More Young Adults Are Dying From Rectal Cancer–Early Signs Often Go Unnoticed

Once considered a disease of older adults, colorectal cancer is now causing a rising number of deaths among people under 45.

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Bryce Ramsey was 33, a nurse who spent her shifts watching for symptoms in other people. When she noticed blood in her stool, she told herself it was hemorrhoids. She had just had a baby, and she was exhausted. She had a reason for everything—right up until the day she did not.

A 2.5-inch polyp was found during her first colonoscopy. Five days later, she received the diagnosis: colorectal cancer. Ten days later, she underwent surgery.

“Too many young people are being diagnosed with colon cancer, often dismissing early symptoms just like I did,” Ramsey said. “It’s a silent disease that doesn’t always follow the rules people expect.”

Her story is becoming less rare. Once considered a disease of older adults, colorectal cancer is now driving a concerning rise in deaths among people younger than 45.

Older Millennials Take the Brunt

A recent study analyzing U.S. death rates from colorectal cancer in adults aged 20 to 44 found that deaths—particularly from rectal cancer—have increased across sex, race, and geographic regions, with older millennials among the hardest hit.

Researchers used the CDC WONDER database (1999 to 2023), a national system that compiles U.S. mortality and public health data. When broken down by age, both colon and rectal cancer deaths were highest among adults aged 35 to 44.

Both cancers increased among men and women. Colon cancer death rates rose gradually, while mortality from rectal cancer climbed two to three times faster across every demographic group examined.

A Worrying Trajectory

The rise of colorectal cancer in younger people may be an early warning sign of a larger generational shift.

“Colorectal cancer incidence and mortality are not rising in young people per se, but in generations born after the 1950s,” Rebecca Siegel, a cancer epidemiologist and senior scientific director of Surveillance Research at the American Cancer Society, who was not involved in the study, told The Epoch Times.

“The increase in early-onset disease is a canary in the coal mine for the future disease burden.”

Siegel also noted that risk rises with each successive generation.

That pattern is reflected in the study’s projections.

The study used ARIMA, a machine-learning model, to project trends through 2035. If current patterns continue, deaths from both colon and rectal cancer are expected to rise. Rectal cancer deaths are projected to rise by roughly a quarter, while colon cancer deaths are expected to increase only modestly.

“Rectal cancer isn’t becoming more deadly, but it is increasing in incidence, which ultimately leads to more deaths,” Siegel said.

Why Rectal Cancer May Be Rising Faster

The faster rise in rectal cancer may be partly due to how easily its symptoms are overlooked.

“Rectal cancer can be especially tricky because the symptoms are often subtle or easy to brush off,” Dr. Abraham El-Sedfy, a colon and rectal surgeon and chair of the Department of Surgery and surgeon-in-chief at St. Joseph’s Health, told The Epoch Times. “Rectal bleeding, for example, is commonly attributed to hemorrhoids, particularly in younger adults, which can delay further evaluation.”

Biological differences between the rectum and the rest of the colon may also help explain the rise in rectal cancer, he said. The rectum has a distinct local environment from the colon, including differences in the microbiome and prolonged exposure to stool and inflammatory byproducts, all of which may influence cancer development.

However, separating rectal cancer from colon cancer in mortality data remains a challenge, Siegel noted, with one study finding that 39 percent of rectal cancer deaths were misclassified on death certificates, most often recorded as colon cancer, suggesting that the true burden of rectal cancer may be even higher than reported.

The exact reasons driving the increase remain unclear, although experts suggest that it’s likely multifactorial. While known factors such as excess body weight and sedentary behavior likely contribute, she said, they do not fully explain the trend.

“Established risk factors are based on cancer in older adults who had different exposures than those in more recent generations,” Siegel said.

For instance, she pointed to data showing that about 14 percent of colorectal cancer cases overall are attributable to smoking—a figure that is likely lower among younger adults, who are less likely to smoke.

Researchers are also beginning to explore newer biological pathways that may help explain the shift. El-Sedfy noted emerging evidence, including findings linking certain strains of E. coli that produce DNA-damaging toxins to early-onset colorectal cancers diagnosed more often in younger patients.

“It raises the possibility that exposures early in life, even in childhood, could play a role in setting the stage for cancer years later,” he said.

Early Symptoms

While the rising numbers are concerning, the experts said that many of these deaths may be preventable.

Colorectal cancer, when detected early, is often curable, and outcomes between older and younger adults are comparable. Also, many younger patients respond well to modern treatments.

“The bigger issue we face is often delayed diagnosis rather than inherently more aggressive disease,” El-Sedfy said.

Three in four colorectal cancers in people younger than 50 are diagnosed at advanced stages, “when the disease is harder to treat, and increasing incidence in people 50 to 64 years is confined to advanced diagnosis,” Siegel said.

“Symptoms like change in bowel habits or rectal bleeding are often missed or attributed to benign causes like stress or hemorrhoids, leading to advanced-stage diagnosis,” Mythili Menon Pathiyil, a gastroenterology fellow at SUNY Upstate Medical University and lead author of the study, told The Epoch Times.

The stage at diagnosis is one of the strongest predictors of survival.

“Young patients with rectal bleeding may wait several months before seeking care, often believing they are ‘too young for cancer,’” Pathiyil said.

Ramsey knows this firsthand. She made a deal with herself: If the bleeding happened again, she would make the call. When it did, she followed through.

“Looking back, I had been experiencing symptoms, but like so many people, I found ways to explain them away,” she said.

Colorectal cancer often does not cause noticeable symptoms until later stages, underscoring the importance of screening—particularly for those at higher risk, such as people with a family history of colorectal cancer or polyps diagnosed at a young age.

In the United States, average-risk adults are currently advised to begin colorectal cancer screening at age 45.

“For people under 45, the bigger message isn’t necessarily to screen everyone earlier just yet, but rather it’s to not ignore symptoms,” El-Sedfy said. “Those are red flags and should be evaluated with a colonoscopy.”

By the time Ramsey was diagnosed, her cancer had already reached stage 3. Now she’s cancer-free.

Ramsey encourages people not to ignore symptoms simply because they seem easy to explain away.

“Too many young people are being diagnosed with colon cancer, often dismissing early symptoms just like I did,” she said.

Ramsey said she hopes that greater awareness will help others seek care sooner—when colorectal cancer is most treatable.