Rising Colorectal Cancer Rates: What You Need to Know

While overall colorectal cancer diagnoses have been decreasing in the U.S., likely due to increased screenings and lifestyle changes, a concerning trend is emerging: a rise in cases among individuals under 50. Colorectal cancer – encompassing cancers of the colon and rectum – is now the leading cause of cancer death in this younger demographic.

Why is Colon Cancer Rising in Young People?

Several factors are associated with the increase in early-onset colorectal cancer. Some of these are modifiable, meaning you can change your behavior to reduce your risk. These include:

• Obesity
• A diet high in processed foods and sugar-sweetened beverages, with limited fiber
• A sedentary lifestyle
• Cigarette smoking
• Heavy alcohol consumption

Recent research highlights the impact of ultraprocessed foods, suggesting that increased consumption of these foods may elevate the risk of developing early-onset colorectal cancer.

“I encourage all patients who are concerned about their cancer risk to quit smoking, aim for 150 minutes of exercise a week, and incorporate fruits and vegetables for increased fiber intake,” says Dr. Sheila Rustgi, a gastroenterologist at NewYork-Presbyterian/Columbia University Irving Medical Center.

Who is at Risk for Colorectal Cancer?

Colorectal cancer is the third most commonly diagnosed cancer in both men and women in the United States. While genetic predispositions can increase risk, colorectal cancer can occur even without a family history. African Americans are disproportionately affected, being about 20% more likely to get colorectal cancer and about 40% more likely to die from it.

When Should I Get Screened for Colorectal Cancer?

The U.S. Preventive Services Task Force updated its guidelines in 2021 to recommend that everyone begin screening for colorectal cancer at age 45, regardless of family history. This aligns with the American Cancer Society’s guidelines, which were updated in 2018.

“Colorectal cancer can affect everyone, and screening saves lives,” says Dr. Rustgi.

If you have a family history, consider getting screened ten years earlier than the age at which your relative was diagnosed (or at 40, whichever comes first). Discuss any persistent changes in bowel habits, rectal bleeding, persistent abdominal discomfort, or a feeling of incomplete bowel emptying with your doctor, regardless of age, and consider a colonoscopy.

Is a Colonoscopy Painful?

A colonoscopy is an exam used to detect abnormalities in the large intestine (colon) and rectum. It’s performed while the patient is under anesthesia, ensuring no pain during the procedure.

Preparation for a colonoscopy is generally painless. “The day before your colonoscopy, you can work normally, but you’ll be on a limited diet, such as clear liquids like chicken broth or a small, low-fiber breakfast like eggs and white toast,” explains Dr. Rustgi. “You’ll also be prescribed a laxative solution to drink in stages, which flushes out the colon. It doesn’t taste good and can be a little nauseating, but it shouldn’t be painful.”

The procedure itself typically takes 30-45 minutes, during which gastroenterologists search for and remove any polyps. Removing these small clumps of cells that form on the lining of the colon can prevent them from developing into tumors. Colonoscopies remain the gold standard for preventing and detecting colon cancer, being both safe and effective.

“A colonoscopy is a relatively small inconvenience compared to potentially missing an early-onset colorectal cancer,” says Dr. Rustgi. “It’s one day of your life, hopefully not more frequent than once every 10 years, to prevent colon cancer.”

What Else Can You Do to Prevent Colorectal Cancer?

Beyond colonoscopies, noninvasive stool-based screening tests offer a convenient way to detect colorectal cancer early, when it’s most treatable. These tests don’t require special diets or procedures and can be completed at home and sent to a lab for analysis.

These tests are suitable for individuals at average risk (no family history or prior polyps) who may face barriers to colonoscopy, such as time off work or childcare needs. However, it’s crucial to note that stool-based screenings cannot match the benefits of a colonoscopy, as they don’t allow for the removal of precancerous polyps. “If a stool-based screening test is positive, you will need to have a colonoscopy to discover out why,” says Dr. Rustgi.

“The most important thing is to get screened when you need to,” says Dr. Rustgi. “You can discuss with a doctor what the best option is for you in your personal situation — whether that’s a colonoscopy or a stool-based test.”