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World J Gastroenterol. May 28, 2014; 20(20): 6055-6072
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6055
Epidemiological transition of colorectal cancer in developing countries: Environmental factors, molecular pathways, and opportunities for prevention
Faraz Bishehsari, Mahboobeh Mahdavinia, Michele Vacca, Reza Malekzadeh, Renato Mariani-Costantini
Faraz Bishehsari, Division of Gastroenterology, Robert H Lurie Comprehensive Cancer Center, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, United States
Mahboobeh Mahdavinia, Division of Allergy-Immunology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, United States
Michele Vacca, Medical Research Council-Human Nutrition Research, MRC-HNR, Cambridge CB1 9NL, United Kingdom
Michele Vacca, Institute of the Metabolic Science IMS, Cambridge CB2 0QQ, United Kingdom
Reza Malekzadeh, Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran 1411713135, Iran
Renato Mariani-Costantini, Unit of General Pathology, Aging Research Center, G. d’Annunzio University Foundation, 66100 Chieti, Italy
Renato Mariani-Costantini, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University, 66100 Chieti, Italy
Author contributions: Bishehsari F designed the outline, searched and reviewed the literature, and prepared the manuscript; Mahdavinia M and Vacca M helped in conducting the search and drafting the manuscript; Malekzadeh R reviewed and edited the final draft; Mariani-Costantini R reviewed, and revised the final draft.
Supported by Institutional NRSA, clinical oncology research training program, No. T32 CA079447 (Bishehsari F); the Associazione Italiana per la Ricerca sul Cancro (AIRC), Milan to Mariani-Costantini R; the Office for Internationalization, G. d’Annunzio University, Chieti; the Carichieti Foundation, Chieti; Ministero dell’Istruzione, dell’Università e della Ricerca (MIUR), Rome, Italy; the Fondazione Umberto Veronesi, Milan, Italy and the MRC (5PT57) to Vacca M
Correspondence to: Faraz Bishehsari, MD, PhD, Division of Gastroenterology, Robert H Lurie Comprehensive Cancer Center, Northwestern University, 303 E Superior Street, Lurie 3-250, Chicago, IL 60611, United States. faraz-bishehsari@fsm.northwestern.edu
Telephone: +1-312-5031837 Fax: +1-312-5032576
Received: September 29, 2013
Revised: February 20, 2014
Accepted: April 15, 2014
Published online: May 28, 2014
Processing time: 241 Days and 0.6 Hours
Abstract

Colorectal cancer (CRC) is one of the leading causes of cancer and cancer-related mortality worldwide. The disease has been traditionally a major health problem in industrial countries, however the CRC rates are increasing in the developing countries that are undergoing economic growth. Several environmental risk factors, mainly changes in diet and life style, have been suggested to underlie the rise of CRC in these populations. Diet and lifestyle impinge on nuclear receptors, on the intestinal microbiota and on crucial molecular pathways that are implicated in intestinal carcinogenesis. In this respect, the epidemiological transition in several regions of the world offers a unique opportunity to better understand CRC carcinogenesis by studying the disease phenotypes and their environmental and molecular associations in different populations. The data from these studies may have important implications for the global prevention and treatment of CRC.

Keywords: Colorectal cancer; Developing countries; Environment; Diet; Nuclear receptors; Gut microbiota

Core tip: This highlight addresses the rise of colorectal cancer (CRC) in the developing countries. We review the epidemiological data on the growing CRC burden in these countries, discuss the role of changing environmental risk factors, and examine preventive strategies that could contribute to control the spread of CRC. The molecular pathways of CRC and the roles of nuclear receptors and of the intestinal microbiota are discussed in the light of the current epidemiological transition.