Understanding Colorectal Cancer
Colorectal cancer (cancer of the colon or rectum) has long been seen as an older person’s disease. However, rates are rising among people under 50, a trend often called young-onset colorectal cancer (YO-CRC) or early-onset colorectal cancer (EOCRC). In fact, colorectal cancer is now one of the leading causes of cancer death in adults under 50.
Over the past three decades, EAO-CRC rates have surged, now accounting for approximately 10% of all colorectal cancer cases. By 2030, projections indicate that 11% of colon cancers and 23% of rectal cancers will occur in younger adults. This rising trend has led to changes in screening guidelines and an urgent need for increased awareness.
Risk Factors Associated with Early-Onset Colorectal Cancer
Understanding the risk factors can help you gauge your own risk and take proactive steps.
Some risk factors are beyond your control, while others are related to lifestyle and can be changed.
Diet: Eating a diet high in red and processed meats (like beef, bacon, hot dogs) is linked to higher colorectal cancer risk. Diets low in fiber, fruits, and vegetables may also raise risk. Conversely, diets rich in veggies, fruits, and whole grains are thought to lower risk.
Weight and Inactivity: Being overweight or obese increases your risk of developing colorectal cancer (especially in men). A sedentary lifestyle (not getting regular exercise) is also associated with higher risk. Staying active and maintaining a healthy weight can help reduce your risk.
Gut Health: A bacterial imbalance in the gut may play a role.
Chronic Inflammation: Chronic inflammatory conditions of the colon like ulcerative colitis or Crohn’s disease raise the risk of developing colorectal cancer, especially after many years of active disease. (This is not the same as IBS, which does not increase cancer risk.)
Inherited Genetic Syndromes: Lynch syndrome, familial adenomatous polyposis (FAP), and other hereditary conditions account for 20-30% of colon cancer diagnoses, but the majority of people with colon cancer and the majority of young people with colon cancer do not have a known genetic predisposition.
Race and Ethnicity: African Americans have higher colorectal cancer incidence and death rates than other groups. Experts recommend that Black adults be particularly vigilant about screening and early detection. (Ashkenazi Jewish heritage is also associated with higher risk, due to certain genetic factors.)
LGBTQ+: Individuals are less likely overall to receive screening or have less access to care. However, gay and bisexual men are more likely to receive colon cancer screen than heterosexual men.
Family History: If a first-degree relative (parent, sibling, or child) had colorectal cancer or advanced polyps, your risk is significantly higher. The risk is especially high if your relative was diagnosed young (before 50) or if you have multiple affected relatives.
Smoking: Long-term tobacco smoking doesn’t just harm your lungs – it’s linked to a higher risk of colon and rectal cancers as well. Smokers are also more likely to develop polyps that can turn into cancer. Quitting smoking can reduce this risk (and has countless other health benefits).
Alcohol: Heavy alcohol use is associated with greater colorectal cancer risk. Even moderate drinking might contribute. For cancer prevention, it’s best to limit alcohol to no more than 2 drinks a day for men and 1 for women (or even less)
Tip: Even if you’re young, discuss your risk factors with your doctor. They may recommend earlier or more frequent screening if you have significant risks (for example, a strong family history or IBD).
Common Symptoms to Watch For
Early colorectal cancer may not cause obvious symptoms, but there are several warning signs that should never be ignored, especially in a younger person:
BLOOD IN YOUR POOP
Finding bright red blood on toilet paper or in the toilet bowl, or dark/black poop indicating older blood, is a red flag. Don’t assume it’s just hemorrhoids—get it checked.
CHANGES IN YOUR POOP
Persistent diarrhea, constipation, or narrowing of the stool that lasts more than a few days. You might also feel like you need to poop even after going.
BELLY PAIN OR CRAMPING
Ongoing lower stomach pain, cramping, bloating, or gas pains that don’t go away with usual remedies should be evaluated.
UNEXPLAINED WEIGHT LOSS
Losing weight without trying – when you haven’t changed your diet or exercise – could be a sign of an underlying issue like colorectal cancer.
Many of these symptoms can be caused by other conditions (hemorrhoids, IBS, infections). But it’s vital to see a doctor if any of these issues persist more than a couple of weeks. When it comes to your health, it's better to be safe and get tested. Catching colorectal cancer early makes a huge difference in outcomes.
you know your body best
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you know your body best ✼
Many younger patients face delayed diagnoses because providers dismiss symptoms as IBS, hemorrhoids, or diet-related. If your symptoms persist, insist on further evaluation. If a provider is hesitant, ask for a referral to a colorectal surgeon or gastroenterologist for a second opinion. Keep track of symptoms in a journal, including frequency, severity, and any patterns—this helps make a stronger case when speaking with a doctor.
If you're experiencing symptoms (such as blood in the stool, persistent changes in bowel habits, or unexplained weight loss), demand further testing. Do not accept "you're too young" as an answer.
Survival Statistics and Trends in Younger Patients
Understanding the statistics can highlight why action is so important – but also provide hope. Here are some key facts and trends:
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High Survival if Caught Early
Colorectal cancer is very treatable in early stages. The 5-year survival rate is around 90% when the cancer is diagnosed at a localized early stage. This is why screening and early detection are critical. However, if the cancer has spread to distant organs (stage IV), 5-year survival drops to about 14%. Early detection truly can be life-saving.
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Overall Survival
Across all stages and ages, the average 5-year survival rate for colorectal cancer in the U.S. is roughly 64-67% (it varies a bit by demographic). Survival rates have been improving over past decades thanks to better treatments and earlier detection.
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Colorectal Cancer is Common
It’s the fourth most common cancer diagnosis in the United States and the second leading cause of cancer death when men and women are combined. About 150,000 Americans will be diagnosed with colon or rectal cancer this year, and over 50,000 will die from it. This disease affects both men and women nearly equally.
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Rising Cases in Young Adults
Unlike older adults (who have seen declining rates due to screening), younger adults are seeing an increase in colorectal cancer. Young adults are the only age group in which new colorectal cancer cases are climbing. About 10% of colorectal cancers are now diagnosed in people under 50, and about 20% in people under 55 – double the proportion in 1995. This is an alarming shift.
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More Advanced Disease in the Young
Not only are cases rising in the under-50 crowd, but these cancers are often found at a later stage. Rates of advanced (metastatic) colorectal cancer in younger patients have been increasing ~3% each year. This may be because routine screening wasn’t happening before 50, and symptoms can be overlooked in younger people. It underscores why awareness is so important.
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Deadliest Cancer in Young Men
Recent data show that among Americans ages 20–49, colorectal cancer has become the #1 cause of cancer death in men and #2 in women (after breast cancer in women). This is a striking change from a couple decades ago. It’s a wake-up call that colorectal cancer can and does affect younger people – sometimes with tragic outcomes, as seen in the next section.
Celebrity Colorectal Cancer Cases
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Chadwick Boseman (1976–2020) – Actor
Diagnosed with Stage III colon cancer in 2016, Chadwick Boseman privately battled the disease while continuing to star in major films. Despite undergoing multiple surgeries and chemotherapy, he never publicly disclosed his illness. He passed away in 2020 at age 43, sparking global conversations about young-onset colorectal cancer and the importance of early detection.
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![James Van Der Beek. PHOTO: Emma McIntyre via Getty]()
James Van Der Beek (born 1977) – Actor
Famous for portraying Dawson Leery on the teen drama series Dawson's Creek, James Van Der Beek announced in November 2024 that he had been diagnosed with stage 3 colorectal cancer. He has been undergoing treatment and remains optimistic about his recovery, continuing to work and spend time with his family.
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These stories, while sobering, reinforce that colorectal cancer can impact anyone – young or old, famous or not. They also show the importance of early detection and advocacy. Many of these individuals have saved lives by publicly encouraging others to get screened after learning from their experiences.
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⚕︎ This information was medically reviewed by Dr. Carmen Fong