You might think of colorectal cancer as a condition that only affects older people. While it’s true that the risk rises as you age, an increasing number of younger adults are developing the disease.
For adults under age 50, the rate of colorectal cancer diagnosis rose 2.2 percent each year from 2011 to 2016, according to a March 2020 report from the American Cancer Society (ACS). The rate also increased about 1 percent annually in Americans aged 50 to 64. At the same time, it dropped 3 percent each year for seniors.
But that’s not all. The ACS report found that between 2008 and 2017, the colorectal cancer death rate for people under 50 increased 1.3 percent yearly. In those aged 50 and up, it decreased, due in part to more screening.
“People can get colon cancer under 50,” says Rya Kaplan, MD, a gastroenterologist with Trident Medical Center in Charleston, South Carolina. “It’s not the norm, but it can happen.” That's part of the reason the ACS updated its screening guidelines in May 2018. The organization recommends beginning at age 45 for people of average risk, rather than age 50. In May 2021, the U.S. Preventive Services Task Force also lowered its recommended age to begin screening from 50 to 45.
Colorectal cancer is the second leading cause of cancer deaths in the United States, according to the U.S. National Cancer Institute. About 90 percent of people diagnosed with the disease live five or more years if their cancer is found early.
Evidence for younger screening
According to a February 2017 study in the Journal of the National Cancer Institute, while colorectal cancer has generally declined in people over the age of 55 since the 1970s and 80s, it has risen for people younger than 55. “We are certainly seeing younger patients with colorectal cancer more frequently,” says Keith Roach, MD, associate professor in clinical medicine in the division of general medicine at Weill Cornell Medical College and New York Presbyterian Hospital.
Another study, published in the journal Cancer in March 2016, found that of more than 258,000 people with colorectal cancer, about one in seven developed it before age 50. The ACS estimates that about 12 percent of new cases diagnosed in 2020 will occur in this age group.
Eating too much red meat and too little fiber might increase a person's risk of colorectal cancer, as can insufficient exercise and excess body weight. In fact, an October 2018 study published in JAMA Oncology linked obesity and weight gain in young adulthood to a higher colorectal cancer risk in women under 50.
Current screening guidelines
Without screening, most people under the age of 50 won’t know they have colorectal cancer until symptoms show up, and by then it has probably already spread, says Dr. Kaplan. At later stages, younger people who undergo colorectal cancer surgery are more likely to get potentially debilitating chemotherapy after the operation, but are no more likely to survive, according to a January 2017 study published in JAMA Surgery.
While guidelines now recommend that people at average risk for colon cancer start screening at age 45, those at a higher risk may need to start sooner. “People with a family history of colon cancer or people with polyps will probably be screened earlier,” says Kaplan.
They're not the only ones. “Higher rates are seen in people of lower socioeconomic status, possibly due to lower physical activity, unhealthy diet, smoking, obesity and lower screening rates,” says Julia Saylors, MD, a medical oncologist also with Trident Medical Center. And, African Americans have the highest rates of colorectal cancer of any ethnic group in the U.S. That could be partially due to genetic factors, but also because they’re less likely to be screened, says Dr. Saylors.
The ACS says the most important thing is to get screened, no matter which test you choose, and there are several options.
- Colonoscopies should be done every 10 years.
- Fecal tests need to be repeated every one to three years, depending on the specific test used.
- CT colon scans and flexible sigmoidoscopies are done every five years.
What you can do
If you have an increased risk of colorectal cancer or other types of cancer, talk to your healthcare provider (HCP) about when you should start screening. Also, be aware of colorectal cancer symptoms and see your HCP if you have:
- Blood in your stool
- Narrow stool
- Change in bowel habits
- Unexplained weight loss
- Fatigue or weakness
- Cramps or bloating
No matter your age, healthy habits can reduce your risk of colorectal cancer. These include:
- Eating a high-fiber, low-fat diet and limiting red and processed meat
- Drinking alcohol sparingly
- Maintaining a healthy weight
- Not smoking
Getting regular physical activity is also a good way to help lower your odds. In one 2016 meta-analysis in the British Journal of Sports Medicine, researchers found that the most physically fit individuals had a 19 percent lower risk of colorectal cancer than the least physically fit individuals. It’s just another good reason to get moving.
