David Garrell, MD

While the overall rates of colorectal cancer are declining, colorectal cancer for people under age 50 has been rising to an alarming degree since the mid-1990s. In the last 30 years, the rate for those 18-49 has increased by 50%, and it is estimated that 13% of all patients diagnosed with colorectal cancer are in this age group. By 2030, it is predicted that colorectal cancer will be the leading cause of cancer death for those under 50.

A diagnosis of cancer between the ages of 18-49 is called early-onset cancer. With more cases of colorectal cancer found in 20, 30, and 40-year-olds, Millennials and members of Gen-Z need to be alert to the symptoms and risk factors. While the ultimate cause is still not clear, lack of physical activity, poor diet, smoking, and exposure to environmental chemicals are all being explored as potential causes. Family history and genetics are also a factor.

The general risk factors for colorectal cancer include being overweight or obese, having Type 2 diabetes, heavy alcohol use, smoking, and diets low in fiber and high in red meats and processed meats. Risk also increases with age, any personal history of colorectal polyps, inflammatory bowel disease, radiation to the abdomen or pelvis, family history of colorectal polyps or cancer, and any genetic markers for increased risk. Colorectal cancer is also more prevalent in African American and Native American populations.

Having colorectal cancer might not cause symptoms immediately, but over time, a person may experience one or more of the common symptoms:

• A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
• A feeling that you need to have a bowel movement that’s not relieved by having one
• A new need to strain to have a bowel movement
• Rectal bleeding with bright red blood
• Blood in the stool, which might make the stool look dark brown or black
• Iron-deficient anemia
• Cramping or abdominal (belly) pain
• Weakness and fatigue
• Unintended weight loss

Common symptoms of colorectal cancer may actually be caused by other medical conditions such as irritable bowel syndrome, hemorrhoids, or infections. If you have any of the symptoms listed, it’s important to see your health care provider to discuss and determine the cause.

While all of the above symptoms warrant attention, important research from the American Cancer Society showed four red-flag symptoms linked with early-onset colorectal cancer. These symptoms are diarrhea, abdominal pain, rectal bleeding, and iron-deficient anemia. Even having one of these risk factors increases your risk of colon cancer and needs to be evaluated by a health care provider immediately.

Early screening is vital for the best outcomes with colorectal cancer. The earlier cancer is caught, the earlier it can be treated. The age guidelines to start routine colorectal screening changed in 2021, dropping from age 50 to 45 with the rise in colorectal cases in younger adults. It is recommended to start screening soon after turning 45, and at regular intervals depending on the results until age 75.

Since the overall incidence of colorectal cancer is low in people under 45, there are currently no preventive screening guidelines or recommendations. Individuals who need to be screened earlier than age 45 include those with inflammatory bowel disease such as ulcerative colitis, celiac, or Crohn’s disease, a family history of colorectal cancer or polyps, and those with certain genetic conditions such as Lynch disease.

Younger individuals may have other gastrointestinal issues or other medical indications to need screening earlier. These patients can work with their provider to decide when to screen. A diagnosis of colorectal cancer can be missed, and the condition may be in advanced stages in some young people when diagnosed, since they are not routinely screened. It’s important to advocate for a colorectal cancer screening to rule out cancer if there are symptoms that do not resolve on their own.

Colorectal screenings may be completed with a stool test and/or colonoscopy.

Stool tests are a simple and easy first-line screening tool for younger populations. A sample of stool is collected and analyzed. All colorectal stool tests check for blood, and some brands may also check for altered DNA/RNA changes in the stool that occur with polyps and/or cancer. Explore the options on your own and talk to your provider about the different choices available. If results are normal, stool tests are recommended every one to three years depending on the brand. If any stool tests are abnormal, a colonoscopy will be prescribed to determine the cause.

A colonoscopy procedure is the gold standard of colorectal screening and has been used as a regular part of preventive care since the 1970s. During a colonoscopy, a physician uses a flexible, lighted tube to view the rectum and the entire colon. Polyps and some types of cancers can be removed and biopsied if found. If the test is normal, a colonoscopy is recommended every 10 years. If the test is abnormal, the physician will individualize recommendations after the procedure on how often to have follow-up colonoscopies.

Protective lifestyle factors that can help decrease the risk of colorectal cancer include incorporating regular physical activity, curbing or eliminating alcohol, not smoking, and consuming a diet with more whole grains, fruits, and vegetables, and less red and processed meats.

Taking care of your health, having a provider you trust and can talk to, prioritizing annual visits and recommended screenings can help prevent colorectal cancer, as well as other types of cancer and medical conditions. With the increasing risk of colorectal cancer rising in younger populations, it’s critical to be aware of the signs and symptoms. Don’t brush symptoms off, have them checked out as soon as possible to stay on top of your health!