Colorectal cancer has emerged as the leading cause of cancer deaths among young Americans, according to alarming new research from the American Cancer Society. The disease, once considered unlikely to affect younger populations, has seen a dramatic surge over the past two decades, with incidence rates climbing from 8.6 cases per 100,000 people in 1999 to 13 cases per 100,000 in 2018.
Disturbing Trends in Young Adult Cancer Mortality
Since 2004, colorectal cancer incidence among people under 50 has increased by approximately two percent annually. This population was historically considered at low risk for developing the disease, making the current trends particularly concerning for public health officials and medical professionals.
The American Cancer Society research team examined eight different cancer types and found that while death rates decreased for all other cancers in people under 50, colorectal cancer mortality increased by 1.1 percent annually from 2005 through 2023. This makes colorectal cancer the only cancer with rising mortality rates among young Americans.
From Fifth to First in Cancer Deaths
The dramatic shift in colorectal cancer's impact is starkly illustrated by its changing ranking among cancer killers. During the early 1990s, colorectal cancer was the fifth-leading cause of cancer death in Americans under 50. By 2023, it had risen to become the leading cause overall.
Breaking down the statistics by gender reveals further concerning patterns. Colorectal cancer is now the leading cause of cancer death in men under 50 and the second-leading cause for women in the same age group, surpassed only by breast cancer.
The Challenge of Subtle Symptoms and Late Diagnosis
One significant factor contributing to the high mortality rate is the often subtle nature of symptoms in young patients. Warning signs may include small amounts of blood on toilet paper, persistent abdominal pain, or in some cases, no symptoms at all until the disease has progressed significantly.
Dr Nikita Wagle, study co-author and principal scientist of Surveillance Research at the American Cancer Society, noted that "nearly three in four patients younger than age 50 are diagnosed with advanced-stage disease, when treatment can be difficult, and survival is worse." This reflects what she describes as "missed opportunities for earlier diagnosis, timely treatment and symptom recognition."
Gender Differences in Risk and Diagnosis
Dr Christine Molmenti, cancer epidemiologist and co-director of the Northwell Health Early-Onset Cancer Program in New York, highlighted potential gender differences in colorectal cancer presentation and diagnosis. While men may have higher rates of certain risk factors like alcohol consumption and smoking, women may face different challenges in obtaining timely diagnoses.
"For example, many of their symptoms manifest as menstrual cycle findings," Dr Molmenti explained. "So, if they have bleeding or abdominal pain, their symptoms may be dismissed because of their menstrual cycle. In addition, they could be also misdiagnosed as hemorrhoids, especially if they've had children."
Contrasting Trends with Other Cancers
The research reveals a striking divergence between colorectal cancer and other common cancers affecting young Americans. While breast cancer and leukemia rates have also increased in people under 50, deaths from these cancers have slowed since the 1990s.
From 2014 to 2023, annual cancer deaths decreased significantly for several other cancers:
- Brain cancer: 0.3 percent decrease
- Breast cancer: 1.4 percent decrease
- Leukemia: 2.3 percent decrease
- Lung cancer: 5.7 percent decrease
Overall, the age-standardized death rate for all cancers in people under 50 decreased by 44 percent from 1990 through 2023, dropping from 25.5 to 14.2 per 100,000 people. This makes the increasing colorectal cancer mortality rates even more notable against this backdrop of general improvement.
The Screening Imperative
Medical experts emphasize that improved screening represents a crucial strategy for addressing this growing public health concern. Current guidelines recommend colorectal cancer screening with colonoscopy starting at age 45, repeating every 10 years for average-risk individuals. Those with family histories of the disease should consider earlier screening.
Dr Wagle stressed the importance of removing stigma around colorectal cancer symptoms: "We need to remove the stigma around this disease and its symptoms so that people feel comfortable discussing concerns with their doctors. There are specific red flag symptoms among people younger than age 50, such as rectal bleeding and abdominal pain, that should not be ignored."
Unanswered Questions About Risk Factors
While research suggests potential risk factors including diets high in processed or fried foods, alcohol consumption, sedentary lifestyles, and early antibiotic exposure, many young patients diagnosed with colorectal cancer don't fit these traditional risk profiles.
Dr Molmenti noted this puzzling discrepancy: "We're seeing what's come forward with a lot of patients who are diagnosed; they don't meet a lot of those criteria. They say they're healthy. They say they eat well, and that they are generally fit and active. And so, we have this conundrum of what is the phenotype that the risk factors are sort of painting for this disease."
The research findings, published as a peer-reviewed research letter in the journal JAMA, analyzed National Cancer Institute figures from 1990 through 2023. The study examined trends in colorectal, lung, breast, brain, uterine and pancreas cancers, as well as leukemia and Non-Hodgkin lymphoma in men and women under 50.
Approximately 1.2 million Americans under 50 died of cancer during the study period, with women accounting for 53 percent of these deaths. The rising colorectal cancer mortality among young people represents a significant public health challenge that requires increased awareness, improved screening protocols, and continued research into the unique risk factors affecting younger populations.
