Colorectal cancer: deaths in the under 50s are increasing in the USA. The situation in Italy

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True Martinella

In the United States it is the only cancer for which mortality in young people is increasing rather than decreasing. In our country it is the second most frequent but there is not the same increase in deaths. The causes and possible solutions explained by the experts

The alarm sounded in the United States a few years ago: is from 2022in fact, that experts have highlighted an increase in cancer cases among young people, before the age of 50. Since then, numerous studies have been published confirming the growing trend especially for the breast cancer and for that to colorectal. Llatest report from the American Cancer Societyhowever, adds a new, worrying piece: for colorectal cancer, it is not only new diagnoses that are increasing, but also deaths. Indeed, to be precise, this is thethe only neoplasm among young people for which deaths among those under 50 are increasingas he points out study just published in the scientific journal Jama. «It is now clear that colorectal cancer can no longer be defined as “a disease of the elderly” – he says Ahmedin Jemal, senior vice president of the American Cancer Society -. We must redouble our efforts to identify the cause of this tsunami of cancers in generations born after 1950.”

The latest statistics in America and the UK

In the most recent survey, researchers examined cancer mortality in the US between 1990 and 2023 and focused on most lethal pathologies in the population under 50 years of age: leukemia, brain, breast, lung and colorectal tumors.
In the time period taken into consideration (33 years), 1.27 million Americans under 50 died from cancer and, in general, mortality dropped by 44%. However, by analyzing the various tumors individually it emerged that i deaths decreased for all types of cancer except one, colorectal cancer, whose mortality has grown by 1.1% every year from 2005 onwards. While it fell annually by 0.3% for the brain, 1.4% for the breast, 2.3% for leukemia and 5.7% for the lung.
Breaking down the cases by sex, in 2023 colorectal cancer was the first in the ranking (as a cause of death from cancer under the age of 50) among men and second (after breast cancer) among women.
A a similar situation was recorded in the United Kingdomwhere data collected by Cancer Research UK indicates the colorectal cancer as the second most common cause of cancer death in Britainwith approximately 17,400 deaths per year (between 2021 and 2023 it accounted for 10% of all cancer deaths).
A research published in the British Medical Journal in 2024 had also highlighted a decline in cancer deaths among people aged 35-69 in the UKassuming that the credit should be distributed among various advances: the dissemination of smoking cessation programsl’increase in early diagnoses through screening programs el’arrival of new therapies.

The Italian situation

«The one in the colorectum which, with almost 49 thousand (48.706) new cases registered every yearAnd the second most frequent type of tumor in Italy and it is also second in the little coveted ranking of the most lethal, causing approximately 20 thousand deaths per year – remember Carmine Pinto, director of Medical Oncology at the Comprehensive Cancer Center of the AUSL-IRCCS of Reggio Emilia –. And if mortality is decreasing (thanks to early diagnosis programs, improvements in surgery and advances in therapies) and At the moment we have not noticed the increase in mortality emerging in Americathe number of cases is unfortunately growing, even in young people, before the age of 50despite well 9 out of 10 cases could be avoided only thanks to a simple and painless test which millions of Italians choose not to do.”

The life-saving test that too many Italians don’t take

In fact, almost 90% of colorectal cancers develop from adenomas that take years, on average about ten, to transform into malignant forms. It is in this time window that screening with the fecal occult blood test allows for an early diagnosis ed eliminate intestinal polyps before they have acquired dangerous characteristics and evolve into a malignant tumor. But over half of Italians do not take the opportunity. The exam is offered by the National Health Service to all citizens between the ages of 50 and 70 who receive, every two years, a letter from their local health authority with the invitation to go to the nearest pharmacy to collect a small container in which collect a stool sampleand then return it and receive the letter with the report at home within a couple of weeks.
“If he test for occult blood in feces (Sof) tests positive, the patient is sent for treatment colonoscopy which allows you to highlight and remove any precancerous lesion or to perform a biopsy – continues Mario Scartozzi, full professor at the University of Cagliari and director of medical oncology at the University Hospital of the Sardinian capital -. Screening allows us to intervene when the person does not yet have symptoms. The advantage is clear and so are the numbers: participating in screening reduces mortality from colorectal cancer by 20-30%, thanks to early diagnosis and the possibility of intervening immediately on lesions in the initial stage.”

Problems and solutions: symptoms not to be overlooked

What could be due to this increase in colon cancer mortality among those under 50 in America? «Various factors can have an influence – replies Pinto -: meanwhile, screening with the Sof test only involves the population from the age of 50, which makes early diagnosis more difficult. And then there is the question of lifestyles: the bad eating habitsthe sedentary lifestyle e obesity are on the rise among young Americans and this has a great impact, while in Italy we still enjoy a protective effect of the Mediterranean diet.” Protective effect increasingly threatened by overweight, by lack of physical activity and incorrect nutrition which are increasingly widespread in Italy too. “Furthermore colorectal cancer appears to have more aggressive characteristics at a young age and this makes it more difficult to treat – he concludes Scartozzi -. Making matters worse is the fact that those under 50 they often arrive late at the diagnosis Why they ignore the first signs such as for example frequent and persistent diarrhea, blood loss (bright red, together with feces or not), continuous abdominal pain and which persist for long periods.”

January 27, 2026 (changed January 27, 2026 | 10:36)

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How does colorectal cancer mortality among people under 50 compare between the US and Italy?

Colorectal Cancer: Rising Deaths in the Under 50s – A US & Italy Comparison

Colorectal cancer, frequently enough thought of as a disease of older adults, is exhibiting a disturbing trend: increasing incidence and mortality rates in individuals under 50. While overall cancer deaths are declining in the US,colorectal cancer is bucking that trend,notably amongst younger populations. But how does this compare to other nations, specifically Italy? Let’s delve into the specifics, risk factors, screening recommendations, and what you can do to protect your health.

The US Situation: A Concerning Surge

Recent data, including findings from Scientific American https://www.scientificamerican.com/article/colon-cancer-is-killing-more-young-people-in-the-u.s-than-any-other-cancer/, highlights a significant rise in colorectal cancer cases and deaths among Americans under 50.This isn’t a minor uptick; it’s a noticeable surge, making it the leading cause of cancer death in this age group.

Here’s a breakdown of key observations:

* Increased Incidence: The rate of diagnosis for early-onset colorectal cancer (diagnosed before age 50) has been steadily increasing for decades.

* Mortality Shift: While overall cancer mortality is decreasing,colorectal cancer mortality in younger adults is increasing.

* Stage at Diagnosis: Younger patients are often diagnosed at later stages of the disease, leading to poorer prognoses and more aggressive treatment requirements.

* Geographic Variations: Some regions within the US are experiencing more pronounced increases than others, suggesting potential environmental or lifestyle factors.

Italy’s Perspective: A Different Landscape?

The situation in Italy presents a contrasting, though still concerning, picture. While Italy generally has lower colorectal cancer incidence rates compared to the US, data suggests a similar, albeit less dramatic, trend of increasing cases in younger adults.

Several factors contribute to this difference:

* Dietary Habits: The conventional Mediterranean diet, prevalent in Italy, is rich in fiber, fruits, and vegetables – factors associated with lower colorectal cancer risk. However,dietary patterns are shifting with increased consumption of processed foods.

* Healthcare System: Italy’s universal healthcare system provides broader access to screening and treatment, potentially leading to earlier detection.

* Screening Programs: National colorectal cancer screening programs are being implemented, but uptake varies regionally.

* Lifestyle Factors: Smoking rates are lower in Italy compared to the US, a known risk factor for colorectal cancer.

however, studies indicate that the incidence of early-onset colorectal cancer is rising in Italy, particularly in certain regions. This highlights the importance of ongoing surveillance and preventative measures.

Understanding the Risk Factors

Regardless of location, several risk factors contribute to the development of colorectal cancer, especially in younger individuals:

* Family History: A strong family history of colorectal cancer or polyps significantly increases your risk.

* Inflammatory Bowel disease (IBD): Conditions like Crohn’s disease and ulcerative colitis elevate risk.

* Genetic Syndromes: Lynch syndrome and familial adenomatous polyposis (FAP) are inherited conditions that dramatically increase risk.

* Diet: A diet high in red and processed meats,and low in fiber,is linked to increased risk.

* Obesity: Being overweight or obese increases your risk.

* Physical Inactivity: A sedentary lifestyle contributes to risk.

* Smoking: Smoking is a well-established risk factor.

* Alcohol Consumption: Excessive alcohol intake is associated with increased risk.

* Gut Microbiome: Emerging research suggests the composition of your gut microbiome plays a role.

Screening: When Should You start?

traditional screening guidelines recommended starting regular colonoscopies at age 50. Though, given the rising incidence in younger adults, these guidelines are evolving.

* US Guidelines: Major organizations are now considering lowering the recommended screening age to 45. Individuals with a family history or other risk factors should discuss earlier screening with their doctor.

* Italian Guidelines: Italy’s national screening program currently targets individuals aged 50-69, but regional variations exist. Doctors are increasingly recommending earlier screening for those with risk factors.

Available Screening Methods:

1. Colonoscopy: Considered the gold standard, allowing for visualization of the entire colon and removal of polyps.
2. Fecal Immunochemical Test (FIT): A non-invasive test that detects blood in the stool.
3. Stool DNA Test (Cologuard): Detects both blood and abnormal DNA in the stool.
4. flexible Sigmoidoscopy: Examines onyl the lower portion of the colon.
5. CT Colonography (Virtual Colonoscopy): Uses CT scans to create images of the colon.

Recognizing the Symptoms

Early detection is crucial. Be aware of potential symptoms, which can be subtle:

* Changes in Bowel Habits: Persistent diarrhea, constipation, or a change in stool consistency.

* Rectal Bleeding: Any blood in your stool, even small amounts.

* **Abdominal Pain or Cram