Colorectal Cancer Surges Among Young Adults, Becoming Leading Cancer Killer Under 50
A new study reveals a disturbing trend: colorectal cancer is now the leading cause of cancer death for adults under 50 in the United States, surpassing breast, lung, and other cancers that have historically posed greater threats to this age group. The findings, published Thursday in the medical journal JAMA, underscore a critical need for increased awareness, earlier screening, and a deeper understanding of the factors driving this alarming rise.
Jenna Scott, now 39, embodies this unsettling shift. She vividly remembers the joy of her pregnancy, shadowed by persistent and intense abdominal pain. Despite reporting her discomfort to doctors throughout her pregnancy, she was told it was a normal part of the process. The pain didn’t subside after giving birth, and more than a year later, Scott received a devastating diagnosis: stage 4 colon cancer. “We did a colonoscopy and when I woke up, my husband, my doctor and four nurses were in the room. The gastroenterologist said I didn’t need to send anything to pathology to know I had cancer,” Scott recounted.
Stage 4 cancer signifies the disease has metastasized, spreading from its origin to other parts of the body. In Scott’s case, the cancer had spread to her liver. “I have always been in very good shape and have been in good health. I have been an athlete all my life. I didn’t even grow up eating red meat. In an instant, my life changed completely and unexpectedly,” she said, adding, “I was in a state of disbelief because that word, ‘cancer,’ didn’t exist in my world. Cancer means death.”
The study revealed that deaths from colon and rectal cancer in individuals under 50 have increased by an average of 1.1% annually since 2005. This has propelled colorectal cancer from being the fifth leading cause of cancer death in this age group in the early 1990s to the number one position in 2023.
“We don’t know why it’s increasing,” stated Dr. Ahmedin Jemal, senior vice president of surveillance, prevention and health services research at the American Cancer Society and lead author of the study. “Mortality from the other leading causes of cancer death in young adults under age 50 is decreasing. Only mortality from colorectal cancer is increasing, but we really don’t know for sure what is contributing to this increase.”
Scott, now an advocate for the Colorectal Cancer Alliance, finds these findings deeply concerning. After years of treatment – including chemotherapy, targeted therapy, and surgery – she is currently in stable condition, but requires ongoing, indefinite treatment. “Each time I have stopped treatment, the cancer has returned and spread to other organs in my body,” she explained. Despite her ongoing battle, Scott remains hopeful, stating her goal is “to become a grandmother one day.”
Researchers analyzed data from the National Center for Health Statistics of the U.S. Centers for Disease Control and Prevention, spanning from 1990 to 2023, to arrive at these conclusions. The analysis revealed that between 1990 and 2023, over 1.2 million people in the United States died of cancer before turning 50, with the overall cancer death rate declining by 44% during that period. However, this decline was not observed for colorectal cancer.
In 2023, the top five causes of cancer death among those under 50 were: colorectal cancer, breast cancer, brain cancer, lung cancer, and leukemia. “We did not expect colorectal cancer to reach this level so quickly, but it is now clear that it can no longer be called a disease of the elderly,” Jemal emphasized. “We must redouble our research efforts to determine what is causing this tsunami of cancer in generations born since 1950.” He added that individuals aged 45 to 49 account for half of all diagnoses in those under 50, highlighting the importance of increased screening in this age group.
Scott expressed her frustration and concern, questioning, “What needs to happen to bring more attention to this disease and the people who suffer from it the most today? Why do seemingly healthy adults and children continue to die from this disease? Why are women increasingly affected? How can you prevent something when neither you nor your team of doctors know how you contracted it?” She concluded with a plea: “We have to stop this increase in mortality.”
Approximately 60 new cases of colorectal cancer are diagnosed each day in the United States among individuals under 50 – roughly one diagnosis every 25 minutes, according to the Colorectal Cancer Alliance. Current recommendations suggest that individuals with average risk factors should begin regular colorectal cancer screenings at age 45. However, only 37% of adults aged 45 to 49 are up to date with these screenings, according to Jemal.
“Colorectal cancer screening not only identifies cancer in early stages, but also removes polyps before they turn into cancer,” Jemal explained. “So, it’s one of two types of screening tests we have that not only detect cancer early, but also prevent it, the other being cervical cancer screening.”
Dr. Y. Nancy You, a professor at the University of Texas MD Anderson Cancer Center and director of its Early Onset Colorectal Cancer Program, described the research as “timely” and a “red flag.” While emphasizing the critical role of screening in healthy young adults, she also noted a significant gap in quickly diagnosing and treating individuals already experiencing symptoms.
Common symptoms of colorectal cancer include blood in stool or rectal bleeding, unexplained changes in bowel habits (diarrhea, constipation, or narrowing of stool lasting more than a few days), persistent abdominal pain or cramps, weakness, fatigue, unintentional weight loss, and a persistent feeling of fullness. Dr. You explained that many young adults either ignore these symptoms or encounter healthcare providers who initially attribute them to less serious conditions like hemorrhoids, leading to delays in diagnosis.
Delayed diagnosis often results in cancer being detected at more advanced stages (3 or 4), making treatment more challenging and reducing survival rates. Dr. Andrea Cercek, a gastrointestinal medical oncologist at Memorial Sloan Kettering Cancer Center, explained that individuals under 45 are often not screened, leading to diagnosis only after symptoms appear, and in many cases, the disease is already advanced. Over 60% of colorectal cancer patients under 50 are diagnosed at stage 3 or 4.
“In this younger group, when we see late-stage diagnoses, this is strongly associated with poorer survival,” said Christine Molmenti, an associate professor and cancer epidemiologist at Northwell Health in New York. She shared heartbreaking anecdotes of patients who were healthy and active – even completing marathons – just months before receiving a stage 4 diagnosis. “Often, young people ignore the symptoms or they are dismissed. So I think there needs to be more awareness.”
The rising incidence of colorectal cancer in young adults demands urgent attention and a renewed commitment to research, early detection, and prompt treatment to reverse this alarming trend.
