Colon cancer is now the leading cause of cancer deaths in young Americans, ‘alarming’ research has found.
Colorectal cancer (CRC) has surged in young people across the country over the past two decades, from 8.6 cases per 100,000 people in 1999 to 13 cases per 100,000 people in 2018, past studies have shown.
Since 2004, incidence among people under 50, a population historically thought of as unlikely to develop the disease, has increased by about two percent every year.
For many young patients, CRC symptoms are subtle, like dabs of blood on toilet paper or lingering abdominal pain, and in some cases, symptoms are even nonexistent, leading to later diagnoses and more advanced, harder-to-treat tumors.
Now, researchers with the American Cancer Society have found that the picture for young CRC patients may be even more grim than other forms of cancer.
Out of eight forms of cancer, the ACS team found that deaths decreased in people under 50 in all except CRC. The disease is now the leading cause of cancer death in people under 50, up from the fifth-leading cancer death in the early 1990s.
Colorectal cancer is also the leading cause of cancer death in men under 50 and the second-leading cause for women in the same age group, surpassed only by breast cancer.
And while breast cancer and leukemia rates have also increased in people under 50, the team found deaths have slowed among this age group since the 1990s.
Bailey Hutchins of Tennessee, pictured, died of colon cancer last year at 26 years old
The above graphs show rates of cancer deaths among people under 50 from 1990 until 2023. The data shows deaths from all cancers except colorectal cancer have decreased in young Americans
Dr Christine Molmenti, cancer epidemiologist and co-director of the Northwell Health Early-Onset Cancer Program in New York, who was not involved with the study, said: ‘I think this is a very impactful and well thought out and executed study. It is bringing to light the major public health problem that we’re dealing with in the United States and globally.
‘The fact that colorectal cancer has now risen to the leading cause of cancer death in men under 50 and second leading in women under 50, only second to breast cancer, are extremely alarming results.
‘It’s something that we need to take note of from a screening perspective, and from an awareness perspective as it relates to patients and to providers.’
The findings were published in the journal JAMA as a research letter, a peer-reviewed publication that is shorter and less detailed than a full study.
Using National Cancer Institute figures from 1990 through 2023, the latest data available, the team looked at trends in CRC, lung, breast, brain, uterine and pancreas cancers, as well as leukemia and Non-Hodgkin lymphoma in men and women under 50.
About 1.2 million Americans under 50 died of cancer from 1990 through 2023, 53 percent of whom were women. Overall, the age-standardized death rate decreased by 44 percent, from 25.5 to 14.2 per 100,000 people.
The team also found from 2014 to 2023, annual deaths decreased 0.3 percent for brain cancer, 1.4 percent for breast cancer, 2.3 percent for leukemia and 5.7 percent for lung cancer.
CRC, meanwhile, increased by 1.1 percent per year from 2005 until 2023. From 1990 through 1994, CRC was the fifth-leading cause of cancer death in Americans under 50, but in 2023 it became the leading cause.
Dr Nikita Wagle, study co-author and principal scientist of Surveillance Research at the American Cancer Society, told the Daily Mail: ‘What surprised us most is how clearly colorectal cancer now stands apart from other cancers in young people. Colorectal cancer was the only cancer with increasing mortality.’
The team also found that CRC was the top cause of cancer death in men under 50 and second-leading in women younger than 50.
Karina Ureña, 30, was diagnosed with stage 4 colon cancer after throwing up five times during her first-ever half-marathon. She is pictured above
Dr Molmenti said that while more research on sex differences is needed, men ‘do have some of the risk factors that are problematic for colorectal cancer.’
‘They may be higher alcohol users, they may smoke more, they may have more behaviors that can lead to an increased risk of colorectal cancer compared to women,’ she added.
She noted, however, that women may be more likely to dismiss CRC warning signs.
‘For example, many of their symptoms manifest as menstrual cycle findings. So, if they have bleeding or abdominal pain, their symptoms may be dismissed because of their menstrual cycle,’ she said.
‘In addition, they could be also misdiagnosed as hemorrhoids, especially if they’ve had children.’
Lung cancer and leukemia dropped from the first to fourth and third to fifth leading cause, respectively. Breast cancer has remained the second-leading cause of overall cancer death and the top cause in women.
Cervical cancer, which affects women, has remained steady, ranking third in deaths among young people in 1990 and 2023.
Dr Wagle notes that the rising number of deaths in young people with CRC ‘reflects missed opportunities, for example, missed changes for earlier diagnosis, timely treatment and symptom recognition’ due to the symptoms being dismissed or negative stigma surrounding the disease.
Liz Healy, pictured here, was diagnosed with stage four colon cancer and stage two kidney cancer in 2022 after imaging following a skiing accident
‘Nearly three in four patients younger than age 50 are diagnosed with advanced-stage disease, when treatment can be difficult, and survival is worse,’ she told the Daily Mail.
She warned that if this continues, deaths ‘could remain elevated.’
‘The hopeful sign is that we now have clear levers to change it,’ she added. ‘We need to remove the stigma around this disease and its symptoms so that people feel comfortable discussing concerns with their doctors.
‘There are specific red flag symptoms among people younger than age 50, such as rectal bleeding and abdominal pain, that should not be ignored.’
She also urged colorectal cancer screening with a colonoscopy starting at age 45 and reoccurring every 10 years, though people with a family history should be screened at earlier ages.
Exact risk factors for colorectal cancer are still being investigated, but recent research suggests diets high in processed or fried foods, alcohol consumption, sedentary lifestyles and early exposure to antibiotics may be to blame.
But Dr Molmenti notes that ‘we’re seeing and what’s come forward with a lot of patients who are diagnosed; they don’t meet a lot of those criteria. They say they’re healthy. They say they eat well, and that they are generally fit and active.
‘And so, we have this conundrum of what is the phenotype that the risk factors are sort of painting for this disease, and then what do some of our patients look like upon presentation in the clinic? And I think this is something that needs to be really further investigated.’
