- Colorectal cancer deaths in people under 50 have risen 1.1% annually since 2005.
- It is now the leading cause of cancer death in Americans under 50, surpassing lung cancer.
- Early screening and symptom awareness are key to reversing this trend.
When we think about the long-term trends in healthcare and medicine, we often hope for a straight line pointing toward progress. For the most part, when it comes to cancer mortality in the United States, that’s exactly what we see. Thanks to breakthroughs in treatment, better screening technologies and widespread public health campaigns against smoking, fewer people are dying from cancer today than they were 30 years ago. That is a massive victory for science and public health.
However, a recent letter published in The Journal of the American Medical Association (JAMA) highlights a startling and worrisome exception to this rule. While death rates for nearly every major type of cancer have plummeted among people under the age of 50, one type is moving in the opposite direction: colorectal cancer (CRC).
How Was This Evaluation Conducted?
To understand exactly what is happening with cancer trends in young adults, researchers conducted a comprehensive observational study. They didn’t only look at a small sample size; they analyzed massive amounts of data covering the entire United States population over a period of more than three decades.
Specifically, the study examined cancer mortality trends from 1990 through 2023 for the five leading causes of cancer-related death among individuals younger than 50. The researchers sourced their data from the National Center for Health Statistics (NCHS), which compiles information based on the underlying cause of death reported on death certificates filed in all 50 states and the District of Columbia.
What Did the Evaluation Find?
First, the good news: Though more than 1.2 million people under the age of 50 died of cancer in the U.S. between 1990 and 2023, during that same period, the age-standardized death rate for this demographic actually decreased by 44%—from 25.5 to 14.2 deaths per 100,000 people. The authors note that this is a testament to the efficacy of modern oncology and prevention efforts.
When the researchers broke down the data by specific cancer types, the success stories continued for four out of the five leading killers:
- Lung cancer: Patients with lung cancer saw the most dramatic improvement, with a mean annual decline of 5.7% between 2014 and 2023. It dropped from being the No. 1 cause of cancer death to No. 4.
- Breast cancer: Deaths from breast cancer decreased by 1.4% annually in recent years, though it remains the leading cause of cancer death specifically for females.
- Leukemia: Related deaths dropped by 2.3% annually.
- Brain cancer: Deaths due to brain cancer saw a modest decline of 0.3%.
Then, there is the outlier. Colorectal cancer (CRC) mortality has increased by 1.1% annually since 2005.
While 1.1% might sound like a small number, the cumulative effect over nearly two decades has been profound. In the early 1990s, colorectal cancer was the fifth most common cause of cancer death in young people. By 2023, it had surged past the others to become the leading cause of cancer death in men and women under 50 combined.
This shift is alarming because it reverses decades of progress. While we have successfully driven down deaths from lung cancer (largely due to reduced smoking rates) and improved survival for leukemia and breast cancer, we are losing ground on colorectal health in younger generations.
Limitations of the Study
While this study provides a powerful high-level view of the landscape, it does have limitations that are important to acknowledge. The research is based on national-level ecologic data. This means the researchers were looking at population-wide statistics derived from death certificates.
Also, the data tells us what is happening (that more young people are dying of colon cancer), but it cannot definitively explain the biological or environmental mechanisms driving that rise. It highlights the trend but leaves the “why” open for further research.
How Does This Apply to Real Life?
The rise of CRC to the number one spot for young people means that finding ways to reduce one’s risk of developing this disease is key. Here are some things to keep in mind:
1. Screening Guidelines Have Changed
For a long time, the “magic number” for a colonoscopy was 50. That is no longer the case. Because of trends exactly like the ones identified in this study, the recommended age to begin screening for people at average risk has been lowered to 45.
If you have a family history of colon cancer or polyps—or if you have certain genetic conditions—you may need to start screening even earlier. The study notes that screening is associated with reduced mortality, yet many people in their late 40s still believe they are “too young” to worry about it. If you are 45 or older, it’s time to speak with your healthcare provider about getting screened.
2. Watch for “Red Flag” Symptoms
The study emphasizes that three out of four patients younger than 50 are diagnosed with advanced-stage disease. This suggests that symptoms are often missed or ignored until it’s too late. We must normalize talking about gut health. Be vigilant for symptoms such as:
- Hematochezia: This is the medical term for blood in the stool. You should never assume it’s “just hemorrhoids.”
- Abdominal pain or cramping: If you experience persistent discomfort that doesn’t go away, make an appointment with a healthcare professional.
- Changes in bowel habits: Sudden constipation, diarrhea or narrowing of the stool that lasts for more than a few days may be a sign that you should consult a healthcare provider.
3. Lifestyle Adjustments
While this specific study didn’t analyze diet directly, the researchers noted the need to identify causes, and general medical consensus suggests that lifestyle plays a significant role in colorectal cancer risk.
- Diet: Certain foods stand out for their potential to reduce colorectal cancer risk. For example, incorporating more broccoli and other cruciferous vegetables, adding dairy foods and eating plenty of legumes like lentils and beans can all support colon health. Focusing on a diet rich in these foods while generally increasing fiber, fruits and vegetables offers a simple way to help lower your risk over time.
- Physical activity: A sedentary lifestyle is a known risk factor for cancer, and regular moderate exercise is a powerful tool for overall cancer prevention.
- Alcohol and smoking: Limiting alcohol intake and avoiding tobacco are universally recommended for reducing cancer risk.
Our Expert Take
This comprehensive study published in JAMA serves as both a celebration of progress and a critical wake-up call. By utilizing rigorous statistical methods, researchers confirmed that we are winning the war against cancer on many fronts, with overall death rates for those under 50 dropping by nearly half.
However, the rise of colorectal cancer to the number one leading cause of cancer death in this age group cannot be ignored. The 1.1% annual increase in mortality since 2005 is a trend we have the power to reverse. By understanding that colon cancer is no longer just an “older person’s disease,” we can empower ourselves with early action. Getting screened at 45, listening to our bodies when something feels wrong and making healthy lifestyle choices are actionable steps we can take today to ensure the trends for the next 30 years point back in the right direction. And that direction is downward!
