Colorectal cancer surge tied to industrial food systems and delayed care: Lancet Commission calls for systemic prevention over late-stage intervention

Indigenous healing systems globally emphasize dietary balance, seasonal eating, and plant-based therapies to prevent colorectal cancer, yet these are dismissed as 'alternative' rather than foundational to systemic health. Traditional diets rich in fiber, fermented foods, and phytonutrients (e.g., millet in Africa, seaweed in Japan) show protective effects against colorectal cancer, but industrial monocultures have eroded these practices. Indigenous land stewardship, which maintains biodiversity critical for medicinal plants, is also undermined by agribusiness expansion.

The global rise in colorectal cancer mirrors the 20th-century shift from whole-food diets to processed foods, accelerated by post-WWII agribusiness consolidation and the Green Revolution’s emphasis on high-yield, low-nutrient crops. Colonial food systems imposed starchy, low-fiber diets on colonized populations, laying groundwork for later health disparities. The late 20th century also saw the normalization of antibiotic use in livestock, disrupting human gut microbiomes—a factor now linked to colorectal cancer risk.

Cross-cultural comparisons reveal that populations with traditional diets (e.g., Mediterranean, Okinawan, or rural African) exhibit far lower colorectal cancer rates than Westernized cohorts, despite similar genetic predispositions. The Japanese experience—where colorectal cancer rates rose 4-fold after adopting Western diets—highlights the role of dietary transition in disease emergence. In contrast, communities maintaining pre-industrial diets (e.g., rural Papua New Guinea) report near-zero colorectal cancer incidence.

Epidemiological evidence links colorectal cancer to ultra-processed foods (UPFs), red/processed meats, and environmental carcinogens (e.g., glyphosate, PFAS), while fiber, whole grains, and fermented foods show protective effects. The gut microbiome’s role in colorectal cancer is increasingly recognized, with dysbiosis linked to inflammation and tumor progression. However, most research prioritizes pharmaceutical solutions (e.g., immunotherapy) over upstream interventions like dietary policy or chemical regulation.

Artistic traditions often symbolize the gut as a site of transformation and emotional processing, mirroring modern understandings of the gut-brain axis. In many cultures, colorectal cancer is framed as a 'disease of civilization,' reflecting a disconnect from natural rhythms and seasonal foods. Indigenous ceremonies (e.g., sweat lodges, fasting) are used to 'cleanse' the body, aligning with evidence on detoxification and microbiome restoration.

By 2050, colorectal cancer cases could triple without systemic dietary and environmental reforms, with the highest burdens in low-income countries adopting Westernized diets. Scenario modeling suggests that reducing UPF consumption by 50% and increasing fiber intake could avert 30% of cases globally. Climate change may exacerbate risks by reducing access to fresh produce and increasing reliance on processed foods in vulnerable regions.

Black Americans face 20% higher colorectal cancer mortality due to systemic barriers in screening access, mistrust in healthcare (rooted in historical abuses like Tuskegee), and environmental racism (e.g., proximity to industrial polluters). Indigenous communities in Canada and Australia experience delayed diagnoses due to geographic isolation and culturally insensitive healthcare systems. Low-income groups globally are disproportionately exposed to carcinogenic food additives and lack resources for preventive care.