Bold claim: Rectal cancer is rising in the U.S., and it’s hitting younger adults harder than ever before. Now more than ever, people under 65 are being diagnosed with colorectal cancer, while rates in those 65 and older are falling. A new American Cancer Society report highlights that rectal cancers, in particular, are climbing across all adults and now make up almost one-third of all colorectal cancer cases, up from about a quarter in the mid-2000s. Between 2018 and 2022, rectal cancer diagnoses rose by roughly 1% each year across every age group.
What’s puzzling is that researchers still don’t know why this specific cancer type is becoming more common. Dr. Arif Kamal, the ACS’s chief patient officer, notes that this increase appears to be a recent phenomenon—something we’ve only started seeing in the last five years or so.
Looking at long-term trends since the late 1990s, the report shows:
- Colorectal cancer incidence rose about 3% per year for people aged 20–49
- Incidence rose about 0.4% per year for people aged 50–64
- Incidence fell about 2.5% per year for those 65 and older
This shift toward younger patients is pushing doctors to stress earlier education and awareness. Historically, colorectal cancer was viewed as a disease of older adults, but that narrative is changing. Andreana Holowatyj from Vanderbilt University Medical Center points out that there’s typically a 4–6 month lag between symptom onset and diagnosis for young patients, which is troubling. She asks how we can better educate Gen Z and millennial generations to recognize warning signs sooner.
Symptoms to know: Colorectal cancers involve the colon (the large intestine) and rectum (the final section just before the anus). Rectal tumors often present with more pronounced signs than colon tumors. Common colon cancer symptoms can be vague—fatigue, abdominal pain, bloating, and unexplained weight loss—while rectal cancer often features bright red blood on toilet paper or in the toilet and a strong, urgent need to use the bathroom even after a bowel movement.
Even though the exact drivers of the rectal cancer rise aren’t clear, experts emphasize the importance of listening to your body and seeking medical attention promptly if you notice symptoms.
Screening guidance has evolved. Previously, average-risk colorectal cancer screening started at age 50. In 2021, the U.S. Preventive Services Task Force lowered the recommended start age to 45. People with higher risk—such as a family history of colorectal cancer, prior precancerous polyps, or inflammatory bowel disease—may need earlier screening.
The new report reveals that only about one-third of people aged 45–49 are getting screened, and roughly three-quarters of colorectal cancers diagnosed in those under 50 are already at an advanced stage when detected. With diagnoses trending younger, experts like Kamal say the screening age question will likely be revisited in the coming years.
There’s growing interest in “fast-tracking” evaluations for people under 45 who present concerning symptoms. Caitlin Murphy, a cancer epidemiologist at the University of Chicago, notes that referral delays can allow cancers to progress while patients wait for a step-by-step diagnostic path. The goal is timely treatment and diagnosis.
Reducing risk: Colorectal cancer remains the leading killer among cancers in people under 50. Projections for 2026 estimate about 158,850 new colorectal cancer cases and around 55,230 deaths, with nearly a third of deaths occurring in people under 65. More than half of cases are linked to modifiable risk factors, including smoking, high alcohol use, physical inactivity, and excess body weight. Diet also plays a role: increasing fiber, vegetables, fruits, and whole grains while limiting processed meats can help reduce risk, according to the American Cancer Society.
If you’re seeking a takeaway: stay attentive to bodily changes, pursue timely screening when advised, and adopt heartier lifestyle habits that support colorectal health. Now, a provocative question to consider: given the rise in younger cases, should screening recommendations be lowered even further or personalized more strictly by risk factors? What do you think—are current screening guidelines adequately protecting younger adults, or is this a case where a more aggressive, early-detection approach is warranted? Share your thoughts in the comments.
