March 05, 2021

Don’t Let Age Fool You: Early Onset Colorectal Cancer is On the Rise

This piece originally appeared on

Colorectal cancer deaths among older Americans are declining. So why is the disease being diagnosed in younger people at such an alarming rate?

Did you know that colorectal cancer is the second leading cause of cancer deaths among men and women combined in the US? March marks Colorectal Cancer Awareness Month, and we are working with our partners at Exact Sciences, the makers of Cologuard®, to help raise awareness about the disease. We’ll be sharing crucial information on the importance of screening, details about who is most at risk, and how you can take action to best ensure early detection and prevention of the disease. 

John MacLeod was only 45 when he was diagnosed with stage four colon cancer. He passed away five and a half years later.

While on a trip to Scotland, John began to show symptoms. “He didn’t feel well,” says his wife Dr. Angie Nicholas, Medical Director for Einstein Physicians Montgomery in Pennsylvania. “I made an appointment for him to see his doctor because he had blood in his stool. We joked and said, ‘Oh, maybe you just need probiotics.’” 

Since he was showing symptoms, John was considered high-risk, and was given a colonoscopy two days later. Doctors found a seven centimeter tumor in his colon. “I kept telling the doctor, ‘no, you have the wrong person. I’m the 45 year old’s wife,’” says Dr. Nicholas. “I’m a physician myself, and I just couldn’t believe it.”

Since the 1990s, an alarming new trend has emerged among colorectal cancer patients— the rate of colorectal cancer has more than doubled among adults younger than 50. This trend is particularly surprising considering that in the past 20 years or so, the death rate from colorectal cancer has decreased among older Americans, largely due to the increase in regular colorectal cancer screenings among people 50 years and older (something that is actually known as The Katie Couric effect).

Right around the time John was diagnosed, Dr. Andrea Cercek, a medical oncologist at Memorial Sloan Kettering who specializes in young onset colorectal cancer, noticed that she was seeing a lot more patients who were under the age of 50: “We realized very quickly that this was occurring at other cancer centers both in the United States and world-wide.” According to Cercek, incidence rates of colorectal cancer are rising by about 2% annually among young adults: “The median age of diagnosis of colorectal cancer dropped from 72 in the early 2000s to 66 in 2016. This shift can be attributed to the rise in incidence of early onset disease, and a decline in people over the age of 65.”

So that leads to the big question: WHY is this happening? Dr. Cercek says they don’t yet have an answer, but she notes that there is a clear uptick in early onset colorectal cancer in people born after 1960. She and her team are exploring a number of reasons for this. “Colorectal cancer is linked with several lifestyle risk factors including diet, exercise and weight, and we have certainly seen changes in all of those since the 1960s,” Dr. Cercek explains. In addition to diet and lifestyle changes, Dr. Cercek and her team are also exploring environmental factors, such as early or repeated exposure to antibiotics. “The delicate interplay between the environmental factor, diet, and the effects on the gut microbiome could also play a role.”  

Although there have been some reports linking obesity to early onset colorectal cancer, Dr. Cercek says that she sees many young fit patients, and generally does not believe that this is the main cause. 

While symptoms for early and late onset colorectal cancer are generally the same and include rectal bleeding, blood in the stool, unexplained weight loss and bloating, there are some things that young people should look out for. According to Dr. Cercek, “Young onset colorectal cancer occurs more commonly on the left side of the colon, which is the end of the large intestine and the rectum…so young patients tend to present with more rectal bleeding, blood in the stool, or abdominal pain, and are less likely to have anemia, which is associated with right sided tumors.” That said, it is important to pay attention to all potential symptoms including bloating and weight loss, since colorectal cancer can present with those symptoms in young people as well. 

There’s another crucial factor for young people to consider when scheduling a screening— family history. Dr. Nicholas explains, “You need to talk to your family members. If your mom or dad had polyps, there’s pretty good evidence that you should be screened five to ten years before the age at which they developed their polyps, especially if the polyps were precancerous.” 

In response to the rise in colorectal cancer in younger patients, the American Cancer Society lowered its recommended baseline screening age for colon cancer from 50 to 45. Early screenings are absolutely crucial when it comes to identifying and treating this disease. “As a result of increased screenings, the incidence and death rates of colorectal cancer in people over the age of 65 have declined significantly,” says Cercek. 

Dr. Nicholas agrees. “Don’t ignore symptoms, and don’t be afraid to talk to your doctor, even about the smallest symptom,” she says. “Maybe you just have hemorrhoids, but as a physician, I see that as a great opportunity to talk to that patient about colon cancer screening. I bring up colon cancer screenings with patients who are 40, so they know that as soon as they turn 45, this is what we’ll be doing.” 

After John’s diagnosis, he devoted the rest of his life to fighting this disease, and Dr. Nicholas has kept up the fight in his honor. “I don’t regret a thing,” she says. “He was the love of my life, and I would do it all over again. I would cut off my arm if I could get one more day with him, but that’s not possible.” Dr. Nicholas now works with Exact Sciences and the organization Fight CRC to advocate for patients and raise awareness about the disease. This is, according to Dr. Nicholas, how she gets “one more day” with John. “I talk about him, and I advocate, so that his legacy lives on. I feel him with me, when I’m talking about this. John was in six clinical trials before he died. He felt that whether the trial helped him to live another week or not, he was contributing to the science that would one day help cure somebody. So that’s why I’ve continued to advocate. Every day I wake up and thank God I was married to him, because I truly do feel like working with the colorectal community has given me a vision and a purpose.” 

The best screening test is the one that gets done so talk to your doctor about your screening options. Guidelines recommend several colon cancer screening options for average risk patients, including stool- based tests. Dr. Cereck explains, “Many people put off screening colonoscopies because of time and prep, or they don’t want to take time off work… but with a stool test there are less excuses.” If you are 45 and older and at average risk for colon cancer, talk to your doctor to see if Cologuard® may be right for you. Rx only. See for Important Risk Information.

Written and Reported by Emily Pinto