Colorectal cancer is increasingly affecting people in their 40s and younger, making it the leading cause of cancer death in adults under 50. While screening guidelines recommend starting at age 45, many younger people don't realize they could have warning signs years before a diagnosis. Understanding these early symptoms and knowing your family history could be the difference between catching cancer early and facing a late-stage diagnosis. What Are the Early Warning Signs of Colon Cancer? Unlike many cancers that develop silently, colorectal cancer often sends signals that appear months or even years before diagnosis. Research has identified four distinct symptoms that can appear up to two years before a formal diagnosis. The key is recognizing when these symptoms persist and warrant a conversation with your doctor. - Changes in Bowel Movements: Persistent alterations in your normal bathroom habits, including constipation or diarrhea that lasts longer than a few weeks, can be an early warning sign. - Abdominal Pain: Unexplained cramping or discomfort in your abdomen, especially if it's new or different from your usual digestive issues, deserves medical attention. - Rectal Bleeding: Blood in the stool or visible bleeding during bowel movements is never normal and should prompt an immediate call to your doctor. - Iron Deficiency Anemia: Low red blood cell counts, typically discovered during routine annual blood work, can indicate internal bleeding from polyps or tumors. Actor James Van Der Beek, who died from colon cancer at age 48, first noticed changes in his bowel movements in the summer of 2023 when he was 46. He initially attributed the symptoms to drinking coffee, but when the issues persisted, he asked his doctor about a colonoscopy. That screening revealed Stage 3 colon cancer. "It's really important for people to know the red flag symptoms. Many symptoms of colorectal cancer can be passed off as a more benign gastrointestinal problem," said Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society. Rebecca Siegel, Senior Scientific Director of Surveillance Research at the American Cancer Society The critical takeaway is persistence. If you experience one of these symptoms for more than a few weeks, especially if you have more than one symptom at the same time, it's time to contact your doctor. Additionally, anyone with a history of anemia or unexplained low red blood cell counts should be screened promptly. Should You Get Screened Before Age 45? Federal guidelines recommend that people with average risk begin colorectal cancer screening at age 45. However, certain groups should start earlier. If you have a family or personal history of colorectal cancer or polyps, your screening timeline changes significantly. Even if a parent had a non-cancerous polyp at age 40, you should begin screening younger than 45. The risk of colorectal cancer jumps dramatically between age groups. For people ages 40 to 44, the risk is about 21 cases per 100,000 people. That risk more than doubles for ages 45 to 49, reaching 47 cases per 100,000 people. This sharp increase is one reason experts set the screening age at 45, though rising rates in younger populations have sparked conversations about lowering it further. "The fact that trends do not suggest colorectal cancer rates in young people are dropping certainly opens the door for conversations around policy change dropping the screening age again," said Van Karlyle Morris, section chief for colorectal cancer at MD Anderson Center in Houston. Van Karlyle Morris, Section Chief for Colorectal Cancer at MD Anderson Center If you want a colonoscopy before age 45 and don't have risk factors, you can theoretically get one with a doctor's referral, but insurance typically won't cover it. Out-of-pocket costs range from $1,250 to more than $4,000, which creates a significant barrier for many people. How to Prepare for a Colorectal Cancer Screening Conversation - Know Your Family History: Talk to your relatives about any history of colorectal cancer, polyps, or other cancers. If anyone in your family was diagnosed before age 50 or had polyps, you may need earlier screening. - Track Your Symptoms: Keep notes about any digestive changes, bleeding, or persistent abdominal pain. Write down when symptoms started, how long they lasted, and any patterns you notice to share with your doctor. - Discuss Your Lifestyle: Be honest with your doctor about diet, exercise, obesity, and other risk factors. Research suggests that rising obesity rates, declining physical activity, and diets high in ultraprocessed foods are contributing to increased colorectal cancer rates in younger people. - Ask About Screening Options: Colonoscopy remains the gold standard, but noninvasive options like Cologuard (an at-home stool test) and Shield (a blood test) are available. Cologuard detects about 92% of colorectal cancers, while Shield detects about 83%, though both require colonoscopy follow-up if results are abnormal. Only about 20% of people aged 44 to 49 who are eligible for colorectal cancer screening are up to date with their screenings, according to the American Cancer Society. This low uptake means many younger people with early warning signs may not be getting the care they need. Why Are Younger People Getting Colon Cancer? The rise in colorectal cancer among younger adults remains poorly understood, but researchers have identified several contributing factors. Obesity, sedentary lifestyles, and diets rich in ultraprocessed foods have become increasingly common since the 1980s and appear to play a major role. Changes in the gut microbiome, antibiotic use, and the presence of certain bacteria in the gut may also contribute to rising rates. "While screening is important, people should also focus on improving their diet and getting enough exercise, two lifestyle factors that have been shown to significantly reduce a person's risk of colorectal cancer," said Dr. Andrew Chan, a gastroenterologist and chief of the clinical and translational epidemiology unit at Mass General Brigham in Boston. Dr. Andrew Chan, Gastroenterologist and Chief of Clinical and Translational Epidemiology Unit at Mass General Brigham The good news is that colorectal cancer is highly preventable and treatable when caught early. Overall cancer death rates in people younger than 50 have dropped by 44% since 1990, showing that prevention and early detection strategies work. However, colorectal cancer is bucking this trend, making awareness and proactive screening more important than ever. If you're in your 40s and experiencing any of the warning signs mentioned above, don't wait for your next annual physical. Contact your doctor, describe your symptoms, and ask about screening options. Your family history matters too. Having these conversations now could catch cancer at an earlier, more treatable stage and potentially save your life.
