By Russell R. Barksdale, Jr
Cancer has long been associated with aging, as its prevalence increases due to the accumulation of genetic mutations, cellular damage, and decreased immune surveillance over time. Yet, an alarming and underreported crisis is unfolding—colorectal cancer (CRC) rates in younger adults have nearly doubled since the 1990s. This is in stark contrast to the declining CRC rates among older adults.
So why has this seismic shift remained largely in the shadows? The answer may lie in the overwhelming noise of today’s media landscape, where critical public health crises can be drowned out by the barrage of global headlines. But when have we ever witnessed such a dramatic surge in cancer among our youth while simultaneously seeing improvements in our senior population? This glaring paradox should serve as a wake-up call, compelling public health agencies to mobilize resources, ramp up research funding, and pinpoint their root causes. Failure to act reflects the growing dysfunction within federal health programs, dwindling confidence in their capabilities, and a fractured system of oversight and funding priorities.
This disturbing trend could be just the tip of a much larger iceberg—one that, if left unchecked, might herald an even broader health emergency for our younger generation.
A Deadly Shift in Cancer Trends
According to a recent 2024 report, colorectal cancer has catapulted to the leading cause of cancer death in men under 50 and the second-leading cause in women under 50, trailing only breast cancer. Two decades ago, CRC ranked fourth in cancer-related deaths for both groups. What’s driving this shift?
Certain risk factors—family history of CRC or polyps, inflammatory bowel disease—are well-established contributors, yet genetic explanations alone fail to account for the dramatic rise in early-onset cases. Instead, experts have been left speculating about a range of potential culprits: the modern diet laden with low-fiber, high-fat, processed foods; excessive sugar consumption; chronic inflammation from environmental toxins; sedentary lifestyles exacerbated by screen addiction; exposure to microplastics and chemicals like triclosan; or a surge in inflammatory conditions such as Crohn’s disease and irritable bowel syndrome. The sheer breadth of possible factors underscores the urgent need for a more targeted research agenda.
Whatever the cause, the data is undeniable. Early-onset CRC (diagnosed in individuals under 50) has been rising globally at a rate of 2% to 4% annually since the 1990s, with the most dramatic increases seen in those under 30. Notably, 37% of CRC cases in younger adults originate in the rectum, compared to just 24% in those over 65. The disproportionate impact on younger individuals makes it all the more critical to identify—and mitigate—whatever is fueling this surge.
The Challenges of Early Diagnosis
Unraveling the mystery behind early-onset CRC has been frustratingly slow. Most studies have been limited in scope, investigating only single contributing factors rather than the complex interplay of genetic, environmental, and lifestyle influences.
Meanwhile, younger patients face an additional, deadly challenge: delayed diagnosis. Many are diagnosed at more advanced stages, despite having fewer overall health complications. This suggests that younger individuals may either be dismissing early warning signs—constipation, rectal bleeding, sudden bowel changes—or are not being taken seriously by healthcare providers because of their age. It also raises another disturbing question: Is the disease itself becoming more aggressive in younger patients?
Recognizing this trend, the U.S. Preventive Services Task Force (USPSTF) and the U.S. Multisociety Task Force on Colorectal Cancer recently revised their screening recommendations, lowering the suggested age for routine CRC screening from 50 to 45. While a step in the right direction, it may not be enough.
A Tale of Two Generations
Colorectal cancer is still most commonly diagnosed in individuals over 65, yet paradoxically, incidence in this older cohort is declining. Even more striking, older patients are less likely than their younger counterparts to be diagnosed with advanced disease. What explains this discrepancy?
One factor may adherence to routine colonoscopies. Early detection through colonoscopy allows for the removal of precancerous polyps before they develop into full-blown malignancies, offering a major protective benefit to seniors. Despite the stigma surrounding the procedure’s preparation, colonoscopy remains the gold standard for CRC screening—and it saves lives.
Meanwhile, researchers are making strides in molecular tumor profiling, a breakthrough that analyzes the DNA and biological markers of tumor tissues to guide targeted treatment strategies. This emerging field holds promise in improving outcomes, but prevention and early detection remain the most powerful weapons in combating this growing crisis.
A Call to Action: No More Ignoring the Warning Signs
Despite being a highly treatable disease when caught early, a colorectal cancer diagnosis can be devastating—especially for younger individuals who never expected to face such a battle.
We can no longer afford complacency. The rise of colorectal cancer among younger generations signals an urgent need for increased awareness, research, and prevention efforts. If we fail to act, we risk overlooking the early warning signs of a broader health crisis that could have devastating consequences for our younger generation.
Russell R. Barksdale, Jr., Ph.D, MPA/MHA, FACHE is President & CEO of Waveny LifeCare Network
