The untimely death of 48-year-old actor James Van Der Beek has brought renewed attention to a worrying trend: colorectal cancer increasingly affecting younger adults. While overall cancer death rates for people under 50 have dropped by 44% since 1990, colorectal cancer is now the leading cause of cancer-related deaths in this age group. The disease begins in the colon or rectum, often developing slowly from precancerous growths called polyps.
Experts warn this trend is likely to continue. Dr Van Karlyle Morris, head of colorectal cancer at MD Anderson Center in Houston, stresses the importance of early detection. Federal guidelines and the American Cancer Society now recommend that adults at average risk begin screening at age 45—via colonoscopy every 10 years or stool-based tests every one to three years—though most cases still occur in people over 50.
Why Screening Starts at 45
Colon cancer is usually slow-growing, giving time for early detection. The U.S. Preventive Services Task Force lowered the recommended screening age from 50 to 45 in 2021, following the American Cancer Society’s lead in 2018. Dr Rebecca Siegel of the American Cancer Society notes that despite initial skepticism, lowering the age addresses the dramatic rise in cases among people in their 20s, 30s, and early 40s.
Screening guidelines also weigh risk against resource availability. Gastroenterologists are limited, and even under current rules, it can take months to book a colonoscopy. Currently, only about 20% of 44–49-year-olds are up to date with screenings, and uptake is even lower for those younger than 45.
Who Should Consider Earlier Screening
Individuals with a family or personal history of colorectal cancer or polyps should start screening before 45. Dr Siegel advises that even non-cancerous polyps in relatives warrant earlier tests. Once symptoms appear, a colonoscopy becomes a diagnostic, not a screening, procedure.
Recognising Early Symptoms
Van Der Beek first noticed changes in bowel movements at age 46, initially attributing them to coffee consumption. A colonoscopy later revealed Stage 3 colon cancer. Common early warning signs can appear up to two years before diagnosis:
- Abdominal pain
- Rectal bleeding
- Persistent diarrhea
- Iron deficiency anemia
Persistent symptoms, especially multiple warning signs, should prompt immediate medical attention. Blood tests or stool-based screenings like Cologuard or the Shield blood test can detect cancer, though they are less effective for precancerous polyps.
Cost and Accessibility
Colonoscopy remains the gold standard for detection. Without insurance, procedures can range from $1,250 to over $4,000. Noninvasive tests offer an easier alternative but still require follow-up colonoscopies if abnormalities are found.
Lifestyle Factors and Prevention
While early detection is crucial, experts highlight the role of lifestyle. Rising obesity, sedentary habits, diets high in ultraprocessed foods, and gut microbiome changes may contribute to increasing colorectal cancer rates among young adults. Maintaining a healthy diet and regular exercise can significantly reduce risk, complementing the benefits of screening.
Dr Andrew Chan, gastroenterologist at Mass General Brigham, emphasizes that while screening saves lives, proactive lifestyle changes are equally important: “Screening is critical, but improving diet and physical activity can offer benefits beyond early detection.”
Early vigilance, lifestyle modifications, and awareness of warning signs remain key in tackling this growing health threat among younger adults.
