In recent years, a startling trend has emerged within the realm of oncology: a growing number of younger individuals are being diagnosed with colorectal cancer. Specifically, those born after 1990 are seeing an unprecedented rise in cases, which has become a cause for concern within the medical community. Once considered a disease primarily affecting older adults, colorectal cancer is now shifting demographics, and the reasons behind this shift are as complex as they are alarming.

An Unsettling Rise in Numbers

According to the American Cancer Society, colorectal cancer rates have been declining overall in the United States, primarily due to increased awareness, improved screening methods, and advancements in treatment. However, this decline is not universal. The incidence of colorectal cancer among individuals under the age of 50 has been steadily rising. In fact, for those born around 1990, the risk of developing colorectal cancer is twice as high as those born in 1950, and their risk of rectal cancer is quadruple.

This shift is especially concerning given that colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, and it remains a leading cause of cancer-related deaths. While older adults continue to be the most affected group, the sharp rise in diagnoses among younger adults suggests that new factors are at play.

Understanding the Causes

While there is no single definitive explanation for this uptick in cases, researchers have identified several possible contributing factors that may be fueling this trend:

• Diet and Lifestyle Changes: Western diets, characterized by high consumption of processed meats, red meat, and refined grains, have long been associated with an increased risk of colorectal cancer. Over the past several decades, dietary habits have shifted, particularly with the increased availability of highly processed, low-fiber foods. Studies have shown that diets high in fiber, fruits, and vegetables may reduce the risk of colorectal cancer, while a lack of these foods may contribute to a higher risk.
• Obesity and Sedentary Lifestyles: The rates of obesity have dramatically increased in younger populations, and obesity is a well-established risk factor for colorectal cancer. Excess body fat, particularly around the abdomen, is thought to cause inflammation and hormonal changes that can promote cancer growth. Coupled with sedentary lifestyles, the lack of regular physical activity may further contribute to the rising incidence in younger adults.
• Gut Microbiome and Inflammation: The gut microbiome— the trillions of bacteria and microorganisms living in the digestive tract—plays a critical role in overall health, including cancer prevention. Disruptions in the microbiome, often due to poor diet, antibiotic use, or other environmental factors, may lead to increased inflammation, which is a known precursor to cancer development. Research is still ongoing, but this connection could help explain why younger adults are increasingly affected by colorectal cancer.
• Delayed Screening and Lack of Awareness: Traditionally, routine colorectal cancer screening is recommended starting at age 45 for those at average risk. However, because colon cancer has been viewed as a disease of older adults, many younger individuals and healthcare providers may not suspect or prioritize screening in this age group. As a result, symptoms like rectal bleeding, abdominal pain, or changes in bowel habits may be overlooked or attributed to other causes, leading to later-stage diagnoses.

Changing the Narrative Around Screening

Recognizing the increasing prevalence of colorectal cancer in younger individuals, the U.S. Preventive Services Task Force (USPSTF) recently updated their guidelines to lower the recommended screening age from 50 to 45 for individuals at average risk. This change is significant and aimed at identifying cases earlier when the cancer is more treatable. However, despite this shift, awareness remains a critical issue.

For younger people, especially those with no family history of colorectal cancer, the idea of screening may still seem distant or unnecessary. However, the rising incidence underscores the need for greater vigilance in recognizing symptoms and being proactive about screening, particularly for those who may be at higher risk.

What Can Be Done?

While more research is needed to fully understand why colorectal cancer is increasing in younger populations, there are clear steps that individuals can take to reduce their risk:

• Maintain a healthy diet: Prioritize a diet rich in fruits, vegetables, whole grains, and lean proteins. Reducing the consumption of processed foods and red meat can also help lower cancer risk.
• Exercise regularly: Aim for at least 150 minutes of moderate-intensity activity each week, as regular exercise has been shown to reduce the risk of colorectal cancer.
• Know your family history: If colorectal cancer runs in your family, you may need to start screening earlier than the general population. Speak with your healthcare provider about personalized screening recommendations.
• Pay attention to symptoms: Rectal bleeding, persistent abdominal pain, unexplained weight loss, and changes in bowel habits should never be ignored, regardless of age. If you experience any of these symptoms, it’s important to consult a healthcare professional.

The Road Ahead

As the medical community continues to grapple with the growing incidence of colorectal cancer in younger adults, it’s crucial that both healthcare providers and patients remain aware of the changing dynamics of this disease. Early detection through timely screening, coupled with lifestyle modifications, offers the best hope for reducing the impact of this concerning trend.

By raising awareness and addressing risk factors head-on, we can work toward a future where colorectal cancer no longer claims the lives of so many young individuals. It’s a challenge that demands attention, but with the right strategies in place, it’s one we can meet head-on.

 

Editorial feature from the 2025 NJ Top Docs Issue of Healthy Living Magazine