the blood but doesn't provide precise diagnostic information about the condition of the prostate.

Results of PSA tests are reported as nanograms of PSA per milliliter of blood (ng/mL). There's no specific cutoff point between a normal and abnormal PSA level. Your doctor might recommend a prostate biopsy based on results of your PSA test.

Your doctor might use other ways of interpreting PSA results before deciding whether to order a biopsy to test for cancerous tissue. These other methods are intended to improve the accuracy of the PSA test as a screening tool.

Researchers continue to investigate variations of the PSA test to determine whether they provide a measurable benefit.

Variations of the PSA test include:

• PSA velocity. PSA velocity is the change in PSA levels over time. A rapid rise in PSA may indicate the presence of cancer or an aggressive form of cancer. However, recent studies have cast doubt on the value of PSA velocity in predicting a finding of prostate cancer from biopsy.
• Percentage of free PSA. PSA circulates in the blood in two forms — either attached to certain blood proteins or unattached (free). If you have a high PSA level but a low percentage of free PSA, it may be more likely that you have prostate cancer.
• PSA density. Prostate cancers can produce more PSA per volume of tissue than benign prostate conditions can. PSA density measurements adjust PSA values for prostate volume. Measuring PSA density generally requires an MRI or transrectal ultrasound.

NHS

There is an informed choice programme, called prostate cancer risk management, for healthy men aged 50 or over who ask their GP about PSA testing. It aims to give men good information on the pros and cons of a PSA test.

If you're a man aged 50 or over and decide to have your PSA levels tested, you can have it performed for free through the NHS.

Other Tests

The PSA test is only one tool used to screen for early signs of prostate cancer. Another common screening test, usually done in addition to a PSA test, is a digital rectal exam.

Neither the PSA test nor the digital rectal exam provides enough information for your doctor to diagnose prostate cancer. Abnormal results in these tests may lead your doctor to recommend a prostate biopsy.

During this procedure, samples of tissue are removed for laboratory examination. A diagnosis of cancer is based on the biopsy results.

From the Mayo Clinic

Colon cancer is a type of cancer that begins in the large intestine (colon). The colon is the final part of the digestive tract.

Colon cancer typically affects older adults, though it can happen at any age. It usually begins as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time some of these polyps can become colon cancers.

Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying and removing polyps before they turn into cancer.

If colon cancer develops, many treatments are available to help control it, including surgery, radiation therapy and drug treatments, such as chemotherapy, targeted therapy and immunotherapy.

Colon cancer is sometimes called colorectal cancer, which is a term that combines colon cancer and rectal cancer, which begins in the rectum.

Signs and symptoms of colon cancer include:

• A persistent change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
• Rectal bleeding or blood in your stool
• Persistent abdominal discomfort, such as cramps, gas or pain
• A feeling that your bowel doesn't empty completely
• Weakness or fatigue
• Unexplained weight loss

Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in your large intestine.

Doctors aren't certain what causes most colon cancers.

In general, colon cancer begins when healthy cells in the colon develop changes (mutations) in their DNA. A cell's DNA contains a set of instructions that tell a cell what to do.

Healthy cells grow and divide in an orderly way to keep your body functioning normally. But when a cell's DNA is damaged and becomes cancerous, cells continue to divide — even when new cells aren't needed. As the cells accumulate, they form a tumor.

With time, the cancer cells can grow to invade and destroy normal tissue nearby. And cancerous cells can travel to other parts of the body to form deposits there (metastasis).

Factors that may increase your risk of colon cancer include:

• Older age. Colon cancer can be diagnosed at any age, but a majority of people with colon cancer are older than 50. The rates of colon cancer in people younger than 50 have been increasing, but doctors aren't sure why.
• African-American race. African-Americans have a greater risk of colon cancer than do people of other races.
• A personal history of colorectal cancer or polyps. If you've already had colon cancer or noncancerous colon polyps, you have a greater risk of colon cancer in the future.
• Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn's disease, can increase your risk of colon cancer.
• Inherited syndromes that increase colon cancer risk. Some gene mutations passed through generations of your family can increase your risk of colon cancer significantly. Only a small percentage of colon cancers are linked to inherited genes. The most common inherited syndromes that increase colon cancer risk are familial adenomatous polyposis (FAP) and Lynch syndrome, which is also known as hereditary nonpolyposis colorectal cancer (HNPCC).
• Family history of colon cancer. You're more likely to develop colon cancer if you have a blood relative who has had the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater.
• Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a typical Western diet, which is low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meat.
• A sedentary lifestyle. People who are inactive are more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer.
• Diabetes. People with diabetes or insulin resistance have an increased risk of colon cancer.
• Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight.
• Smoking. People who smoke may have an increased risk of colon cancer.
• Alcohol. Heavy use of alcohol increases your risk of colon cancer.
• Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers increases the risk of colon cancer.
• Vitamin D deficiency.  in 1980, Garland and Garland first proposed a link between cancer and vitamin D from observations of higher colon cancer mortality in higher latitudes and areas with less solar radiation.  This has been confirmed by multiple studies. 

Doctors recommend that people with an average risk of colon cancer consider colon cancer screening around age 50. But people with an increased risk, such as those with a family history of colon cancer, should consider screening sooner.Several screening options exist — each with its own benefits and drawbacks. Talk about your options with your doctor, and together you can decide which tests are appropriate for you.

You can take steps to reduce your risk of colon cancer by making changes in your everyday life. Take steps to:

• Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may play a role in cancer prevention. Choose a variety of fruits and vegetables so that you get an array of vitamins and nutrients.
• Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount of alcohol you drink to no more than one drink a day for women and two for men.
• Stop smoking. Talk to your doctor about ways to quit that may work for you.
• Exercise most days of the week. Try to get at least 30 minutes of exercise on most days. If you've been inactive, start slowly and build up gradually to 30 minutes. Also, talk to your doctor before starting any exercise program.
• Maintain a healthy weight. If you are at a healthy weight, work to maintain your weight by combining a healthy diet with daily exercise. If you need to lose weight, ask your doctor about healthy ways to achieve your goal. Aim to lose weight slowly by increasing the amount of exercise you get and reducing the number of calories you eat.
• Maintain Vitamin D levels.  Vitamin D deficiency is highly associated with colon cancer.  Keep vitamin D levels above 30 ng/ml and ideally above 40 

Some medications have been found to reduce the risk of precancerous polyps or colon cancer. For instance, some evidence links a reduced risk of polyps and colon cancer to regular use of aspirin or aspirin-like drugs. But it's not clear what dose and what length of time would be needed to reduce the risk of colon cancer. Taking aspirin daily has some risks, including gastrointestinal bleeding and ulcers.These options are generally reserved for people with a high risk of colon cancer. There isn't enough evidence to recommend these medications to people who have an average risk of colon cancer.If you have an increased risk of colon cancer, discuss your risk factors with your doctor to determine whether preventive medications are safe for you. 

People with some conditions have a higher risk of getting bowel cancer at a younger age than usual. They might have screening earlier than the normal NHS bowel cancer screening programme. 

. 

If you are not in a high risk group 

There's no NHS screening available outside the age range covered by the UK bowel cancer screening programmes if you don't have a higher than average risk of bowel cancer.