The American Cancer Society (ACS) released its annual Facts & Figures report this week, highlighting concerning trends in cancer incidence and mortality along with some positive progress. While cancer death rates in the U.S. continued a steady decades-long decline, driven by advances in early detection and treatment, colorectal cancer emerged as a growing threat among adults under age 50.
Colorectal Cancer Now #1 Cancer Killer In Young Men
For the first time ever, colorectal cancer surpassed lung cancer as the leading cause of cancer deaths in men under 50 years old, according to the ACS report. From 2012-2019, mortality from colorectal cancer increased by 3% per year in men ages 20-49.
Over the same period, incidence rates rose by 2% annually in both men and women under 50. As a result, more than 17,000 cases of colorectal cancer are expected to be diagnosed in Americans under age 50 this year.
“It’s very alarming,” said Dr. Kimmie Ng, director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute in Boston. “The fact that in this day and age, during a time period where cancer death rates overall are declining, there’s this one cancer that is rapidly increasing in young adults – it suggests that there are modifiable risk factors at play here.”
While rates have been rising with statistical significance since the mid-2000s, doctors only began noticing an influx of young adult patients about a decade ago, Ng said. That highlighted a need for more research and awareness surrounding colorectal cancer risks in the under 50 population.
Potential Causes Under Investigation
So far, the causes of rising early-onset colorectal cancer remain unclear. The traditional risk factors for the disease – being over age 50, family history of colorectal cancer, inflammatory bowel diseases, smoking, heavy alcohol use, obesity and diabetes – do not seem to account for the recent increases among young adults.
Ng pointed to the alcohol epidemic, growing obesity problem and dietary shifts as potential contributing factors. Studies show younger generations since the 1990s consume fewer fruits, vegetables and fiber compared to prior cohorts. Meanwhile, consumption of processed and red meat – both considered carcinogenic to humans – continues to rise globally.
“We clearly need more research to better understand the underlying exposures in early life or even inter-generational exposures that might be contributing to the rise,” Ng said.
Beyond lifestyle changes, researchers are also considering the influence of the microbiome, antibiotic exposure, vitamin D deficiency, sleep deprivation and nocturnal light exposure from screen time. Each of these factors may negatively impact immune function or metabolism and enable tumor growth.
The increase also corresponds to growing popularity of abdominal imaging, such as CT scans. While detecting tiny precancerous growths earlier could help save lives down the road, the radiation itself may trigger tumor development in some cases, experts say. Guidelines advise limiting scans without a clear medical rationale.
Whatever the cause, the ACS found the surge in young-onset colorectal cancer has disproportionately harmed communities of color. Compared with prior generations, incidence rates grew the most rapidly from 2012-2016 for Black men and women under 50, by 4.2% and 4.5% per year, respectively.
“Unfortunately we see this pattern where certain exposures happen and then you see the cancer burden increase first in populations that face more discrimination and barriers to healthcare access,” Ng said. “I worry we’ll see even worse disparities emerging.”
Earlier Screening Recommended As Cases Rise
To catch colorectal cancer earlier and boost the chance of survival, the ACS lowered its recommended screening age from 50 to 45 in 2018 for people at average risk. But studies show fewer than one-quarter of at-risk adults in their mid-40s are up to date on screening.
Unlike breast or prostate cancers, there has been no effective screening to catch pre-cancerous polyps and early stage colorectal tumors in young people who have no family history of the disease. So symptoms like persistent diarrhea, constipation, cramping, blood in the stool, unintended weight loss and fatigue often get overlooked or dismissed in younger patients.
“The most common story I hear from my patients is that their symptoms were present for months to years before the diagnosis, but no one ever thought it could be cancer,” Ng said.
After Brian Call underwent surgery in 2019 to remove 30 inches of his colon invaded by cancer, the Florida construction worker shared a similar story with WESH in Orlando:
“Six months prior, I had gone to my primary care physician and explained the symptoms,” Call said. “He said there was no chance at my age.”
Another recent patient – 37-year-old mother of two, Becky Alsept – told Syracuse.com she saw multiple doctors for nearly a year and a half before her Stage 3C colon cancer was detected in November.
“I was told it was probably just internal hemorrhoids or IBS (irritable bowel syndrome),” Alsept said. “I was given hemorrhoid cream, stool softeners, laxatives, told to eat more fiber.”
Finally, she persuaded doctors to perform a colonoscopy. When the results confirmed advanced cancer, Alsept said “none of them could believe it due to my age.” Now she’s urging others: “You have to advocate for yourself and not ignore or mask what’s going on.”
Similarly, Call’s experience motivated him to speak out.
“It’s becoming way too normal,” Call said. “With the younger age group, don’t take no for an answer.”
Battle For Screening Coverage Continues
Last month, the American College of Gastroenterology (ACG) updated its guidelines to recommend African Americans begin screening for colorectal cancer and polyps at age 45 rather than 50 given the growing disparities. The ACG also advises screenings every five years for average risk adults ages 45-75, while the ACS sticks to every 10 years.
Some experts want insurers to cover earlier screening without cost-sharing and see Medicaid programs expand eligibility to people under age 50.
“We need to make sure screening happens in these communities,” Ng urged. “It has to be accessible and affordable.”
Bills recently introduced in Congress also aim to make more data around early-onset colorectal cancer readily available and fund research into potential causes as well as prevention initiatives in disproportionately affected communities.
Additionally, the ACS continues pushing to expand health insurance access to lifesaving cancer treatments and medications. The report shows uninsured patients are significantly more likely to get diagnosed at later stages and face higher death rates across all cancer types.
Overall Cancer Mortality Rate Drops By 32%
Beyond emerging concerns, the annual report also highlighted substantial progress reducing deaths from the most common cancer types over the past three decades.
Steadily declining smoking rates, coupled with advances in early detection and treatment, helped drive a 32% reduction in overall cancer mortality since 1991. The cancer death rate dropped by about 2.5% annually from 2016 to 2019.
Lung cancer remains the leading cause of cancer deaths among men and women combined, but new lung cancer cases dropped significantly. Declines also emerged among nearly every major cancer type for both new diagnoses and deaths – with the exception of pancreatic cancer. Improvements were most pronounced in lung, breast, prostate and colorectal cancers.
| Cancer Type | % Change in Incidence Rates 2010-2019 | % Change in Mortality Rates 2010-2019 |
:–|:–:|–:
| Lung & Bronchus | -1.5% | -4.0%
| Breast (Female) | +0.5% | -1.3%
| Prostate | -2.1% | -3.3%
| Colorectal | -1.0% | -2.4%
Data Source: ACS Facts & Figures 2024 Report
“The news this year is mixed,” said William Cance, ACS chief medical and scientific officer. “The exciting gains in reducing mortality speak to real progress thanks to cancer screening programs, new and effective therapies and treating more patients in NCI-Designated Cancer Centers where they can access high-quality treatment.”
Still, Cance finds the emerging threat of colorectal and other cancers in younger populations concerning.
“For some cancers, we’re still seeing increases for new cases as well as mortality for certain populations,” Cance noted. “We have to work to close those gaps.”
More Cancer Diagnoses Expected As Population Ages
Looking ahead, the ACS predicts over 2 million people will receive a cancer diagnosis this year as the U.S. population expands and ages. About 609,360 Americans are expected to die from cancer – equivalent to 1,670 deaths per day, which exceeds the number of daily COVID-19 deaths at the pandemic’s peak.
Breast cancer alone accounts for 30% of new cases among women, while prostate cancer makes up 21% of new male cases. Non-melanoma skin cancer represents about half of the expected diagnoses.
The 5-year survival rate for all cancer patients stands at 67% currently, up from 49% in the mid-1970s. While cancer usually becomes more treatable if found early, only about 7% get diagnosed at the disease’s most treatable stage.
More Research Needed To Expand Treatment Options
“The broad story is fewer people are being diagnosed with cancer and more people are surviving cancer,” Cance said. “But when you peel that back…we see areas that continue to be very alarming.”
Ng echoed the need to celebrate the progress while recognizing where more work lies ahead:
“The fact that cancer deaths are continuing to decline represents a lot of hope we can share with our patients. We are saving more lives today because of discoveries from cancer research and better access to quality screening and treatment,” Ng said. “At the same time, when we see rates going up for earlier-onset cancers, it’s a sign we urgently need more research to guide prevention and catch these cancers sooner.”
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