Colorectal cancer is now the leading cause of cancer deaths for Americans under 50, and rates continue to climb at nearly 3 percent annually.
A Rising Tide of Early-Onset Cancer
Table of Contents
The incidence of cancer in younger adults is increasing, demanding a shift in how we approach detection and treatment.
- Over the past three decades, researchers have observed a global rise in early-onset cancer.
- While overall cancer survival rates have improved, colorectal cancer rates are increasing in young adults.
- New multi-cancer early detection (MCED) tests offer potential, but require further validation.
- A proactive approach, including lifestyle assessments and genetic risk scoring, is crucial.
Fifteen months ago, the growing trend of early-onset cancer was beginning to surface as more than just isolated cases. For years, researchers, scientists, and healthcare professionals had been monitoring a concerning increase in cancer diagnoses among younger people. Initial reports in medical journals like Nature, The New England Journal of Medicine, and The Lancet were sporadic, but the pattern was becoming undeniable.
From 2005 to 2011, early warnings appeared in mainstream media outlets such as The Wall Street Journal and The New York Times, often framed as tragic anomalies. A 2017 study published by the American Cancer Society (ACS) marked a turning point, shifting the narrative from “anecdotal” to “epidemic.” The 2020 death of actor Chadwick Boseman, who was 43 when diagnosed with colorectal cancer, brought the issue into sharper public focus. That loss resonated deeply, occurring just one month before the author’s son, Patrick, passed away at age 32, and was later featured in a Wall Street Journal article in January 2024.
The Shifting Landscape of Cancer Statistics
Since then, publications like Time magazine and The Economist, along with major news organizations, have covered the increasing incidence of cancer in younger adults. The recently released ACS report Cancer Statistics, 2026 presents a complex picture. Overall, five-year survival rates have risen from 50 percent to 70 percent since the mid-1970s—a 40 percent increase and a significant achievement.
However, this progress is overshadowed by a disturbing trend: colorectal cancer rates and deaths are still rising in young people. For adults under 50, incidence rates are climbing nearly 3 percent per year, an acceleration from the 1 to 2 percent annual increase reported in the previous decade. Alarmingly, colorectal cancer is now the leading cause of cancer-related deaths in this age group.
A recent JAMA Research Letter titled “Leading Cancer Deaths in People Younger Than 50 Years” visually illustrates this trend. The graph depicting colorectal cancer mortality rates from 1990 to 2023 shows a stark upward trajectory. The line representing CRC stands out as a striking red streak, while the lines for other cancers are in decline.
This trend is particularly concerning because young patients are more likely to be diagnosed with advanced (stage III–IV) disease, making treatment more challenging.
The Need for Proactive Solutions
The U.S. House of Representatives recently passed the bipartisan Nancy Gardner Sewell Medicare Multi‑Cancer Early Detection Screening Coverage Act (H.R. 842), a significant step toward enabling Medicare to consider coverage of multi‑cancer early detection (MCED) tests. This is the furthest this bill has progressed in the legislative process, but it still requires final approval.
While promising, these diagnostic tests face hurdles to widespread adoption. Some researchers argue that rigorous data from large-cohort clinical trials are needed to prove their effectiveness before they can be routinely used in primary care. This debate between those prioritizing epidemiological rigor and advocates for early detection is likely to intensify.
However, waiting for years for gold-standard Randomized Controlled Trials (RCTs) is a luxury we cannot afford. Historically, it takes an average of 17 years for clinical trial evidence to translate into widespread clinical practice. MCED tests offer a valuable opportunity to reach “screening-refusers”—individuals who consistently avoid colonoscopies or stool-based tests. These tests should be positioned as complements to colonoscopies, and physicians should be encouraged to conduct more comprehensive lifestyle and environmental assessments.
Research suggests that a polygenic risk score (PRS), based on common genetic variants associated with CRC, combined with an evaluation for typical CRC signs, can effectively identify individuals at higher risk for early-onset colorectal cancer. This approach would allow for personalized screening and intervention strategies.
Estimates suggest that 2,800 to 3,200 people under 50 will die from CRC in 2026. While the statistics are complex, the human cost is clear: these deaths are preventable.
It’s reasonable to anticipate that the Cancer Statistics, 2027, report will show another increase in mortality rates among those younger than 50.
As the saying goes, “Insanity is doing the same thing over and over again and expecting different results.” We cannot continue with the status quo and expect a different outcome.
Current blood-based early detection tests are sensitive in detecting CRC but have limitations in identifying advanced precursor lesions (APLs)—polyps. A negative test result might falsely reassure individuals, leading them to forgo a colonoscopy that could have detected and removed these polyps. Furthermore, the potential for false positive results can cause anxiety and sleepless nights. Improvements in biological signal enhancements and algorithmic optimization are needed to enhance the accuracy of these tests.
We must not let the pursuit of perfection hinder progress. If a blood test encourages a screening-averse patient to seek evaluation, it’s a win. If it prompts a physician to inquire about fatigue or bowel habit changes in a 35-year-old, rather than dismissing their concerns due to their age and apparent health, it’s a win.
A validated blood or breath-based MCED test, or another innovative approach, is on the horizon. Preventing avoidable deaths and the devastating impact on families is paramount.
The hope is to see a decline in CRC mortality among people younger than 50 in future Cancer Statistics reports. Innovation is the key to achieving this goal.
