Dr. Bethany Malone has treated a lot of colorectal cancer patients. The youngest, not counting those with genetic conditions, was 19 years old.
Colorectal cancer used to be considered a cancer of older age. Not anymore.
Patients in their teens and early 20s still aren’t the norm, exactly, but are becoming more common.
“I have not gone a year in practice without taking a colon cancer out of someone in their 20s,” Malone said.
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Malone is a colon and rectal surgeon and the associate program director for the general surgery residency at Texas Health Harris Methodist Hospital Fort Worth. Her experience in North Texas reflects a worldwide trend.
Colorectal cancer — which includes cancer of the colon and of the rectum — is considered early onset when diagnosed in people under the age of 50. While the majority of diagnoses are still among people aged 65 or older, early onset rates have been increasing worldwide, particularly in high-income countries.
In a 2023 report, the American Cancer Society wrote that the trends of decreasing incidence in older people and increasing incidence in younger people are “rapidly shifting the patient population younger.”
In 2020, Black Panther actor Chadwick Boseman died from colon cancer at age 43. More recently, former Dallas Cowboys Cheerleaders choreographer Criscilla Anderson died of colon cancer at age 45.
Also locally, Dallas musician Joshua Ray Walker was diagnosed with colon cancer in late 2023, at age 33. (About 10 months later, after treatment and surgery, he announced that he was cancer-free.)
Here’s what medical experts say about the rising rates of colorectal cancer in younger people.
Why are colorectal cancer rates rising among younger people?
Medical experts say there isn’t one reason why colorectal cancer rates are rising in the below-50 age groups. But there are some contributing factors.
First, it’s not because of genetics. Dr. Radhika Kainthla, a medical oncologist at Parkland Memorial Hospital in Dallas, said that about 20% of early onset colorectal cancer patients have a genetic tie-in. That means 80% do not.
“There’s a misconception a lot of times that if it’s a young person being diagnosed with cancer, it must be genetic,” Kainthla said. “But that’s not actually what we’re seeing.”
All three experts who spoke with The Dallas Morning News pointed instead to a combination of environmental factors and lifestyle factors, such as diets high in red meat, diets packed with ultra-processed foods and lack of regular exercise.
Malone at Texas Health Fort Worth said fiber intake especially tends to be low for Americans, which can increase the risk for colorectal cancer. Fiber does a lot of work in the gut, Malone said, including feeding a healthy microbiome and helping to flush carcinogens out of the body before they’re absorbed.
Malone noted that the “lifestyle” factors are not always easily controllable. The U.S. food system has shifted significantly toward ultra-processed foods, which tend to be low in necessary nutrients such as fiber.
There are also environmental factors at play, said Dr. Emina Huang, a professor of surgery and a colorectal surgeon at UT Southwestern Medical Center. For instance, living near a superfund site — which are hazardous waste sites — has been shown to increase the risk of cancer.
How can I reduce my risk of colorectal cancer?
Reducing the risk of colorectal cancer, the three experts said, comes down to a lot of the standard advice that medical professionals recommend for general health, too.
The three experts said that folks should focus on getting regular exercise, avoiding smoking, moderating alcohol intake and eating a diet that’s low in red meat but rich in fruits, vegetables and fiber.
Obesity is also a risk factor for colorectal cancer, the experts said, although Malone cautioned against focusing on weight loss alone. Restrictive diets may also end up being low in fiber, which is harmful rather than helpful for colorectal cancer risk.
And, of course, patients should pay attention to their bodies and seek medical care if they notice abdominal pain or changes in their bowel movements.
When should I start getting screened for colorectal cancer?
Because of the rising rates of colorectal cancer among younger people, the U.S. Preventive Services Task Force advises regular screenings beginning at age 45. The gold standard of screening is a colonoscopy, but stool tests and scans can also be used for screening.
The age 45 recommendation, however, is for patients who have a standard risk for colorectal cancer. Some people may be at higher risk due to personal or family history.
People with a first-degree relative — a sibling, parent or child — diagnosed with colorectal cancer or colorectal polyps may be advised to begin screenings at a younger age. In general, medical professionals advise beginning screening when a patient is 10 years younger than their relative was at the age of diagnosis. For instance, if your father was diagnosed with colorectal cancer at age 48, you should begin screenings at age 38.
Patients with such a family history should start screenings no later than 40.
Similarly, patients who have personal histories of Crohn’s disease or ulcerative colitis are at higher risk of colorectal cancer, too, and should also begin screenings at an earlier age.
Kainthla, at Parkland, also noted that there are other types of screenings besides colonoscopies, such as blood tests and stool tests, that may be a useful option for some patients.
What are the warning signs of colorectal cancer?
Medical experts are quick to point out that, for most young people, abdominal or gastrointestinal symptoms are unlikely to indicate colorectal cancer.
Still, some symptoms should serve as red flags.
The most common early symptoms are stomach pain that doesn’t go away, changes in bowel movements with no improvement or blood in the stool.
Sometimes, these symptoms can indicate hemorrhoids or other relatively benign conditions. However, if a patient is treated for a benign condition but symptoms do not improve, that’s a sign that something more may be going on.
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