Colorectal cancer is increasingly showing up in younger adults, a trend that has brought the condition back into public focus after recent celebrity deaths at ages 48 and 43. In the U.S., cancer specialists say the disease remains more common in older age groups but that diagnoses are rising in people under 50, with the American Cancer Society estimating that more than 3,890 people under 50 will die of it this year.
An AP wellness guide anchored the discussion on colorectal cancer’s growing relevance for younger adults and on what clinicians say people can do about prevention, early detection and symptom awareness. Dr. John Marshall, of Georgetown University’s Lombardi Comprehensive Cancer Center and a medical consultant to the Colorectal Cancer Alliance, said younger adults are now part of the population his patients include more often than in past decades.
Marshall said, “We’re now starting to see more and more people in the 20-, 30- and 40-year-old range developing colon cancer. At the beginning of my career, nobody that age had colorectal cancer,” adding that the trend is “shaking us all, to be blunt.” The guide noted that while screening and early detection have contributed to progress for people 50 and older, colorectal cancer diagnoses in younger adults have been rising since the early 2000s.
The American Cancer Society forecasts that more than 158,000 colorectal cancer cases will be diagnosed in the U.S. this year. Across all ages, the society estimates colorectal cancer will remain the nation’s second leading cancer killer, behind lung cancer, with expected deaths exceeding 55,000 this year.
For prevention and risk reduction, the guide listed factors that raise risk at any age, including obesity, lack of physical activity, a diet high in red or processed meat and low in fruits and vegetables, smoking, heavy alcohol use, inflammatory bowel disease and family history of colorectal cancer. Marshall advised patients and the public to eat lots of fruits and vegetables and whole grains, while noting, “Meat’s not evil” but encouraging people to eat less of it.
The guide also emphasized warning signs and the need to act quickly when they appear. Symptoms can include blood in stool or rectal bleeding; changes in bowel habits such as diarrhea, constipation or narrowing of stool that lasts more than a few days; unintended weight loss; and cramps or abdominal pain. Marshall stressed, “Don’t ignore symptoms. Get it checked,” and said survival is far more likely when colorectal cancer is diagnosed early, before it spreads.
On screening, the guide said medical guidelines recommend that average-risk people begin screening at age 45, which some younger adults may find too late if they are higher risk. It said people known to be at higher risk should discuss whether to start earlier, and it described screening intervals based on the type of test—such as yearly stool-based tests or colonoscopies that may be done every 10 years if no problems are found, as well as a newer blood test for adults 45 and older.
The guide also pointed to uncertainty about why colorectal cancer is rising among younger adults. It said no one knows what is causing the increase, but Marshall suggested that many of his younger patients may lack common risk factors and that changes in the gut microbiome could play a role. It also noted that where cancer develops along the colon—described as starting on one side of the abdomen and swooping to the other before ending with the rectum—can influence how aggressive it is and how it is treated, with differences in tumor locations among younger versus older patients also being explored.
Finally, the AP guide noted that a recent study found that a three-year exercise program improved survival in colon cancer patients and reduced cancer recurrence. It also said the article is part of AP’s Be Well coverage and that the Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation, with the AP solely responsible for all content.