WASHINGTON: Colorectal cancer has overtaken other cancers as the leading cause of cancer-related deaths among Americans under 50, according to a new report from the American Cancer Society (ACS).
In the early 1990s, the disease ranked fifth among younger adults.
The ACS study examined cancer deaths in adults under 50 over the past three decades.
It found that while overall cancer mortality in this age group fell by 44%, deaths from colorectal cancer have steadily risen.
The report highlights colorectal cancer as the only major cancer to show an upward trend in mortality among younger Americans.
Deadliest cancers in youth
The five deadliest cancers for those under 50 remain: brain cancer, breast cancer, leukemia, lung cancer, and colorectal cancer.
While mortality rates for the first four cancers declined between 2014 and 2023, colorectal cancer deaths increased by an average of 1.1% annually since 2005.
This rise pushed colorectal cancer past lung cancer in 2023 as the top killer among adults under 50.
Possible causes
Experts say the reasons for rising colorectal cancer in younger adults remain unclear, but lifestyle and environmental factors are likely contributors.
Arif Kamal, MD, chief patient officer at the ACS, said Americans consume insufficient fruits, vegetables, and whole grains, while eating high amounts of red, smoked, and processed meats.
Obesity, which increases colorectal cancer risk, is another major factor.
“The colon is uniquely vulnerable because everything you put into your body, your colon will see,” Kamal told Healthline.
Anjee Davis, CEO of advocacy group Fight Colorectal Cancer, emphasised the need for national attention.
“We have to figure out why this keeps rising in young people because in our community, we hear it as young as 11, 17, 20 years old,” she said.
Early detection critical for survival
The ACS report shows that three in four patients under 50 are diagnosed only after the disease reaches an advanced stage. Early detection dramatically improves survival rates.
The US Centers for Disease Control and Prevention (CDC) notes that 89% of people diagnosed at the earliest stage survive at least five years, compared with 16% at the most advanced stage.
A 2024 study found that four to six months often pass between symptom onset and diagnosis.
Common warning signs include abdominal pain, blood in stool, and persistent changes in bowel habits, such as diarrhoea or constipation.
Other symptoms include unexplained weight loss, fatigue, and a sensation of incomplete bowel evacuation.
High-risk groups
Screening typically begins at age 45 for average-risk adults. However, family history, genetic conditions, and specific symptoms may require earlier screening.
Fewer than 30% of 45- to 49-year-olds are up to date on screenings, compared with over 70% of older adults, according to the CDC and ACS.
Certain demographic groups face higher risk. Native Americans and Alaska Natives have the highest colorectal cancer incidence globally, prompting some communities to encourage screening from age 40.
Black men are also disproportionately affected, with a more than 40% higher risk of dying from the disease than white men.
Family history plays a significant role. Dr Kamal advised that anyone with a parent or sibling diagnosed with colorectal cancer start screening 10 years before that relative’s diagnosis age.
Genetic conditions such as BRCA2 mutations and inflammatory bowel diseases also elevate risk.
Stigma and delayed diagnosis
Experts say stigma around bowel health contributes to delayed diagnosis.
Lynn Durham, president and CEO of Georgia CORE, said reluctance to discuss stool habits often prevents early medical intervention.
“People don’t want to talk about their poop… If you have dramatic changes, you need to see your doctor right away,” she said.
Anjee Davis stressed maintaining open conversations about bowel health throughout life. She advised patients to seek alternative providers if symptoms are dismissed.
“I really feel like our young onset patients need to be heard,” she said.
Lifestyle measures
While research continues, experts recommend lifestyle modifications to lower risk.
Limiting red and processed meats, eating more fruits, vegetables, and whole grains, maintaining a healthy weight, exercising regularly, reducing alcohol intake, and avoiding tobacco use can all help.
“Lifestyle changes made today can affect your colon cancer risk 10 years from now,” Kamal said.
Both Durham and Davis highlighted the preventable nature of colorectal cancer.
“The fact that this is a preventable cancer makes it tragic,” Davis said. “We have it in our power to figure out why. I know we do.”
