Colorectal cancer is silently becoming a leading killer among younger adults, and the recent tragic death of 48-year-old actor James Van Der Beek has thrust this alarming trend into the spotlight. But here’s where it gets controversial: should we be screening for this disease earlier than the current guidelines suggest? Let’s dive into what doctors are saying and why this debate is more critical than ever.
While overall cancer death rates for people under 50 have dropped by 44% since 1990, colorectal cancer has bucked this trend. After decades of steady increases, it’s now the top cancer killer in this age group. Colorectal cancer begins in the colon or rectum, and experts like Van Karlyle Morris, section chief for colorectal cancer at MD Anderson Center, warn that this upward trajectory is likely to continue. And this is the part most people miss: the disease often starts with slow-growing growths called adenomas or polyps, which can eventually turn cancerous.
Federal guidelines and the American Cancer Society currently recommend that average-risk individuals start screening at age 45 with a colonoscopy every 10 years or a stool test every one to three years. But why 45? The risk of colorectal cancer more than doubles between ages 45 and 49, jumping from 21 to 47 cases per 100,000 people. Still, this hasn’t stopped debates about whether the screening age should be lowered further.
Here’s the controversial part: In 2021, the U.S. Preventive Services Task Force lowered the recommended screening age from 50 to 45, a move that sparked pushback from some in the medical community. Rebecca Siegel of the American Cancer Society notes, ‘Even today, not everyone is convinced.’ Developing these guidelines is no simple task—experts must weigh the benefits of early detection against risks, costs, and even the availability of gastroenterologists to perform screenings.
Despite the guidelines, screening rates among younger adults remain shockingly low. Only about 20% of people aged 44–49 are up to date with their screenings. Dr. Andrew Chan points out, ‘Uptake is certainly lower in younger populations, and I would expect for people younger than 45, the uptake would be even lower.’ So, what’s stopping them? Access, awareness, and perhaps a false sense of security that colorectal cancer only affects older adults.
But here’s a thought-provoking question: Should we rely solely on age-based guidelines, or should family history and symptoms play a bigger role in determining when to screen? Siegel emphasizes, ‘People need to talk to their families. Even a non-cancerous polyp in a relative could mean you need screening before 45.’ Symptoms like persistent abdominal pain, rectal bleeding, ongoing diarrhea, or iron deficiency anemia should never be ignored—they could be red flags for colorectal cancer.
Noninvasive tests like Cologuard (a stool test) and Shield (a blood test) offer easier screening options, but they’re not perfect. While Cologuard detects about 92% of colorectal cancers, it only catches 42% of precancerous polyps. Colonoscopy remains the gold standard, but without insurance, it can cost anywhere from $1,250 to over $4,000. Is this cost barrier preventing younger adults from getting screened?
Beyond screening, lifestyle changes can make a big difference. Rising obesity rates, sedentary lifestyles, and diets high in ultraprocessed foods are believed to contribute to the increase in colorectal cancer among younger people. Chan advises, ‘Focus on improving your diet and getting enough exercise. These interventions can reduce your risk significantly.’
So, where do we go from here? Should screening guidelines be lowered further? How can we make colonoscopies more accessible? And what role should lifestyle changes play in prevention? These questions don’t have easy answers, but one thing is clear: colorectal cancer in younger adults is a growing problem that demands our attention. What’s your take? Should screening start earlier, or are the current guidelines sufficient? Let’s start the conversation.
