Colorectal cancer has been making headlines lately as more and more people under the age of 50 are receiving a diagnosis—like actor James Van Der Beek, who was diagnosed at stage 3 at the age of 46 and recently passed, two-and-a-half years into battling the condition.
This type of news has surprised many, as colorectal has been traditionally thought of as a disease that affects older people, with the average age of diagnosis being in the late 60s or early 70s. But in recent years, this narrative has begun to shift. Colon cancer in younger adults is rising—with some experts going so far as to call cases "skyrocketing." People under the age of 50 now make up around 10% of colorectal cancer cases, with the majority of those cases occurring between the ages of 40 and 49. Those who find themselves diagnosed at a younger age are often caught completely off guard, with symptoms that were overlooked, mistaken for other conditions like indigestion, or dismissed.
Colorectal cancer is rising in younger adults but declining in older adults
According to the American Cancer Society, colorectal cancer incidence in adults younger than 50 increased by more than 50% between 1994 and 2014. And more recently, rates in this age group have continued to rise, increasing by about 2.9% per year from 2013 to 2022. Once the fifth leading cause of cancer death, early-onset colorectal cancer is now the leading cause of cancer death in men under 50. In women, it’s the second leading cause of cancer death.
Interestingly, as cases have been rising in younger demographics, they have been lowering in older adults. Over the last decade, deaths associated with colorectal cancer have also been dropping in older adults by about 1.5%. This may be attributed to better screening—which can lead to polyps being found and removed before they turn cancerous, and earlier diagnosis which can be easier to treat. This could also be due to the fact that for decades, colonoscopy recommendations started at age 50. And older adults are significantly more likely to be up to date on colorectal cancer screening than younger adults. Per the American Cancer Society’s 2023 Colorectal Cancer Facts & Figures report, about 71% of adults ages 50 to 75 are up to date with colorectal cancer screening. For the 45 to 49 age group, this drops down to 21%.
Related: Why “healthy” people can still get cancer
What may be contributing
Researchers are still investigating what’s driving the rise in colorectal cancer in younger populations. But some evidence points to it potentially being driven by a combination of lifestyle, dietary changes, and environmental factors. Potential contributing factors under investigation include:
Dietary shifts, including increased ultra-processed food consumption: High intake of sugary drinks, red meats, and processed foods has been cited as a potential increased risk factor. A diet high in fat, combined with a low-fiber intake may also be contributing. One study found that ultra processed foods can put people at a greater risk—especially males.
Related: What the science says ultra-processed foods do to your body
Changes in the gut microbiome beginning early in life: The gut microbiome plays a role in immune regulation, inflammation, and metabolism. Some reports of disruptions in this microbial balance have been linked to colorectal tumor development. Studies suggest that certain bad bacteria, like colibactin, a toxin made by certain strains of E. coli, may increase the risk of developing colorectal cancer.
Antibiotic exposure in childhood: Some studies have linked antibiotic use in early life with an increased risk of colon cancer down the line.
Sedentary behavior: Being inactive and an unhealthy weight are tied to an increased risk of colorectal cancer. One study found prolonged time watching TV was tied to and increased risk of early-onset colorectal cancer, particularly in the rectum.
Chronic low-grade inflammation: Ongoing inflammation can damage cells and alter the body’s normal immune surveillance. And research shows that chronic inflammation may reshape and stiffen the colon, creating conditions that may foster environments that enable cancer to grow.
Environmental exposures: Exposure to toxins in the environment like industrial pollutants and agricultural runoff may be playing a role.
Obesity: Studies have shown that being overweight and obese is a significant risk for colorectal cancer. Researchers are also studying whether certain types of fat, like visceral fat which can hide behind the abdominal wall and is hard to see, may play a role as well.
Related: Why you should be tracking your body composition
Alcohol and smoking: High alcohol consumption and smoking in early adulthood are strongly linked to a higher risk of developing early-onset colorectal cancer. One study found individuals who consumed 15 grams or more of alcohol per day (roughly one standard drink) and had minimal smoking exposure (fewer than 5 pack-years) had a 53% higher risk of developing colorectal cancer later in life compared with nondrinkers who had minimal smoking exposure.
Why this cancer is often caught later in younger people
As colon cancer is typically thought of as a disease of older adults, it can often fly under the radar in people under 50. Many younger adults are not yet eligible for routine colonoscopy screening, which recommendations say to start around age 45. And until recently, most guidelines did not recommend screening before age 50.
Even if they’re eligible, younger patients are less likely to be screened than older populations, often not thinking they don’t need to take the risk seriously until later in life. This can lead to a later diagnosis, which means the disease is caught in stages that are less treatable. And symptoms such as stomach pain or rectal bleeding can be mistaken for other conditions such as hemorrhoids, irritable bowel syndrome, side effects of stress, or other benign conditions.
Signs and symptoms that should not be ignored
Many people with colon cancer do not exhibit signs in early stages. When symptoms do occur, they can include:
- Persistent changes in bowel habits, such as more frequent looser stools or constipation
- Blood in stool or rectal bleeding
- Unexplained iron-deficiency anemia
- Ongoing discomfort in the belly region or cramping that doesn’t resolve
- Feeling like the bowel doesn’t completely empty after a bowel movement
- Unintended weight loss
- Weakness or tiredness
Ways to reduce your risk
There is no proven way to completely ward off cancer of any kind but there are some steps that experts have linked to a reduced risk of colorectal cancer. These include:
- Eating a diet rich in fiber, fruits, vegetables, and whole foods: A higher intake of fruits, vegetables, whole grains, and dietary fiber is associated with lower colorectal cancer risk. Fiber, in particular, promotes healthy digestion by absorbing water and increasing stool bulk. This enables waste to pass through the colon faster, limiting carcinogen exposure to the colon lining. And when gut bacteria ferment fiber, they produce short chain fatty acids with anti-cancer properties.
- Limiting excessive red/processed meat: A higher intake of red and processed meat has been linked to an increased risk of colorectal cancer. The American Heart Association suggests prioritizing poultry, fish, or plant-based protein the majority of the time.
- Avoiding ultra processed foods: Some research shows that avoiding ultra-processed foods like fast food, sugary drinks, and processed snacks, can reduce colorectal cancer risk by up to 45%, particularly for early-onset cases.
- Regular physical activity and maintain a healthy weight: Staying active can help to keep your weight in a healthy range. It can also decrease insulin resistance, reduce systemic inflammation, enhance immune performance, and shorten bowel transit time.
- Avoiding smoking; moderating alcohol: Quitting smoking, avoiding secondhand smoke, and limiting alcohol consumption can help to reduce risk.
- Supporting microbiome diversity: Eating a variety of foods, particularly a gut-friendly diet of fiber-rich foods, fermented sauerkraut, and probiotic-rich yogurt, may help nourish a wider range of gut bacteria and support a healthy colon function.
- Get enough vitamin D: A 2021 study found that a daily intake of 300 IU of daily vitamin D—the equivalent of 3 glasses of milk—was associated with a 50% reduced risk of developing early-onset colorectal cancer.
Related: The top 5 proactive health habits our doctors rely on all year long
Why screening is important
Statistics show that starting the recommended colonoscopies at age 45, and keeping up with screenings, can help keep an eye on things. A polyp can take as many as 10 to 15 years to develop into cancer. Colonoscopies enable doctors to help identify polyps early and remove them before they potentially turn malignant.
Colonoscopy remains the gold standard method of testing for colorectal cancer. It allows for direct visualization inside the colon and the ability to remove polyps if detected during the diagnostic procedure.
When it comes to colorectal cancer, catching it early is key. And colonoscopies are now available for younger demographics. In 2021, the U.S. Preventive Services Task Force (USPSTF) lowered the recommended starting age for average-risk screening from 50 to 45 in response to the rising rates of early-onset colorectal cancer. Earlier screening may be recommended for those with family history or symptoms.
Other screening options include stool tests, and a sigmoidoscopy, which involves a small flexible scope looking at the lower part of the colon. Some testing is also performed via a capsule endoscopy, where a small, pill-sized camera is swallowed that takes a video inside the large intestine.
Screening frequency for colonoscopies varies by an individual’s risk factor but is often performed every 10 years in average-risk patients.
In addition to recommended screenings, like colonoscopies, many people are taking a proactive approach to their health and looking for ways to better understand what’s going on inside their bodies. That’s where Prenuvo may fit in. Prenuvo is not a screening or diagnostic test for colorectal cancer and it is not a replacement for recommended colorectal cancer screening, but it can complement a broader, proactive-focused health plan.
A Prenuvo Whole Body Scan looks at multiple organ systems at once and may help identify certain conditions before symptoms appear, giving patients detailed health information and helping them take a more proactive role in their health.
To learn more about the benefits of whole body MRI and other Prenuvo services including Body Composition Analysis and advanced blood panel testing, book a call with a member of our Patient Services Team.
