Recognize the symptoms, know the risk: Colorectal cancer cases on the rise for patients under 50

For years colorectal cancer was considered an older person’s disease. But that has recently changed. According to a 2024 report from the American Cancer Society, two decades ago colorectal cancer was the fourth leading cause of cancer death in both men and women under age 50. It is now first in men and second in women (second to breast cancer).

“This recent trend in colorectal cancer found in young people caught our society by surprise,” says Dr. Bob Etemad, Medical Director at the Gastroenterology and Hepatology Center at Valley View. “We did not expect we would see this dramatic trend and to see it steadily rising among young people under the age of 50. Younger people are not only getting colorectal cancer but they are dying from the disease. This may suggest young people who are getting the disease are getting an aggressive form or it’s not being caught at an early stage.”

According to Dr. Etemad, there are a number of causes that may have contributed to this steep increase in advanced cases of colorectal cancer. “Obesity continues to be an issue in young people,” says Dr. Etemad. “Diabetes is more common, and an increase in ultra-processed food in the diet is a concern.”

Other increased risk factors include a sedentary lifestyle, obesity, smoking, heavy alcohol use, low-fiber, high-fat diets or diets high in processed meats, and some environmental factors. Additionally, a family history of colorectal cancer or polyps, and conditions such as inflammatory bowel disease, are also risk factors.

Young people should be aware that colorectal cancer is something that could affect them and to be aware of its rising prevalence, says Dr. Etemad. Many young people don’t have colorectal cancer on their radar and often ignore symptoms such as constipation, consistent rectal bleeding, sudden changes in bowel movements, or a change in the caliber of the stool. “In general,” says Dr. Etemad, “if a young person notices there is persistent frequent blood from the rectum, they need to mention it to their primary care provider. This may help the young person tease out other symptoms that might be serious.”

To accurately diagnose colorectal cancer, a patient should undergo screening measures, these include a rectal exam and/or a colonoscopy. Dr. Etemad notes he now recommends routine colonoscopies beginning at the age of 45, five years younger than the previous recommendation of 50. (This recommendation correlates with the U.S. Preventive Services Task Force and the U.S. Multi-society Task Force on Colorectal Cancer, two groups that provide preventive guidelines, which also recommended that most Americans be screened for colorectal cancer at age 45.)

Dr. Etemad notes that for some, a colonoscopy could take place even earlier. “For those at higher risk, meaning if you have a family history of the cancer, your doctor may recommend colonoscopy screening at 40 or 10 years before the age when your family member was diagnosed.”

If there is good news, it is that colorectal cancer, when found early, is highly treatable.

“This is a very treatable cancer when caught early,” says Dr. Etemad. “More often than not, patients are referred to a multi-disciplinary team of doctors and support professionals at Valley View – medical oncologist, surgeon, geneticists, radiation oncologist, and gastroenterologist. All parties get involved.”

He also notes that surgery for both colon and rectal cancers can be highly successful—even for patients with advanced disease. Additional chemotherapy and the need for radiation therapy, may also apply.

Dr. Etemad notes there are ways to prevent the early onset of colorectal and other types of cancer. “Whatever process that leads to cancer also has a lead time,” he says. “The onset of cancer may very well be 10 years or more before diagnosis. So far, as we know, tobacco and alcohol both are contributors to an increase in colorectal cancer, and that diet can be a significant contributor to the development of the environment that might lead to the changes that then leads to cancer.”

A healthy diet as defined by science includes, minimum consumption of highly processed food, a diet rich in fruits and vegetables, eating foods higher in fiber and a diet sparse in sugars and sugared drinks. “A diet that does not promote obesity is important,” says Dr. Etemad, “and there is definitely a protective effect in exercise and regular physical activity.”

“People should continue to take personal ownership of their health,” he says. “There are many information resources available to people. Taking personal responsibility and investing in a healthy lifestyle early in your life sets the stage for a pattern of living that generally reduces the risk of cancer in the future.”