A Troubling Trend: Why Colorectal Cancer Is Increasing Among Younger Adults
Introduction
A troubling trend is reshaping cancer outcomes in younger adults: colorectal cancer has become the deadliest cancer for Americans under 50.
This distinction marks a sharp change from the early 1990s, when the disease was far less prominent within that population. Researchers, however, report that deaths in this age group have risen steadily since 2005, increasing by about 1.1 percent each year.
Even before screening guidelines lowered the recommended age for colonoscopies to 45, physicians were already observing increasing numbers of younger patients undergoing colonoscopy for unrelated reasons who were found to have colorectal cancer or advanced precancerous growths.
“This is an active area of research currently. Initial theories have always pointed to ultra-processed foods and lack of fiber,” said Dr. Mohamad A. Abdulhai, general surgeon for the Division of Colorectal Surgery at the University of Illinois Chicago (UIC). “Here, we continue to confront this trend through early detection initiatives and proactive education.”
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The Leading Cause of Cancer-Related Deaths in Young People
The tumors develop in the colon or rectum, typically beginning as small growths, or polyps, that form along the inner lining of the large intestine.
More commonly seen in adults over the age of 50 due to the cancer development being closely linked to aging, long-term environmental and lifestyle exposures. As a result, colorectal cancer was long considered a disease primarily affecting older adults, making the recent rise among younger populations particularly concerning to clinicians and researchers.
Younger patients who develop colorectal cancer without known risk factors are unlikely to undergo preventive testing, meaning the disease often goes undetected until symptoms appear.
This underscores the need for greater awareness, earlier symptom evaluation, and continued research into why there is a rise in colorectal cancer in young adults who fall outside traditional screening guidelines.
Links to Family History and Genetics
“We strongly encourage everyone to ask their families about any medical histories to anticipate and catch any diseases as early as possible,” said Dr. Abdulhai. “Initial screenings should be 10 years before a relative was diagnosed. For instance, if a patient discovers a parent was diagnosed at age 40, your first colonoscopy should be at age 30.”
This is where genetic counselors play a pivotal role, helping patients understand their inherited cancer risk by reviewing family histories and recommending appropriate genetic testing when needed. They also guide patients and families through screening strategies and prevention plans.
Dr. Abdulhai and his team also examine how colorectal cancer affects diverse populations differently. Incidence rates vary across racial and ethnic groups, including among Hispanic communities from different regions of the world.
“At UIC, we have a Spanish-speaking clinic, so we see a fair amount within the Hispanic population,” Dr. Abdulhai said, emphasizing the importance of culturally responsive care and research. “We encourage our patients to talk with their families and urge loved ones to seek evaluation as well. In many cases, we end up caring for entire families—particularly within Hispanic communities, where barriers related to education and access to care still exist despite higher risks.”
Dr. Mohamad A. Abdulhai
Our goal is simple: We want to detect cancer earlier, treat it more precisely, and make sure no community is left behind.
Signs and Symptoms
Delayed diagnosis remains a significant challenge in early-onset colorectal cancer, driven in part by limited awareness among both patients.
Changes in bowel habits, including new and persistent constipation, unexplained weight loss, or ongoing fatigue, can signal the need for further evaluation. Consistent rectal bleeding is another warning sign that many people disregard as just hemorrhoids or irritation, further delaying evaluation.
Fertility in Younger Patients
Treating younger patients with colorectal cancer also requires physicians to consider long-term quality-of-life issues that may not arise as frequently in older populations. For many young adults, future fertility is a significant concern. Radiation and surgery must be carefully planned to preserve reproductive potential whenever possible.
For women with rectal cancer who qualify for radiation, surgeons can perform a procedure to reposition the ovaries outside of the radiation field to help prevent damage.
Similarly, young men are often counseled about sperm banking prior to beginning radiation therapy. These proactive steps allow patients to move forward with treatment while preserving their future options.
UIC’s Mission and Research
“Our division at UIC has made strides over the years to offer access and education, especially to communities that might not otherwise receive timely screening or specialized colorectal care,” said Dr. Abdulhai. “We have a dedicated multidisciplinary tumor board, where we often meet to discuss every patient’s needs to succeed over their cancer journey.”
The team collaborates closely with gastroenterologists, oncologists, radiologists, and support specialists to develop individualized treatment plans for each patient’s diagnosis and needs.
UIC’s Division of Colorectal Surgery is also advancing research and outreach efforts to improve outcomes for future patients. Through its biorepository program, tissue samples from active cancer patients are studied to better understand the genetic mutations that drive colon and rectal cancers. Identifying these molecular differences may help physicians develop more personalized treatments, including targeted immunotherapies.
The team also offers various screening methods. While colonoscopy remains the gold standard, UIC offers additional options such as at-home stool-based tests, including the Fecal Immunochemical Test (FIT) and Cologuard, helping reduce barriers to early detection.
“Our goal is simple,” said Dr. Abdulhai. “We want to detect cancer earlier, treat it more precisely, and make sure no community is left behind.”