What Young Adults Need to Know About Colorectal Cancer

When many people think about colorectal cancer, they think it only affects older adults. That is no longer true.

First, the good news: The rates of colorectal cancer (cancers of the colon and rectum) have been declining over the past 40 years, thanks to regular screenings and lifestyle choices such as healthy eating, staying active, and avoiding smoking.

Now, the bad news: While the incidence of colorectal cancer is declining overall, it is not declining for everyone. For people younger than 55, the rates of colorectal cancer have actually increased 1 to 2 percent per year since the mid-1990s.

“Most people with colorectal cancer are still over the age of 50,” says Ashan T. Hatharasinghe, DO, a gastroenterologist with UNC Health Blue Ridge Digestive Health. “But we are seeing more younger patients than we did in the past, and that trend has continued over time. Colorectal cancer just recently became the leading cause of death in people under 50.”

Why Are More Younger Adults Being Diagnosed?

Family history is one of the strongest risk factors for colorectal cancer, but many younger patients do not have a known genetic risk.

“Most younger patients we see do not have a family history or inherited condition,” Dr. Hatharasinghe says. “That suggests lifestyle and environmental factors may play a role, although there is still a lot we are learning.”

Researchers are studying several possible contributors, including diets high in ultraprocessed foods and red or processed meats, low fiber intake, obesity, smoking and vaping, and limited physical activity. Environmental exposures are also being explored. There is likely no single cause, but a combination of factors over time.

Symptoms You Should Not Ignore

Colorectal cancer often does not cause symptoms early on. When symptoms do appear, they can be easy to dismiss.

Talk with your primary care provider if you have any of the following that do not go away:

• Blood in the stool or ongoing rectal bleeding
• A change in bowel habits, especially new constipation or diarrhea
• Ongoing abdominal pain or cramping
• Unexplained weight loss
• Anemia or ongoing fatigue

“These symptoms are common and often caused by conditions like hemorrhoids or irritable bowel syndrome,” Dr. Hatharasinghe says. “That does not mean you should panic. But if symptoms are persistent, they need to be checked.”

If symptoms raise concern, your provider may recommend further testing or a referral to a gastroenterologist.

Why Colorectal Cancer Can Be More Serious for Younger Adults

Colorectal cancer outcomes have improved significantly for older adults over the past several decades. That same progress has not been seen in younger patients.

“One reason is that younger adults are often diagnosed later,” Dr. Hatharasinghe says. “By the time symptoms lead to testing, the cancer may already be more advanced.”

Younger patients may also face unique challenges during treatment, including fertility concerns, caring for young families, and maintaining employment during care. These factors are carefully considered when developing a treatment plan.

Screening Saves Lives

For adults at average risk, colorectal cancer screening should begin at age 45. Some people may need to start earlier if they have a family history, certain medical conditions, or previous polyps.

Screening looks for cancer before symptoms start and can also find precancerous polyps that can be removed before they turn into cancer.

Screening options include:

• Colonoscopy, which allows doctors to see the entire colon and remove polyps during the same procedure
• Stoolbased tests that look for blood or abnormal DNA in stool and can be done at home

If a stool test is abnormal, a colonoscopy is needed to complete screening.

“Colonoscopy remains the most effective test because it can both detect and prevent cancer,” Dr. Hatharasinghe says. “Polyps can occasionally cause bleeding and/or anemia but generally do not present with symptoms. Removing them early can stop cancer before it starts.”

Lowering Your Risk at Any Age

You can lower your risk for colorectal cancer by making healthy choices:

• Eat a high-fiber diet with fruits, vegetables, and whole grains
• Limit ultraprocessed foods and red or processed meats
• Be physically active. Aim for at least 150 minutes of moderate activity each week
• Limit alcohol
• Avoid smoking and vaping

Even if you feel healthy, screening is still important.

“A little discomfort now can prevent a lifechanging diagnosis later,” Dr. Hatharasinghe says. “Getting screened is one of the most important steps you can take for your longterm health.”

Five Reasons to Consider a Colonoscopy

1. It is painless and done with sedation
2. The test is quick
3. Forget the horror stories. Preparation is better and easier than many people expect
4. You may not be too young to need one
5. It can prevent cancer and save your life