A dramatic rise in colorectal cancer among adults under 50 — especially those ages 45–49 — is driving a major shift across gastroenterology and ASCs. Screening guidelines dropped to age 45 in 2021, and early uptake is rising fast, even as providers grapple with reimbursement declines, capacity constraints and workforce pressure.
Colorectal cancer has become the leading cause of cancer deaths for men under 50 and the second-leading cause for women under 50, according to the American Cancer Society’s 2024 data.
Here are five key ways the rise in younger colorectal cancer cases could reshape GI practice and ASC operations:
1. Rising colonoscopy demand
Screening rates in 45-49-year-olds increased 62% from 2019 to 2023, with colonoscopy volumes rising 43% and stool-based testing jumps more than fivefold.
2. Need for expanded ASC capacity
Gastrointestinal procedures already make up more than a quarter of Medicare ASC volume, with eight GI-related procedures — including colonoscopies, CRC screenings and endoscopies — accounting for 28.3% of all billed services in 2023, according to MedPAC. With millions of newly eligible patients, ASCs may need to add procedure slots, anesthesia coverage and recovery space to meet demand.
3. Shifting payer dynamics
Coverage expansion for younger patients creates new billing opportunities, but adjusted reimbursement for GI procedures has dropped 7% to 33% since 2007, with colonoscopy and biopsy payments down 38%. Without rate stabilization, rising volumes may not translate into proportional revenue growth.
4. Heightened workforce pressure
Gastroenterology is projected to face a shortage of more than 1,600 physicians nationwide by the end of 2025. Rising demand from younger screening guidelines could amplify appointment delays, provider burnout and reliance on advanced practice providers.
5. Equity and access gaps
Despite expanded guidelines, nearly 4 in 10 adults older than 45 have not undergone a colonoscopy. Many cite fear, lack of awareness, or cost as barriers, and 79% of Americans do not know the recommended screening age. Programs that partner with community health groups to provide free or low-cost screenings show promise in reaching underserved populations, but disparities persist.
