Why Is Colorectal Cancer on the Rise in Young Adults?

Colorectal cancer is the third most common cancer in the United States. Rates of colorectal cancer are decreasing overall, thanks to screening and earlier detection. But in people under the age of 50, colorectal cancer rates are actually increasing. In fact, 12% of colorectal cancer cases are in those under the age of 50. The risk is higher in certain groups, including American Indians and Alaska Natives.

Read on to learn more about why more young people are getting colorectal cancer, what might increase your risk, and what you can do about it.

What is causing rates to increase?

The reason for this rise of colorectal cancer in young adults isn’t clear, but it’s thought to be due to a combination of dietary factors, obesity, lack of physical activity, and smoking. It could also be related to something in the environment that we haven’t identified yet. 

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Here is what we know that can help explain the increasing rates in young adults:

• Obesity: Rates of obesity are increasing, and obesity is a known risk factor for colorectal cancer. About half of people diagnosed with colorectal cancer at a young age have obesity.

• Diet: Dietary factors contribute to colorectal cancer risk. Processed meats and low fiber in the diet are known risk factors for colorectal cancer.

• Physical activity: A low level of physical activity is a risk factor for colorectal cancer at young ages, and more and more Americans live a sedentary lifestyle with increased screen time.

• Gut microbiome: The gut microbiome likely plays a role in colorectal cancer risk. Our microbiome is shaped by our diet, environment, genetics, medications, and more. 

• Chronic health conditions: Conditions such as Crohn’s disease or ulcerative colitis increase risk of colorectal cancer in young people. 

How can I reduce my risk of colorectal cancer?

There are important steps you can take to lower your risk of colorectal cancer — at any age. This includes the following factors in your lifestyle: 

• Have a diet high in fiber 

• Avoid processed meats

• Avoid smoking

• Maintain a healthy weight

• Do regular physical activity

• Avoid excessive alcohol

What’s the role of genetics in colorectal cancer?

Genetics plays a large role in many cases of colorectal cancer — especially for young adults. There are some known genetic conditions that increase risk of colorectal cancer, including Lynch syndrome and familial adenomatous polyposis.

But as many as 20% of early colorectal cancer cases are due to a genetic mutation. And in around half of these, there’s no personal or family history that suggests an increased risk of colorectal cancer. 

Who should get genetic testing?

Genetic testing may be recommended for people with a strong family history of colorectal cancer. In young people diagnosed with colorectal cancer below the age of 50, genetic testing may also be offered. If you are concerned about your risk, it’s a good idea to discuss genetic testing options with your healthcare provider.

What are some early symptoms of colorectal cancer?

Colorectal cancer can present with the following symptoms:

• Change in stool habits such as new diarrhea or constipation

• Feeling like you still need to have a bowel movement after using the bathroom

• Blood in the stool

• Abdominal or pelvic pain

• Unintentional weight loss

• Anemia (low red blood cell counts)

Colorectal cancer may not cause any symptoms at all, especially early on. 

When should I start screening?

Colorectal cancer often doesn’t lead to any symptoms, particularly in early stages. This is why screening is important. The U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society recommend that adults start screening for colorectal cancer at age 45.

If you have a family history or genetic risk, be sure to connect with your provider to see if they recommend earlier screening. Talk with your family and friends about the importance of screening.

Is colorectal cancer curable?

Colorectal cancer is very treatable when it’s caught early and hasn’t spread beyond the intestine. This is why it’s so important to catch it early — before the cancer spreads through the intestinal wall and to lymph nodes or other organs.

Why trust our experts?

Written by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

John Strickler, MD

John Strickler, MD, joined the Duke University faculty in 2011 and is now an associate professor of medicine in the division of medical oncology. His research focuses on precision cancer medicine: identification of genomic biomarkers that predict sensitivity or resistance to targeted therapies and immunotherapy.

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