Colorectal cancer has become the leading cause of cancer death among Americans under 50, with the increase driven almost entirely by adults without a four-year college degree, according to a modern analysis of government data spanning three decades.
Researchers from the American Cancer Society examined more than 101,000 deaths from colon and rectal cancer in adults aged 25 to 49 between 1994 and 2023. Over that period, the overall death rate rose from about 3 to 4 per 100,000 people in this age group.
But the increase was not uniform. Among those with at least a bachelor’s degree, death rates remained stable at approximately 2.7 per 100,000. In contrast, rates for adults with a high school education or less climbed from 4 to 5.2 per 100,000 — nearly doubling the gap between the two groups since the mid-1990s.
The study, published in JAMA Oncology, is the first national analysis to reveal that the rise in early-onset colorectal cancer mortality is concentrated in less-educated populations. Experts emphasize that a college degree itself is not protective; rather, it serves as a marker for broader socioeconomic advantages.
People without degrees are more likely to work in jobs lacking health insurance or paid sick leave, delaying preventive care. They also face higher exposure to environmental pollutants, limited access to nutritious food and recreational spaces, and elevated rates of smoking and chronic stress — all established risk factors for colorectal cancer.
For more on this story, see 2026 ESMO Guidelines for Metastatic Colorectal Cancer: A Precision Oncology Approach.
Ahmedin Jemal, the study’s lead author, said the findings highlight the urgent demand for increased awareness and adherence to screening guidelines among younger adults. Symptoms such as rectal bleeding, persistent changes in bowel habits, unexplained weight loss, and abdominal pain should prompt medical evaluation.
The American Cancer Society estimates more than 158,000 new colorectal cancer cases will be diagnosed in the U.S. In 2026, with over 55,000 deaths expected. Nearly half of these cases will occur in people under 65 — a significant shift from the 1990s, when the disease predominantly affected older adults.
In response to the rising burden, the organization lowered the recommended starting age for routine screening from 50 to 45 in 2021. Despite this, screening rates among younger adults remain suboptimal, particularly in underserved communities.
This follows our earlier report, Colorectal Cancer Screening and Early Detection in Puerto Rico.
Why are colorectal cancer deaths rising faster among less-educated young adults?
Researchers link the disparity to systemic barriers including limited healthcare access, lower health literacy, higher exposure to environmental risks, and lifestyle factors such as diet and smoking — not the absence of a degree itself.
What symptoms should prompt younger adults to seek medical evaluation for colorectal cancer?
Warning signs include blood in the stool, lasting changes in bowel habits (such as diarrhea or constipation), unexplained weight loss, and persistent abdominal cramps or pain.
