Young Adults Face Alarming Rise in Colorectal Cancer Deaths

A Disturbing Trend Emerges

Colorectal cancer has become the leading cause of cancer-related death among Americans under 50 , marking a dramatic shift from decades past. This represents a significant increase from the 1990s, when it was the fifth deadliest cancer in this age group . The statistics paint a sobering picture: one in five people diagnosed with colorectal cancer are now under the age of 55 , and since the mid-1990s, there has been a consistent annual increase of 2% in cases among adults aged 20-39 .

The trend has caught medical professionals off guard. While overall cancer mortality decreased by 44% in people younger than 50 between 1990 and 2023, colorectal cancer increased by 1.1% each year since 2005, climbing from the fifth leading cause of cancer deaths to the first . This rise isn't limited to the United States either - early-onset colorectal cancer incidence rates are rising in 27 of 50 countries and territories examined globally .

In the early 2000s, about 5% to 7% of colon cancer diagnoses were considered early onset, but now around 10% of diagnoses happen in people younger than 50 . What makes this particularly concerning is that unlike older adults who may be diagnosed through routine screening, most younger people notice symptoms first .

The Screening Response Shows Promise

Medical organizations have responded to this alarming trend by lowering screening recommendations. In 2018, the American Cancer Society updated its guidelines to recommend screening starting at age 45, and in 2021, the US Preventive Services Task Force also lowered the recommended age from 50 to 45 . The results have been encouraging: colorectal cancer screening among U.S. adults 45-49 years of age increased by 62% from 2019 to 2023 .

This increased screening is paying dividends in early detection. After a stable 15-year trend, diagnoses of local-stage colorectal cancer rose steeply in adults aged 45-49 during 2019 to 2022, including a 50% relative increase from 2021 to 2022 . The five-year survival rate for colorectal cancer in early stages is above 90% , making this early detection crucial for saving lives.

However, significant gaps remain. More than half of people diagnosed with colorectal cancer before 50 are not eligible for screening because they haven't reached the recommended age of 45 , and many who are eligible still haven't been screened.

Understanding the Risk Factors

While researchers haven't identified a single cause for the rise, several factors appear to contribute. Experts believe a sedentary lifestyle, lack of exercise and increased consumption of processed foods and red meat are all at play . High intake of sugary drinks and processed foods in adolescence and young adulthood has been linked to greater early-onset colon cancer risk .

The gut microbiome has emerged as another area of concern. Many researchers are focusing on the gut microbiome, an ecosystem of microorganisms that helps digest food. When these microbes are out of balance—a condition called dysbiosis—this causes disruption that allows for inflammation and increased cancer risk . Using antibiotics, especially early in life, may disrupt the gut microbiome, increasing long-term cancer risk .

Having a first-degree relative with colon cancer increases your risk by more than four times , though in about 20% of people with early-onset colon cancer, a genetic condition is the underlying cause, but most people diagnosed have no such condition .

Recognizing Warning Signs

Young adults need to be aware of symptoms that warrant medical attention. The most common signs for early-onset colorectal cancer are blood in the stool, abdominal pain and a change in bowel habits, or any combination of these conditions . Unexplained anemia, or low red blood cell levels, is another potential symptom .

Many colorectal cancers develop silently, without obvious symptoms, and by the time symptoms appear, the disease may already be advanced . This underscores why age alone should never be a reason to delay evaluation when warning signs exist .