Colorectal cancer is increasingly diagnosed in people in their 20s, 30s, and 40s, often with few early warning signs, making prevention and screening more critical than ever. The disease has become the leading cause of cancer death in Americans under 50, up from the fifth-leading cause in the early 1990s. This dramatic shift has prompted national experts to lower the recommended screening age to 45 for people at average risk, a significant change from previous guidelines. Why Is Colorectal Cancer Rising So Dramatically in Younger Adults? Researchers have documented steady increases in early-onset colorectal cancer over the past two decades, even as rates among older adults have declined due to widespread screening. While no single cause has been identified, experts believe the trend reflects a complex mix of factors including diet, obesity, physical inactivity, environmental exposures, and changes in the gut microbiome. The troubling reality is that as many as 75% of colorectal cancers in people under 50 are diagnosed at an advanced stage, partly because symptoms may be dismissed when younger people report them. "We are seeing more patients diagnosed at younger ages than we would have expected a generation ago. That makes prevention, symptom awareness and timely screening more important than ever," said David Goldberg, M.D., a physician and researcher at Sylvester Comprehensive Cancer Center, part of UHealth. David Goldberg, M.D., Physician and Researcher at Sylvester Comprehensive Cancer Center What Symptoms Should Younger Adults Watch For? One of the biggest challenges with colorectal cancer in younger people is that symptoms are often overlooked or attributed to other causes. Age alone should never be used to rule out colorectal cancer, experts warn. If you experience any of the following symptoms that persist, they deserve evaluation regardless of your age: - Stool Changes: Black or very dark brown stools, which occur when blood mixes with stool, or mucus in the stool - Bleeding: Rectal bleeding or blood in your stool - Weight and Digestion: Unexplained weight loss, abdominal pain, or a change in bowel habits lasting more than a few days - Energy Levels: Persistent fatigue that doesn't improve with rest The key takeaway is that symptoms should never be dismissed based on age. A 35-year-old reporting these signs deserves the same evaluation as a 65-year-old. How to Reduce Your Colorectal Cancer Risk The good news is that most individuals can significantly lower their risk of colorectal cancer through a combination of screening and healthy lifestyle choices. Here are the evidence-based steps experts recommend: - Get Regular Screenings: Begin screening at age 45 if you're at average risk. Screening options include stool-based tests completed at home, colonoscopy, CT colonography, sigmoidoscopy, or a blood test. Colonoscopy is considered the gold standard for detecting and removing polyps, which are pre-cancerous lesions, though experts emphasize that the best test is the one you're willing to get. - Stay Physically Active: Regular movement throughout the day reduces colorectal cancer risk over time - Maintain a Healthy Weight: Obesity is a significant risk factor, so aim for a weight appropriate for your height and body type - Eat a Colon-Healthy Diet: Focus on fruits, vegetables, whole grains, and fiber-rich foods while limiting red meat, processed meats, and sugary drinks - Avoid Tobacco and Moderate Alcohol: Smoking and excessive alcohol consumption increase colorectal cancer risk Despite clear screening guidelines, about one in three adults who are eligible for screening are not up to date, leaving early-stage cancers undetected. This gap in screening represents a significant opportunity for prevention. Healthy choices, from daily movement to food selections and habits you avoid, shape cancer risk over decades. It's never too early or too late to make changes that can lower your colorectal cancer risk. Do You Have Personal Risk Factors That Require Earlier Screening? Family history plays a major role in colorectal cancer risk. Having a first-degree relative (parent, sibling, or child) who had colorectal cancer or precancerous polyps increases your likelihood of developing the disease, especially if that relative was younger than 50 when diagnosed or if more than one first-degree relative has been affected. Certain genetic and inherited conditions can also significantly increase your risk. Other risk factors that may warrant earlier or more frequent screening include a personal history of polyps, inflammatory bowel disease, type 2 diabetes, and prior radiation to the abdomen or pelvis. Additionally, people who are Jewish of Eastern European descent (Ashkenazi Jews), American Indian, Alaska Native, or African American have higher rates of colorectal cancer and may benefit from individualized screening plans. "Having a risk factor does not mean that you will get cancer. But knowing that you do is an opportunity to pay closer attention to your screening plan and to consider lifestyle changes that may reduce risk," explained David Goldberg, M.D. David Goldberg, M.D., Physician and Researcher at Sylvester Comprehensive Cancer Center Talk to your primary care provider or a specialist to determine an individualized screening plan based on your personal and family history. This conversation is especially important if you have any of these risk factors, as you may need to start screening earlier than age 45 or be screened more frequently. Colorectal cancer prevention cannot wait until later in life. By understanding your personal risk, recognizing warning symptoms, getting screened at the recommended age, and making healthy lifestyle choices now, you can significantly reduce your chances of developing this increasingly common disease.
