The Role of Glucosamine and Chondroitin Sulfate in the Prevention of Colorectal Cancer: A Systematic Review
Abstract
Currently, colorectal cancer is the third most common cancer in the world. Recently, glucosamine and chondroitin have gained popularity for their beneficial effects on cancer. They have already been recognized for their therapeutic role in osteoarthritis. This systematic review aims to analyze the relationship between the combined consumption of glucosamine and chondroitin and the prevention of colorectal cancer. Three databases: PubMed, Google Scholar, and Science Direct, were searched to collect relevant articles. After screening full-text articles, seven studies were included in the systematic review. The review found a supportive association between glucosamine and chondroitin and the decreased incidence of colorectal cancer. Through an anti-inflammatory effect on the cell signaling pathway, the supplementation caused a reduction in colorectal cancer occurrence. The dose, frequency of usage of the supplement, and weight of individuals, along with the use of non-steroidal anti-inflammatory drugs, also affected the efficacy. To further assess this relationship, it is necessary to conduct double-blind, randomized controls trials for the supplements in cancer prevention and further explore their safety and efficacy with different ethnicities, drugs, doses, and weight individuals.
Keywords: dietary supplements, preventive practices, disability & cancer prevention, colorectal cancer, glucosamine, chondroitin sulfate
Introduction and background
Colorectal cancer is currently the third most common cancer globally, with an alarming number of 1.9 million new cases detected in 2020 [1]. About 10% to 11% of cancers diagnosed are colorectal cancers [1]. In 2018, the highest country ranked in its incidence was Hungary consisting of 51.2% of cancer patients for both males and females combined [1]. The risk of developing colorectal cancer in men is one in 23 and one in 25 for women [2].
The cancer is present in both the colon and rectum. Though these are two separate cancers, they are often grouped because of their similarity [3]. Through the help of screening methods, colorectal cancer can be detected in the early stages [4]. According to the U.S. Preventive Services Task Force, screening of medium to high-risk individuals above the age of 45 is considered beneficial in detecting and reducing mortality of colorectal cancer [5]. It is highly recommended for individuals between the age group of 50 to 75 years [5]. A stratified analysis predicts that the risk of women and African Americans being diagnosed with late-stage colorectal cancer is significantly higher than men and Caucasians [6]. In general, those living under low socioeconomic conditions have more chances of developing colorectal cancer than individuals belonging to privileged backgrounds [6]. The gold standard for screening is coloscopy, where adenoma detection can independently predict the occurrence of colorectal cancer [7]. Also, DNA fecal testing of individuals presenting with adenomas shows a high percentage of methylated genes CDKN2A, MGMT, and MLH1 compared to individuals with no polyps that can be used to determine the risk of colorectal cancer, as shown in Figure 1. [7]. Unfortunately, metastases are present in the primary diagnosis of about 20%-25% in colon cancer patients and 18% in rectal cancer patients [8]. It is detected by the growth on the lining of the colon or rectum called polyps which can change into cancer. Adenomatous polyps are a classification of polyps considered precursors for colorectal cancer because of their high risk of dysplasia [2]. Cancers usually begin from benign neoplasms, progressing into adenocarcinomas through histological changes for polyps/serrated adenomas [9]. Colorectal cancer can be classified from 0 to IV as determined by the Union of International Cancer Control based on the size of the tumor, the extent of metastases, and the spread through lymph nodes [10]. Another classification can be done through molecular and clinical catheterization through CMS 1 to CMS 4 [11]. The treatment varies according to the stages of cancer. Stage 0 and I can be treated by a colonoscopy procedure removing the local polyp [12]. For Stage II and III, removal of part of the colon and the surrounding lymph nodes through partial colectomy is performed, and Stage III patients undergo chemotherapy [12]. Stage IV involves ablation of removal of the colon and parts of the involved organs, along with chemotherapy [12]. Adjuvant treatment such as radiation or medication may be coupled alongside the treatment in cases with high metastases [10].
Dietary supplements have been reported and studied preciously to monitor their efficacy against the prevention of colorectal cancer. Glucosamine and chondroitin are dietary supplements derived from animal products and have been used for many years in patients suffering from osteoarthritis [13]. Glucosamine is categorized as a hexosamine sugar made by humans as a building block for connective tissue elements such as glycolipids, glycoproteins, and hyaluronic acid [14]. Chondroitin Sulfate is a type of glycosaminoglycan in cartilage known for its water-absorbing properties to counteract compressive forces exerted on the cartilage [14]. Increasing popularity has been seen over the years in the use of glucosamine and chondroitin as a supplement for various reasons [15]. Although an extensive systematic quality assessment has concluded the effectiveness of their role in the prevention of osteoarthritis, their efficacy in preventing colorectal cancer has not yet been determined [16]. Because the supplements are not required to undergo official Food and Drug Administration (FDA) screening, the safety of their consumption is unclear as side effects have been reported by various consumers [17].
Some studies promote glucosamine and chondroitin as a preventative tool for serrated polyps and colorectal adenoma, considered precursor lesions to colorectal cancer [18]. The objective of the following systematic review is to explore the effect of glucosamine and chondroitin consumption on the incidence of colorectal cancer.
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