The New Face of Colorectal Cancer
Why rates are rising in younger adults, what the science says about screening and prevention, and how to take action now.
From screen to self: a wake-up moment
After the news about Catherine O’Hara’s death from rectal cancer broke, I put on Schitt’s Creek. What I loved about her comedy wasn’t just the accent, though it did seem to arrive with diplomatic credentials, but the absurdity. Her characters never suspected they were outrageous. They suspected the room was insufficiently evolved. And yet, beneath the hauteur and the lacquered vowels, there was always that flicker of fragility, a reminder that even the most imperious grande dame inhabits a mortal body, one that can falter in the most inelegant of ways, no matter how exquisite the wardrobe.
Her death came just days after the announcement that James Van Der Beek had died from colorectal cancer. When that news broke earlier in the week, my younger sister was instantly transported back to her bedroom walls papered with magazine cutouts. He wasn’t just a TV character to her. He was a childhood crush: the floppy-haired embodiment of capital-R Romance, the first draft of what love might look like. We’re the same age he was. That’s what makes it sting. A childhood crush lives in your memory as perpetually seventeen, permanently windswept. But when that crush dies of colorectal cancer at your own age, the illusion collapses. It isn’t just about him anymore. It’s about you and the uncomfortable realization that the diseases you associate with “later” have quietly arrived.
Two creeks, same current.
From headlines to hard data
Celebrity deaths often trigger surges in public awareness. The Colorectal Cancer Alliance reported increased screening inquiries and website traffic following this week’s announcements. A similar spike in online searches occurred after Chadwick Boseman’s death from colorectal cancer in August 2020.
But awareness does not always translate into sustained increases in completed screenings. Meanwhile, a more consequential epidemiologic trend has been unfolding: colorectal cancer is rising among adults under 50 and is now the leading cause of cancer death among younger adults in the United States.
A cancer that was supposed to be in retreat
Among adults over 50, colorectal cancer incidence and mortality have declined for decades, largely due to screening and polyp removal.
But in adults under 50, colorectal cancer has been moving in the opposite direction. Rates have been rising for years. Today, a study in JAMA reported that colorectal cancer is now the leading cause of cancer death in people under 50 in the U.S. And a January 2025 analysis in The Lancet Oncology examined data across 50 countries and found increasing early-onset colorectal cancer rates in many high-income nations, including the U.S.
What increases your risk?
There is no single cause. But researchers are looking closely at changes in diet, weight, and metabolism, along with long-standing gaps in access to care.
About 10-20% of early-onset colorectal cancers are linked to inherited genetic syndromes such as Lynch syndrome. Most cases are not.
Studies consistently link high intake of red and processed meat to higher colorectal cancer risk. Low fiber intake is also linked to higher risk, while higher fiber intake appears protective. More recent studies have also connected ultra-processed food to higher colorectal cancer risk.
Obesity is a well-known risk factor for colorectal cancer, and U.S. obesity rates have climbed sharply over the past two decades. Type 2 diabetes is also linked to higher colorectal cancer risk, even after accounting for other lifestyle factors.
Race and Ethnicity still shape who gets colorectal cancer and who survives it. Non-Hispanic Black Americans have long had higher rates of colorectal cancer and higher death rates than most other groups in the U.S. Black people are about 20% more likely to get colorectal cancer and about 30-40% more likely to die from it compared with White people. This happens for many reasons. It is linked to later diagnosis, higher rates of other health conditions, and unequal access to screening, insurance, and high-quality treatment.
American Indian and Alaska Native (AI/AN) communities also face serious challenges. Alaska Natives have some of the highest colorectal cancer rates in the world, and overall, AI/AN communities have seen less improvement over time than other groups. Barriers like long travel distances, fewer specialists nearby, limited access to screening, food insecurity, and long-standing social and economic disadvantages all play a role.
The age illusion: who we think gets colorectal cancer
In 2021, the U.S. Preventive Services Task Force lowered the recommended screening age from 50 to 45, in response to rising rates in younger adults.
Colorectal cancer is one of the few cancers that is often preventable. Screening can find and remove polyps before they turn into cancer.
But many people still think of colorectal cancer as an “older person’s disease.” That gap between what we believe and what the data show is part of what makes these deaths feel so unsettling.
Beyond colonoscopy: what today’s tests can (and can’t) do
Scientists are getting better at finding and treating colorectal cancer. But it helps to understand what the newer tests can do and what they still can’t.
There are two main kinds of stool tests. A fecal immunochemical test (FIT) looks for hidden blood in stool. Newer stool DNA tests look for blood and for small pieces of DNA that may come from cancer or pre-cancer cells.
Because cancers and polyps do not always bleed, FIT can miss some cases. Stool DNA tests have more ways to detect a problem. In one large study, a next-generation stool DNA test detected about 94% of colorectal cancers, compared with about 67% for FIT.
But there is a trade-off. Stool DNA tests are more likely to come back positive even when a person does not have cancer. That means more people end up needing a follow-up colonoscopy.
And one key point: a positive stool test does not diagnose cancer. It is a warning sign. The next step is still a colonoscopy.
Blood tests are another new option. These tests look for small signals from cancer in the bloodstream, including tiny pieces of tumor DNA.
In a large study, one blood test detected about 83% of colorectal cancers.
But blood tests have a major weakness: they miss most precancerous polyps.
That matters because polyps are the part we can remove to prevent cancer. So for now, blood tests are not good enough to replace colonoscopy.
Why colonoscopy is still the best
Colonoscopy is still the best screening test overall because it does two jobs at once: it finds polyps and removes them.
This is important because removing polyps can prevent cancer before it starts.
Some doctors now use AI tools during colonoscopy, which can help doctors spot small polyps that might otherwise be missed. Early studies suggest AI can improve detection, but it’s not perfect.
Better treatments: targeted and immune-based therapies
Treatment is also improving. Doctors now test tumors to learn what kind of colorectal cancer a person has. That helps them choose the best treatment.
One important example involves DNA repair. Your cells copy DNA all the time. Mistakes happen. Normally, the body fixes those mistakes, like spell-check for DNA.
In some colorectal cancers, this repair system is broken. That means the tumor builds up lots of DNA errors. These tumors can look more “foreign” to the immune system.
This is where immunotherapy — drugs like pembrolizumab — can help. The immune system has built-in “brakes” that stop it from attacking normal cells. Some cancers use those brakes to hide. Immunotherapy drugs release the brakes so immune cells can attack the tumor.
Immunotherapy works best in tumors with lots of DNA mistakes, because the immune system can recognize them more easily.
New blood tests after surgery
Another new tool is a blood test called circulating tumor DNA (ctDNA). Cancer cells can shed tiny pieces of DNA into the bloodstream. After surgery, doctors can test for ctDNA to see if cancer may still be hiding in the body even if scans look normal.
This matters because ctDNA can help predict who is more likely to have the cancer come back.
Studies show that people with ctDNA after surgery have a much higher risk of recurrence.
ctDNA testing may also help doctors decide who really needs chemotherapy after surgery and who might safely avoid it.
What you can do now
New stool tests, blood tests, immunotherapy, and ctDNA testing are changing colorectal cancer care.
These tools may help doctors:
Find cancer earlier
Match treatment to the tumor
Avoid unnecessary treatment for some patients
But colonoscopy is still the best tool for preventing colorectal cancer, because it can remove polyps before they become cancer.
Moments like this can change the conversation. But prevention takes follow-through.
No matter your age, blood in the stool, ongoing belly pain, changes in bowel habits, or unexplained iron-deficiency anemia should be checked. If you have a family history, you may also need screening before age 45.
Two creeks, same current — but if you act, perhaps a different downstream.