The recent passing of actor James Van Der Beek at age 48 has brought renewed attention to a concerning trend: an increase in colorectal cancer diagnoses among younger adults. While overall cancer death rates have decreased in those under 50 since 1990 – falling by 44% – colorectal cancer is now the leading cause of cancer death in this age group, a stark reversal of previous patterns.
Experts anticipate this trend will continue. Current federal guidelines and recommendations from the American Cancer Society suggest individuals at average risk begin colorectal cancer screening at age 45, typically with a colonoscopy every 10 years or a stool test every one to three years. Still, the rising incidence in younger populations is prompting discussions about potentially lowering that age even further.
Colorectal cancer originates in either the colon or rectum and often develops slowly, beginning as growths called adenomas or polyps. “The fact that trends do not suggest colorectal cancer rates in young people are dropping certainly does open the door for conversations around policy change dropping the screening age again,” said Van Karlyle Morris, section chief for colorectal cancer at MD Anderson Center in Houston.
The Shift in Screening Recommendations
The U.S. Preventive Services Task Force lowered the recommended age for colorectal cancer screening from 50 to 45 in 2021, acknowledging a growing body of evidence supporting earlier detection. The American Cancer Society had already issued a similar recommendation in 2018, though it faced initial resistance from some in the medical community. Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society, noted that “there was a lot of pushback…they thought it was too young,” but even now, not all healthcare professionals are convinced of the necessity.
Developing these guidelines is a complex process, involving careful consideration of research data, benefits versus risks – even seemingly small ones like taking a day off function – and nuanced factors like increasing and overall risk. The risk of colorectal cancer for individuals aged 40-44 is approximately 21 per 100,000 people, more than doubling to 47 per 100,000 people between ages 45 and 49, coinciding with the recommended start of routine screening, according to Siegel.
Understanding Your Risk and Screening Options
While colorectal cancer rates are increasing among younger adults, it’s important to remember that overall incidence remains relatively low. According to the Mayo Clinic, approximately 10% of colorectal cancer cases occur in people under 50. However, individuals with a family or personal history of colorectal cancer or polyps should consider starting screening earlier than age 45. “People demand to talk to their families,” Siegel emphasized. “Even if your mom had a non-cancerous polyp at age 40, you need to start screening for colorectal cancer younger [than 45].”
Several screening options are available. Colonoscopy remains the “gold standard” for detection, but noninvasive stool and blood tests, approved by the Food and Drug Administration, can serve as initial screening tools. These tests, such as Cologuard (detecting about 92% of colorectal cancers in studies) and Shield (detecting about 83%), require follow-up colonoscopy if signs of cancer are detected. However, these at-home tests are less effective at identifying precancerous polyps. Cologuard detects about 42% of these, while Shield detects only 13%.
Symptoms and Costs
James Van Der Beek first noticed changes in his bowel movements in the summer of 2023, at age 46, which ultimately led to a Stage 3 colon cancer diagnosis after undergoing a colonoscopy. Research indicates four distinct symptoms can appear up to two years before a diagnosis: abdominal pain, rectal bleeding, ongoing diarrhea, and iron deficiency anemia. It’s crucial to be aware of these “red flag symptoms,” as they can often be dismissed as less serious gastrointestinal issues, according to Siegel. Anyone with a history of anemia or an unexplained low red blood cell count should also be promptly screened.
The cost of a colonoscopy without insurance can range from $1,250 to over $4,000, according to price comparison website GoodRx. Insurance coverage typically begins at age 45, or earlier for individuals with increased risk factors.
Beyond Screening: Lifestyle Factors
While screening is vital, experts emphasize the importance of lifestyle factors in reducing colorectal cancer risk. Rising rates of obesity, declining physical activity, changes in the gut microbiome, and diets high in ultraprocessed foods – increasingly common since the 1980s – are believed to play a significant role. Dr. Andrew Chan, a gastroenterologist at Mass General Brigham in Boston, stated that focusing on diet and exercise can have benefits “that extend beyond screening.”
The conversation surrounding colorectal cancer screening is evolving, and ongoing research will continue to inform best practices. As we learn more about the factors driving the increase in cases among younger adults, it’s likely that screening recommendations and preventative strategies will adapt accordingly.
This information is for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
Have you discussed colorectal cancer screening with your doctor? Share your thoughts and experiences in the comments below.
