Tip Sheet: What to know about early-onset colorectal cancer among younger adults

The deaths of celebrities, such as Chadwick Boseman and James Van Der Beek, have shone a spotlight on colorectal cancer among younger adults. Colorectal cancer is the third most common cancer worldwide and the second leading cause of cancer-related deaths worldwide. While colorectal cancer primarily affects those aged 50 and above, an alarming trend over the past 20 years has shown early-onset colorectal cancer rising among people under 50 years old.

Michelle Williams, a cancer prevention behavior expert, answers questions about potential contributors to colorectal cancer rates. Williams explains that colonoscopies are the “gold standard for prevention” for this highly preventable disease and how we can reverse the trend of colorectal cancer in younger adults.   

What is colorectal cancer and what are the symptoms? 

Colorectal cancer is a cancer that affects the large intestine, which includes the colon, rectum, and anus. In early stages, many people have no symptoms, but when they appear, symptoms include diarrhea or constipation, blood in the stool, abdominal pain, unexplained weight loss, fatigue, and low iron levels. 

Which groups are most affected by early-onset colorectal cancer?  

Early-onset means the development of a disease, in this case cancer, earlier than average. Early-onset colorectal cancer has historically been highest among American/Alaskan Natives and African Americans. While the rates among those populations have remained steady, early-onset colorectal cancer has been increasing among White adults. 

What are the leading theories behind rising colorectal cases in younger adults?  

Researchers have not been able to pinpoint specific causes for the increased incidence of colorectal cancer among younger adults. Evidence shows that lifestyle factors, such as consuming a diet high in red meat and processed meat (like bacon, sausage, or deli meats), smoking, and moderate to heavy alcohol consumption, contribute to increased risk for colon cancer among younger adults.  

Researchers also suggest that some health care providers may not attribute their patients’ symptoms to colorectal cancer because of their age. This could lead to late-stage detection as opposed to the cancer being found and treated earlier. 

What should younger adults know about colorectal cancer and when to seek care?  

It is important for younger adults to know their family’s health history. In 2021, the recommended age to begin colon cancer screening for average-risk (i.e., no family history or genetic predisposition) individuals was lowered from 50 to 45. Individuals with a family history of colon cancer should discuss the possibility of starting screening before the age of 45 with their health care provider because they may be considered high risk. In addition, all young adults should be aware of the signs of colon cancer and seek medical care when they notice them.  

There are different types of colon cancer screening tests, but the colonoscopy is the “gold standard” because it allows for the detection of precancerous polyps (i.e., abnormal growths that can develop into cancer). The removal of colon polyps before they turn into cancer is the key to preventing colon cancer. The decision on which type of colon cancer screening should be made with your health care provider. 

What actions could help reverse the trend of colorectal cancer in younger adults?  

Colorectal cancer is highly preventable through the detection and removal of precancerous polyps during a colonoscopy. Colorectal cancer is also highly treatable when it is detected at early stages. Screening is the key to reversing the trend in colon cancer mortality among younger adults. Policies aimed at ensuring health insurance companies provide coverage for colorectal cancer screening among younger adults are essential. 

Lifestyle factors are a common risk factor for colorectal cancer. Therefore, there is a need for the development and implementation of policies and programs that will enable people to readily engage in health-enhancing behaviors. Some examples include ensuring that healthy foods are affordable and that people have access to safe places to exercise within their communities. 

Interventions aimed at increasing health care providers’ awareness of early-onset colorectal cancer in their younger patients would also contribute to lowering rates.   

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MEDIA INQUIRIES: For reporters who wish to speak to Michelle Williams about colorectal or other cancers, please email media contact Michelle Thompson at mthomp7@gmu.edu.   

Michelle S. Williams is an associate professor in the Department of Global and Community Health at George Mason University. Williams’ research is focused on developing culturally appropriate health behavior interventions for cancer prevention and control that will lead to a reduction in cancer disparities. Since 2009, Williams has been conducting research in Ghana, West Africa, that is focused on cervical cancer prevention. Williams’ research interests include cancer prevention behaviors, community-based participatory research, qualitative research, and the design and conduct of mix-method studies. She is currently working on studies aimed at using different forms of mhealth to reduce cancer disparities in the Deep South region of the United States and in low- and middle-income countries.  

About George Mason University      

George Mason University is Virginia’s largest public research university. Located near Washington, D.C., Mason enrolls more than 40,000 students from 130 countries and all 50 states. Mason has grown rapidly over the past half-century and is recognized for its innovation and entrepreneurship, remarkable diversity, and commitment to accessibility. In 2023, the university launched Mason Now: Power the Possible, a one-billion-dollar comprehensive campaign to support student success, research, innovation, community, and stewardship. Learn more at gmu.edu.     

About College of Public Health at George Mason University     

The College of Public Health at George Mason University is the first College of Public Health in Virginia and a national leader in inclusive, interprofessional, public health research, education, and practice. The college is comprised of public health disciplines, health administration and policy, informatics, nursing, nutrition, and social work. The college offers a distinct array of degrees to support research and training of professionals dedicated to ensuring health and well-being for all. The college’s transdisciplinary research seeks to understand the many factors that influence the public’s health and well-being throughout the lifespan.  

The college enrolls more than 1,900 undergraduate and 1,300 graduate students in our nationally recognized programs, including 5 undergraduate degrees, 7 master’s degrees, and 4 doctoral degrees, and 10 certificate programs. Our graduates are uniquely prepared to thrive in an increasingly multicultural, multidisciplinary, community-focused public health landscape.