Colorectal cancer has overtaken lung, breast, and all other cancers to become the leading cause of cancer death in Americans younger than 50, a reversal from three decades ago, when it ranked fifth, according to a recent research letter.
A Devastating Reversal
The shift represents a departure from expectations.Colorectal cancer rates were predicted to decline because of improved screening and detection methods. Until recently, only 30 percent of eligible people were screened with a colonoscopy; improved screening should have meant more diagnoses but fewer deaths, as cases were caught earlier.
“But the unexpected findings over the last few years [are these] increased incidence in this younger population,” Dr. Fabio Cominelli, director of the NIH Cleveland Digestive Diseases Research Core Center at Case Western Reserve University, told The Epoch Times. “That was something unexpected and not predicted by the data and everything else.”
The problem is compounded by the fact that no routine screening is recommended for people younger than 45. Someone who develops colon cancer at 30 without a family history would never receive preventive screening, Cominelli said.
“Therefore, the screening procedure does not affect [increased rates in] this younger patient population,” he said.
Christine Molmenti, co-director of the Northwell Early-Onset Cancer Program and cancer epidemiologist at Northwell Health, called it a “devastating trend” affecting young people just as they’re starting their lives, as they’re graduating college, beginning careers, and starting families.
She said that historically, this has been a disease found in older adults; most people with the disease are diagnosed after the age of 55.
“We are now seeing more than 20 percent of cases from young adults under 55,” she said.
About three in four patients younger than 50 who are diagnosed with colon cancer already have advanced disease, making treatment more difficult and less effective, according to the study findings.
Lifestyle Does Not Fully Explain Cancer Rise
“Colorectal cancer is often considered a ‘lifestyle disease’ due to its association with a Western dietary pattern,” Molmenti said. “This pattern is highly concentrated in ultra-processed foods.”
Her team has found that people younger than 50 who had colorectal polyps return after removal showed higher smoking rates, greater intake of red meat and total fat, more sedentary behavior, and diets with more inflammatory properties.However, many young people now being diagnosed with colorectal cancer were following healthy lifestyles.
According to Dr. Robin Mendelsohn, a gastroenterologist at Memorial Sloan Kettering Cancer Center (MSK), the center has been closely monitoring cases of early-onset colorectal and gastrointestinal cancers.
Their data, which include more than 4,000 young patients, reveal a surprising trend—many of these people are less likely to be obese, and they also tend to have fewer traditional risk factors such as tobacco use.
“The working hypothesis is that there is an environmental exposure—or multiple exposures—that people born starting in the 1950s came in contact with,” Dr. Andrea Cercek, gastrointestinal oncologist and co-director of The Center for Young Onset Colorectal and Gastrointestinal Cancer at MSK, stated. “It’s possible that the exposures began in the 1960s or ’70s and have been continuously present since then.”
Other Cancers Show Improvement
While the rate of colorectal cancer deaths has risen, the rates of other major cancers affecting young Americans have declined.The researchers examined the five leading causes of cancer death in people younger than 50: brain cancer, breast cancer, colon and rectal cancer, lung and bronchus cancer, and leukemia. They used national death records tracking causes of death across all 50 states and the District of Columbia, calculating death rates adjusted for population changes.
Warning Signs
Limited awareness among patients and even some health care providers contributes to late diagnoses, according to Molmenti.“Many patients’ symptoms are dismissed, especially with women,” she said.
Many symptoms overlap with “benign” conditions such as hemorrhoids, irritable bowel syndrome, and infectious diarrhea, according to Korenblit.
“Young adults don’t really have a unique symptom that screams cancer, although certain patterns should raise concern,” Korenblit said.
- Blood in the stool or bleeding that keeps coming back
- Persistent abdominal pain
- A lasting change in bowel habits, such as new constipation, diarrhea, or alternating patterns
- Unexplained iron-deficiency anemia, fatigue, or shortness of breath
- Unintentional weight loss
- Symptoms that persist, worsen, or don’t respond to usual treatment
“This has only increased over the years, and now it is estimated that colon cancer will be the most common cancer in Americans between the ages of 20 and 49 by the year 2030,” she said.
