Why This Matters
Colorectal cancer, once seen largely as a disease of older adults, is being diagnosed more often in people in their 20s, 30s, and 40s. A recent health explainer, written after the reported death of actor James Van Der Beek at age 48 from colorectal cancer, has refocused attention on this trend and what can be done to slow it.
The rise in early-onset colorectal cancer comes even as overall cancer death rates in the United States continue to fall. According to the American Cancer Society, about 153,000 new colorectal cancer cases were expected in 2024, including roughly 19,500 in people under 50. The share of cases in adults younger than 55 has nearly doubled since the mid-1990s.
Because symptoms can be subtle and stigma often surrounds bowel problems, younger adults may delay seeking care, increasing the chances that tumors are found at a later, harder-to-treat stage. At the same time, screening guidelines have only recently shifted to start at age 45 for most people, leaving a gap for many in their 20s to early 40s.
Understanding which risks can be changed – and which require closer medical follow-up – is central to what it means for families trying to protect their health across generations.
Key Facts & Quotes
Experts say there is no single clear cause behind the rise in early-onset colorectal cancer, but several patterns are emerging:
- Lifestyle and diet: High intake of red and processed meats, ultra-processed foods, and low fiber, alongside obesity, smoking, alcohol use, and lack of exercise, are all linked to higher colorectal cancer risk.
- Gut microbiome: Researchers are studying how imbalances in the gut’s microorganisms (called dysbiosis) may promote inflammation and raise cancer risk.
- Genetics and family history: People with a family history of colorectal cancer, hereditary cancer syndromes, or inflammatory bowel disease face higher risk and often need earlier, more frequent screening.
Gastrointestinal oncologist Christopher Lieu and cancer researcher Andrea Dwyer, who study early-onset disease, stress the importance of being proactive. “Communication and action are key,” they wrote, urging patients to discuss family history, symptoms, and screening options with their care teams.
Outcomes depend heavily on how early the cancer is found. When detected at an early stage, five-year survival rates can reach 80% to 90%, according to cancer researchers. Once the disease has spread to other organs, survival falls closer to 10% to 15%.
Common early warning signs include blood in the stool, persistent abdominal pain, changes in bowel habits, and unexplained anemia (low red blood cell counts). Doctors emphasize that these symptoms do not always mean cancer, but they should prompt medical evaluation.
For people at average risk, major U.S. guidelines now recommend starting routine colorectal cancer screening at age 45 and continuing at regular intervals until about age 75. Options include stool-based tests that look for hidden blood or abnormal cells, and visual exams that inspect the colon and rectum. For those at high risk, colonoscopy is the preferred test and often begins earlier.
What It Means for You
For adults in their mid-40s and older, the most important step is to know your risk and get screened on time. If you are 45 to 75 and have not had a colorectal screening test, talking with your primary care provider about stool tests or a colonoscopy is a key way to lower your chances of developing advanced disease.
If you have a family history of colorectal cancer, precancerous polyps, or conditions such as inflammatory bowel disease, ask whether you should start screening earlier than 45. Regardless of age, do not ignore signs like rectal bleeding, ongoing changes in bowel habits, or unexplained fatigue; persistent symptoms deserve a medical check.
Everyday choices can also shift risk over time. Regular physical activity, maintaining a healthy weight, eating more fruits, vegetables, and fiber, limiting processed and red meats, and cutting back on alcohol and tobacco all contribute to lower colorectal cancer risk.
Families can help each other by sharing medical histories, encouraging one another to get screened, and normalizing conversations about digestive health. Knowing who in your family has had polyps or cancer can guide the “right test at the right time” for you and your children.
What questions or concerns do you have about colorectal cancer screening or symptoms in your own family?
Sources: Christopher Lieu and Andrea Dwyer, explainer on early-onset colorectal cancer, Feb. 13, 2026; American Cancer Society, “Colorectal Cancer Facts & Figures 2023”; National Cancer Institute, colorectal cancer screening recommendations, updated 2023.
