Dr. Bethany Malone, a colon and rectal surgeon at Texas Health Harris Methodist Hospital Fort Worth, has treated numerous colorectal cancer patients over the years. Alarmingly, the youngest patient she has seen—excluding genetic cases—was just 19 years old.
Traditionally, colorectal cancer was considered a disease of older adults. However, that perception is rapidly changing. Although teenagers and people in their early 20s still represent a minority, their numbers are steadily rising.
“In my entire practice, I have never gone a year without removing colon cancer from someone in their 20s,” Dr. Malone said. Her experience in North Texas mirrors a growing global trend.
Early-Onset Colorectal Cancer Is Increasing Worldwide
Doctors classify colorectal cancer as “early-onset” when it occurs in individuals under 50. While most diagnoses still occur in people aged 65 and older, rates among younger adults are increasing worldwide, particularly in high-income countries.
According to a 2023 American Cancer Society report, declining cancer rates in older adults combined with rising rates in younger populations are “rapidly shifting the patient population younger.”
Several high-profile cases have drawn attention to this trend. Actor Chadwick Boseman died of colon cancer at 43. More recently, choreographer Criscilla Anderson passed away at 45. Closer to home, Dallas musician Joshua Ray Walker was diagnosed at 33 and later announced he was cancer-free following treatment and surgery.
Why Are Colorectal Cancer Rates Rising in Younger People?
Medical experts agree that no single factor explains the rise in early-onset colorectal cancer. Instead, a combination of lifestyle and environmental factors appears to be driving the trend.
Importantly, genetics account for only a minority of cases. Dr. Radhika Kainthla, a medical oncologist at Parkland Memorial Hospital, estimates that only about 20% of early-onset patients have a genetic predisposition.
“There’s a common misconception that cancer in young people must be genetic,” she said. “That’s not what we’re seeing.”
Instead, experts point to diets high in red meat and ultra-processed foods, along with low levels of physical activity. Dr. Malone emphasized that inadequate fiber intake is a major concern, as fiber supports a healthy gut microbiome and helps eliminate carcinogens before the body absorbs them.
At the same time, she acknowledged that lifestyle choices are not always fully within an individual’s control. The modern food system heavily favors ultra-processed foods that lack essential nutrients, including fiber.
Environmental exposures may also play a role. Dr. Emina Huang, a colorectal surgeon at UT Southwestern Medical Center, noted that living near hazardous waste or Superfund sites has been associated with increased cancer risk.
How Can You Lower Your Risk of Colorectal Cancer?
Fortunately, reducing colorectal cancer risk largely aligns with general health recommendations. Experts advise regular physical activity, avoiding smoking, limiting alcohol intake, and consuming a diet rich in fruits, vegetables, and fiber while minimizing red meat.
Obesity also increases risk. However, Dr. Malone cautioned against focusing solely on weight loss. Restrictive diets may inadvertently reduce fiber intake, which can be counterproductive.
Equally important, individuals should remain attentive to their bodies. Persistent abdominal pain or changes in bowel habits warrant medical evaluation.
When Should Colorectal Cancer Screening Begin?
In response to rising early-onset cases, the U.S. Preventive Services Task Force now recommends routine colorectal cancer screening starting at age 45 for people at average risk. Colonoscopy remains the gold standard, although stool tests and imaging studies can also serve as screening tools.
However, individuals with higher risk may need earlier screening. Those with a first-degree relative diagnosed with colorectal cancer or polyps should begin screening 10 years earlier than their relative’s age at diagnosis. For example, if a parent was diagnosed at 48, screening should start at 38. In such cases, screening should begin no later than age 40.
Similarly, patients with inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis face a higher risk and should undergo earlier surveillance.
As reported by medicalxpress, Dr. Kainthla also highlighted newer options, including blood-based and stool-based tests, which may be appropriate for some patients.
Recognizing the Warning Signs
Although gastrointestinal symptoms in young adults rarely indicate cancer, certain warning signs should not be ignored. Persistent abdominal pain, unexplained changes in bowel habits, and blood in the stool are among the most common early symptoms.
While these signs may stem from benign conditions such as hemorrhoids, ongoing symptoms despite treatment should prompt further investigation. Early evaluation can make a critical difference in outcomes.
If you’d like, I can also shorten this for a news brief, adapt it for an Indian medical audience, or rewrite it for a patient-awareness feature.