The startling rise in colorectal cancer (CRC) diagnoses among younger adults is prompting an urgent reevaluation of screening practices. Once considered a disease primarily affecting those over 50, CRC is now tragically impacting Millennials and Gen Z at alarming rates. In fact, it has become the leading cause of cancer death for individuals under 50, a trend experts predict will continue. Recent high-profile cases, such as the actor James Van Der Beek’s battle with Stage 3 colon cancer at 46, underscore the critical need for increased awareness and earlier screening.
This comprehensive guide delves into the updated recommendations for colorectal cancer screening, crucial symptoms to watch for, and actionable steps you can take to protect your health. Understanding your risk and when to act could be life-saving, as early detection is paramount to successful treatment.
The Alarming Rise of Early-Onset Colorectal Cancer
While overall cancer death rates in people under 50 have thankfully dropped by 44% since 1990, colorectal cancer stands as a concerning exception. Its mortality rate in this younger demographic has paradoxically increased by 1.1% each year since 2005. This surge is not a temporary blip; experts like Dr. Van Karlyle Morris, section chief for colorectal cancer at MD Anderson Center, anticipate this trend will continue.
Data reveals a stark reality: individuals born in the 1980s are approximately twice as likely, and those born in the 1990s three times as likely, to develop CRC compared to those born in the 1960s. The American Cancer Society (ACS) reported in early 2023 that 20% of all CRC diagnoses in 2019 were in patients under 55, a doubling of the rate from 1995. This dramatic shift highlights that this is no longer just an “older person’s disease.”
Yale Medicine surgeons, for instance, have observed a clear uptick in younger generations, reporting a week where all seven rectal cancer diagnoses were in patients aged 35 or younger. One patient was as young as 18. This underscores the need for proactive discussions about bowel health at all ages.
When Should You Get Screened for Colorectal Cancer?
In response to the undeniable rise in early-onset cases, major medical organizations have revised their guidelines, advocating for earlier colorectal cancer screening. Both the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) now recommend that individuals with an average risk begin colorectal cancer screening at age 45. This represents a significant shift from the previous recommendation of age 50.
The ACS updated its guidelines in 2018, followed by the USPSTF in 2021. This decision was based on a growing body of evidence, despite initial hesitancy from some in the medical community. Dr. Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society, explains that the risk of CRC more than doubles between ages 40-44 (21 per 100,000 people) and ages 45-49 (47 per 100,000 people). Dr. Andrew Wolf, who chaired the ACS subcommittee for these guidelines, notes that a 45-year-old today faces the same risk of developing CRC as a 50-year-old did in the 1990s.
Special Considerations for Earlier Screening
While age 45 is the general recommendation, certain factors necessitate even earlier screening. You should discuss starting before age 45 if you have:
A family history of colorectal cancer or polyps. For instance, if a first-degree relative was diagnosed at 60, you might start screening at 50. Some guidelines suggest starting 10 years before the age your family member was diagnosed.
A personal history of inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
Certain genetic syndromes such as Lynch syndrome or familial adenomatous polyposis (FAP).
Been previously treated with chemotherapy for other cancers.
Are of Black descent. Black men and women face a higher risk and should begin screening at 45.
It’s crucial to have open conversations with your doctor about your family’s medical history. Even a “non-cancerous polyp” in a parent at a younger age could indicate a need for you to start screening earlier.
Recognizing the Earliest Symptoms of Colon Cancer
One of the most concerning aspects of early-onset CRC is that symptoms are often dismissed or mistaken for less serious gastrointestinal issues. Actor James Van Der Beek shared that he initially attributed changes in his bowel movements at age 46 to coffee consumption. Only when the issues persisted did he pursue a colonoscopy, revealing Stage 3 colon cancer.
Research indicates four distinct symptoms that can appear up to two years before a CRC diagnosis. It’s vital to recognize these red flag symptoms, especially if they are persistent or if you experience more than one:
Abdominal pain: Persistent cramping, gas, or general discomfort in the abdomen.
Rectal bleeding: Blood in your stool or toilet, which can range from bright red to dark. Do not assume it’s just hemorrhoids.
Ongoing diarrhea or constipation: A noticeable and persistent change in bowel habits lasting two weeks or more.
Iron deficiency anemia: Often detected in routine blood tests, this can manifest as unexplained low energy, tiredness, or weakness.
If you experience any of these symptoms, particularly if they are persistent or unexplained, consult your doctor immediately. Do not wait for the recommended screening age. Once symptoms appear, a colonoscopy is considered a diagnostic test, not merely a screening, and is typically covered by insurance.
Understanding Your Colorectal Cancer Screening Options
Colonoscopy remains the gold standard for detecting colorectal cancer. However, several effective screening options are available, and the “best” test is ultimately the one that gets done.
The Gold Standard: Colonoscopy
A colonoscopy is an endoscopic procedure where a flexible tube with a camera is inserted to examine the entire colon and rectum. Patients receive conscious sedation, ensuring the procedure is painless and comfortable. During the 20-30 minute procedure, the doctor can identify and remove precancerous polyps before they turn into cancer, or take biopsies of suspicious masses.
Preparation: Requires a “low residue” diet for about a week prior, followed by a clear liquid diet and strong laxatives the day before to cleanse the bowel.
Frequency: If results are clear, a colonoscopy is typically recommended every 10 years.
Risks: Generally very safe, but minor risks include adverse reactions to sedation, dehydration, slight bleeding after polyp removal, and a rare risk of bowel perforation (about 4 in 10,000 procedures).
Non-Invasive At-Home Screening Tests
For average-risk individuals, non-invasive stool and blood tests offer convenient alternatives. A positive result from these tests necessitates a follow-up colonoscopy.
Fecal Immunochemical Test (FIT): An at-home stool test that checks for hidden blood.
Accuracy: 84% to 97% for colorectal cancer, 12% to 15% for precancerous polyps.
Frequency: Recommended annually.
Cologuard: An at-home stool test that detects both blood and abnormal DNA.
Accuracy: Detects about 92% of colorectal cancers and 42% of precancerous polyps.
Frequency: Recommended every three years.
Shield (Blood Test): A blood test that detects signs of cancer.
Accuracy: Detects about 83% of colorectal cancers but only 13% of precancerous polyps.
It’s important to discuss the pros and cons of each option with your healthcare provider to determine the most suitable screening method for you. While these tests are valuable, they are less effective at detecting precancerous polyps compared to a colonoscopy.
The Cost of Screening
Insurance coverage for colonoscopies and non-invasive tests like Cologuard generally begins at age 45 for average-risk individuals, unless specific risk factors warrant earlier screening. If you are average risk, under 45, and wish to get a colonoscopy without symptoms, you will need a doctor’s referral. However, the out-of-pocket cost for a colonoscopy can range from $1,250 to over $4,000 without insurance, according to price comparison sites. This financial barrier can sometimes hinder earlier, proactive screening.
Proactive Steps: Reducing Your Risk Beyond Screening
While screening is crucial, understanding and modifying lifestyle factors can significantly reduce your risk of colorectal cancer. The exact causes of the rising rates in young people are still being researched, but several factors are strongly implicated:
Diet: Diets high in ultra-processed foods, which became more prevalent in the 1980s, are a suspected contributor. Focus on a diet rich in fiber (aim for 25 grams daily) from fruits, vegetables, whole grains, beans, and legumes. Limit consumption of red and processed meats.
Physical Activity: Declining physical activity and sedentary lifestyles are significant risk factors. Regular exercise is key to maintaining a healthy weight and overall well-being.
Obesity: Rising rates of overweight and obesity are closely linked to increased CRC risk. Maintaining a healthy body weight is a powerful preventative measure.
Alcohol Consumption: Moderate alcohol intake is advised, with the ACS recommending no more than two drinks per day for men and one for women.
Smoking: Quitting smoking, including e-cigarettes, can lower your risk.
Gut Microbiome: Changes in the gut microbiome are being investigated as a potential factor. Early research also suggests a possible role for antibiotic use and certain gut bacteria.
Dr. Andrew Chan, a gastroenterologist at Mass General Brigham, emphasizes that lifestyle interventions extend beyond screening benefits. Focusing on diet and exercise offers broader health advantages and contributes to long-term cancer prevention.
Frequently Asked Questions
What are the main reasons for the colorectal cancer screening age being lowered to 45?
The recommended colorectal cancer screening age was lowered from 50 to 45 by major health organizations like the American Cancer Society (ACS) in 2018 and the U.S. Preventive Services Task Force (USPSTF) in 2021 due to a significant and alarming rise in early-onset colorectal cancer cases among individuals under 50. Data revealed that a 45-year-old today faces the same risk level as a 50-year-old did in the 1990s. This shift was driven by compelling evidence of increasing diagnoses and mortality rates in younger populations, aiming to detect precancerous polyps and cancers earlier when they are more treatable.
Where can I find support or resources if I’m diagnosed with early-onset colorectal cancer?
If diagnosed with early-onset colorectal cancer, you can find support through specialized cancer centers, patient advocacy groups, and hospital-based social workers. Organizations like the American Cancer Society and the Colorectal Cancer Alliance offer extensive resources, including patient navigators, support groups, and financial assistance programs. Yale Medicine’s Smilow Cancer Hospital, for example, highlights clinical social workers who assist patients with financial, transportation, family, and emotional challenges, including concerns about fertility and relationships. It’s crucial to build a strong support system and seek counseling to navigate the physical and psychological impacts of a diagnosis.
Should I consider getting a colonoscopy before age 45 even if I have no symptoms?
While routine screening for average-risk individuals typically starts at age 45, you should strongly consider getting screened earlier if you have specific risk factors. This includes a family history of colorectal cancer or polyps (often recommended 10 years before the youngest affected family member’s diagnosis), a personal history of inflammatory bowel disease, or certain genetic syndromes. Even without these, if you experience persistent “red flag” symptoms like rectal bleeding, unexplained abdominal pain, ongoing changes in bowel habits, or iron deficiency anemia, you should consult a doctor regardless of age. They may recommend a diagnostic colonoscopy, which is typically covered by insurance.
Take Control of Your Bowel Health
The landscape of colorectal cancer is changing, and so must our approach to prevention and early detection. The message is clear: whether through routine screening at age 45 or earlier diagnostic testing for symptoms, proactive steps are critical. With early detection, colorectal cancer is highly treatable, boasting survival rates exceeding 90% for early-stage cases.
Don’t ignore persistent symptoms, understand your family health history, and maintain open communication with your doctor. By being informed and proactive, you empower yourself to navigate the risks and protect your long-term health.
