Colorectal cancer incidence among younger adults is climbing rapidly, creating an urgent public health challenge. U.S. CRC cases in people under 50 have risen about 2% per year since 2011, and younger patients are more likely to present with aggressive, late-stage disease.
Guideline shifts have tried to meet the moment.
The U.S. Preventive Services Task Force lowered the screening age for average-risk adults from 50 to 45, sparking a 62% increase in screenings among 45- to 49-year-olds between 2019 and 2023. But disparities persist, as uninsured patients and those with less education remain far less likely to be screened.
Even with earlier screening, many cancers are still missed.
“While the screening age was appropriately decreased to 45, unfortunately we are seeing many cancers in patients even younger,” Brett Bernstein, MD, chief of gastroenterology at New York City-based Mount Sinai Beth Israel told Becker’s. “Studies need to be done to support lowering the screening age further, as I am concerned we are missing an opportunity to prevent this disease in younger populations.”
Risk factors remain only partially understood.
“Some data suggest obesity, an overly processed diet or early antibiotic exposure may contribute, but we’re far from a clear understanding,” Rajiv Bhuta, MD, assistant professor of clinical gastroenterology and hepatology at the Lewis Katz School of Medicine at Temple University in Philadelphia told Becker’s.
ASCs are central to meeting rising demand, as colonoscopies remain the gold standard. However, reimbursement has not kept pace with volume, creating financial strain even as screening loads grow.
Non-invasive options are also expanding. Stool-based tests such as fecal immunochemical tests are gaining traction among adults ages 45 to 49, offering a lower-cost entry point for screening. Still, stronger follow-up systems are needed to translate these tests into timely diagnoses.
Looking ahead, experts say the next phase of addressing early-onset CRC will hinge on three shifts: risk-stratified screening that incorporates family history and biomarkers, policy and payer reforms to reduce cost barriers, and expanded research into biology and environmental exposures.
