Colorectal cancer in young people: what millennials and Gen Z need to know now

One bright day in March 2024, the grassy green expanse of the National Mall became a sea of blue. 

Advocacy group Fight Colorectal Cancer planted over 27,000 flags in our nation’s busiest park to represent the number of people younger than 50 who are expected to be diagnosed with colorectal cancer (CRC) in 2030.¹

CRC is on the rise among adults in their 20s, 30s, and 40s, increasing by as much as 2% each year since 1994.^2,3 In adults under 50, it has become the No. 1 cancer killer of men, and the No. 2 cancer killer of women.⁴

 So what options does a younger person have for getting ahead of this disease? 

Taking control of your health 

CRC occurs when cells in the colon or rectum divide rapidly, creating tumors that damage the body. Early-onset CRC refers to cases diagnosed before age 50.  

Average-risk patients become eligible for CRC screening at age 45.⁵ If you’re younger than 45, you still have clear steps to take to protect yourself. 

Know your risk 

Talk to your family. Family history is the most significant risk factor for early-onset CRC. If a close relative was diagnosed before age 50, you may be at increased risk. It’s important to share your family history with your doctor, who may recommend you begin screening 10 years earlier than the age at which your relative was diagnosed. 

Be aware of other risk factors. Certain health conditions can also increase your risk of developing CRC at a young age, including type 2 diabetes, inflammatory bowel disease, Crohn’s disease, and certain genetic conditions like Lynch syndrome.³ 

Adopt healthy habits 

While many risk factors are outside of your control, some aren’t. According to the American Cancer Society, up to 55% of CRC cases and deaths could be prevented through healthy lifestyle choices.² 

Durado Brooks, M.D., is associate chief medical officer at Exact Sciences. Dr. Brooks has spent his career on the front lines of screening and prevention, working as a primary care physician and a public health practitioner specializing in CRC. He recommends eating a balanced diet high in fresh, fiber-rich produce and low in processed, fatty foods. Exercising regularly and avoiding alcohol and tobacco can also minimize your risk. 

“Everybody associates tobacco and lung cancer,” Dr. Brooks notes, “but there’s actually a lengthy list of cancers that are influenced by tobacco, including colorectal.” 

Watch out for symptoms 

Early-onset CRC is often asymptomatic, so it’s essential to discuss your risk with a doctor.  If symptoms do appear, they can include abdominal pain, changes in bowel habits, unexplained weight loss, and rectal bleeding.  

“Seek medical attention if you experience these symptoms, especially any kind of bleeding,” Dr. Brooks advises.  

Too often, patients ignore warning signs or mistake them for something less serious, like hemorrhoids. If your provider dismisses your concerns but you’re still worried, don’t hesitate to seek a second opinion, he says. 

Prioritize screening 

Screening significantly improves patient outcomes.  

“You dramatically change the course of the disease if you find it early, but more importantly, we can prevent it from developing with screening tests,” Dr. Brooks says.^6,7 

The five-year survival rate for CRC diagnosed at stage 1 is approximately 90%. It drops to only 18% when diagnosed at stage 4.⁸ 

Unfortunately, about 71% of early-onset CRC cases are diagnosed at later stages when treatment is less effective.^3,9 This often happens because many still believe CRC only affects older adults. As a result, younger patients might ignore their symptoms or wait to see a doctor, and doctors might mistake CRC symptoms for something more common in younger populations.⁹ 

By contrast, the disease is frequently detected earlier in older populations. Here, incidence is actually declining, thanks to technological advancements like the Cologuard^® test which have boosted screening rates among average-risk patients in recent years.^10-12 Over the past decade, the test has been used more than 16 million times, identifying over 623,000 instances of cancer and precancer, with 80% being stage 1 or earlier.¹³ 

For high-risk individuals, like those with a family history of early-onset CRC, colonoscopy is the only recommended screening method.¹⁴ The procedure involves inserting a flexible scope into the large intestine to detect and remove precancerous polyps, a precursor to CRC. Patients are typically sedated for the procedure and prescribed laxatives in preparation. 

Finding a solution 

Researchers are working to understand why early-onset CRC is on the rise. In the meantime, health care professionals, advocacy groups, and industry leaders are focused on boosting screening among eligible populations. 

Exact Sciences has developed several initiatives to break down barriers to screening. Its Funding Opportunities for Colorectal Cancer Screening Uptake Strategies (FOCUS) program provides funding to community organizations, health foundations, public health organizations, and CRC advocacy groups to expand access to colorectal cancer screening and create affordable pathways to follow-up diagnostic care. It also collaborates with Federally Qualified Health Centers (FQHCs) to raise awareness, particularly in communities where the disease is more prevalent due to systemic inequalities. 

The company works with health systems nationwide to make care more accessible too. By bulk-ordering and sending Cologuard^® kits directly to patients overdue for screening, health systems can reach people who might otherwise face barriers to visiting a provider. 

These innovative approaches can help alleviate the pressure on health care professionals to use appointment time to educate every patient about cancer screening. They also help reserve colonoscopies for those who need them most, like patients at greater risk of early-onset CRC, says Bryan Goettel, Exact Sciences’ advocacy and alliance relations director. 

“You hear about people having to wait months or even a year to get a colonoscopy,” Goettel says. “I don’t think we’re alone in the belief that we should be prioritizing these procedures for high-risk populations.”  

There are 60 million people in the United States alone that are behind on their CRC screening.¹⁵ To close the CRC screening gap, we need to meet people where they’re at, raising awareness, removing obstacles, and offering alternatives to colonoscopy. Exact Sciences invests in access, education, and health equity to help ensure that everyone in the eligible population gets screened when they should, Goettel says. 

 “Our purpose is to help eradicate cancer. If we’re going to make a difference, we need to understand the landscape and appropriately engage with this issue from all angles.” 

For the many young people not yet eligible for routine CRC screening, being proactive about your health is key. Knowing your risk, adopting a healthy lifestyle, and watching out for symptoms can make all the difference. And if you are diagnosed and become one of the thousands represented by Fight Colorectal Cancer’s blue flags, they will increase your odds of early detection and a more favorable outcome. 

The information provided is not clinical, diagnostic, or treatment advice. You should consult with a qualified health care professional about any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.  

References

1. Fight Colorectal Cancer. United in Blue National Mall Installation. Fight Colorectal Cancer. Published April 19, 2024. Accessed September 11, 2024. https://fightcolorectalcancer.org/united-in-blue/ 
2. American Cancer Society. Colorectal Cancer ACS Research Highlights. www.cancer.org. Accessed September 11, 2024. https://www.cancer.org/research/acs-research-highlights/colon-and-rectal-cancer-research-highlights.html  
3. Mauri G, Sartore-Bianchi A, Russo AG, Marsoni S, Bardelli A, Siena S. Early-onset colorectal cancer in young individuals. Mol Oncol. 2019;13(2):109-131. doi:10.1002/1878-0261.12417 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360363/ 
4. Siegel RL, et al. 2023. CA Cancer J Clin. 2023;73(3):233-254 
5. ACS. Guideline for Colorectal Cancer Screening. Accessed March 6, 2024. Updated January 29, 2024. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html 
6. Rex DK, et al. Am J Gastroenterol. 2017;112(7):1016-1030.  
7. Limburg P, et al. DDW poster, May 9, 2023;Abstract No. Tu1116  
8. ACS. Survival Rates for Colorectal Cancer. Updated January 29, 2024. Accessed September 17, 2024. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html 
9. Yarden RI, Newcomer KL, Board NTYA. Abstract 3347: Young onset colorectal cancer patients are diagnosed with advanced disease after multiple misdiagnoses. Cancer Research. 2019;79(13_Supplement):3347-3347. doi:https://doi.org/10.1158/1538-7445.am2019-3347 
10. National Cancer Institute. Colorectal Cancer Screening | Cancer Trends Progress Report. Cancer.gov. Published 2019. https://progressreport.cancer.gov/detection/colorectal_cancer  
11. Shapiro JA, et al. Cancer Epidemiol Biomarkers Prev. 2021:30(8):1554-1565. 
12. American Cancer Society. Key Statistics for Colorectal Cancer. Accessed May 8, 2024. Updated January 29, 2024.  
13. Estes C, Dehghani M, Ozbay A, et al. Clinical, social and economic impacts of colorectal cancer screening with the multi-target stool-DNA test: 10-year experience – a simulated study. MedRxiv.org https://doi.org/10.1101/2024.08.07.24311643   
14. Wolf A, Fontham E, Church TR, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68:250-281. 
15. Ebner DW, Kisiel JB, Fendrick AM, et al. Estimated Average-Risk Colorectal Cancer Screening-Eligible Population in the US. JAMA Netw Open. 2024;7(3):e245537.