Colorectal cancer has become the top cause of cancer death for Americans under 50, even as deaths from lung, breast and other cancers decline, raising the stakes for screening, advocacy and health equity.
A new study from the American Cancer Society (ACS) reveals that cancer mortality among Americans under age 50 has dropped sharply overall, but one disease bucks the trend.
According to research published Jan. 22 in the Journal of the American Medical Association, the U.S. cancer death rate for people younger than 50 fell by 44% from 25.5 per 100,000 in 1990 to 14.2 per 100,000 in 2023 – largely due to significant decreases in deaths from lung, breast, brain cancers, and leukemia.
However, colorectal cancer was the lone exception, rising steadily and becoming the leading cause of cancer death in this age group in 2023 after increasing 1.1% per year since 2005.
Rebecca Siegel, MPH, senior scientific director of surveillance research at the ACS and lead author of the report, said: “The steady rise in colorectal deaths under 50 is even more alarming compared to the dramatic declines for lung and breast, even as breast cancer incidence is climbing.”
Siegel added that while the reasons for the rising numbers remain unclear, “lives can be saved now through symptom awareness and destigmatization, and more screening uptake, as three in four people under 50 are diagnosed with advanced disease.”
For the study, scientists analyzed trends in the annual numbers of cancer deaths and age-standardized rates per 100,000 men and women aged 0-49 years for the top 5 cancer-related deaths during 1990-2023 in the U.S. They used data from the National Center for Health Statistics as provided by the Surveillance, Epidemiology, and End Results (SEER) program at the National Cancer Institute.
The ACS said results showed that 1,267,520 people died from cancer in the U.S. before age 50 from 1990 through 2023, and the overall death rate decreased by 44%. Four of the five leading causes of cancer death decreased, with the average annual decline during 2014-2023 ranging from 0.3% for brain cancer and 1.4% for breast cancer to 2.3% for leukemia and 5.7% for lung cancer.
Only CRC mortality increased annually for people under 50. Lung cancer and leukemia dropped from ranking first to fourth and third to fifth, respectively, whereas breast cancer remained the second leading cancer death overall and first in women. Cervical cancer ranked third in women in 1990 and 2023, despite a continuous decline throughout the study period. The cancer distribution in men mirrored the overall pattern, with breast cancer replaced by non-Hodgkin lymphoma (4th) in 1990 and pancreatic cancer (5th) in 2023.
“We weren’t expecting colorectal cancer to rise to this level so quickly, but now it is clear that this can no longer be called an old person’s disease. We must double down on research to pinpoint what is driving this tsunami of cancer in generations born since 1950,” said Dr. Ahmedin Jemal, senior vice president, surveillance, prevention, and health services research at the ACS and senior author of the study. “In the meantime, people 45-49 years make up 50% of diagnoses under 50, so increased screening uptake will prevent disease as well as death.”
Catching it early
CRC is one of the most preventable and treatable cancers when found early, according to the Centers for Disease Control and Prevention (CDC). That’s in part because CRC grows slowly, often starting as a small, noncancerous polyp. Over time, some polyps can turn into cancer.
Another reason why early screening is so essential: Colorectal cancer often produces no early warning signs, especially for adults age 45 and older, the CDC says. When symptoms do occur, they may include persistent changes in bowel habits, such as diarrhea or constipation; blood in or on the stool; a feeling that the bowel does not empty completely; ongoing abdominal pain, cramps or aches; and unexplained weight loss. Because these signs can also stem from non-cancer causes, health officials urge individuals experiencing any of them to consult a clinician promptly.
Health experts stress that multiple colorectal cancer screening options are available, allowing patients and providers to choose an approach that fits individual risk, preferences, and access to care. Screening tests generally fall into two categories: stool-based tests and visual exams of the colon and rectum.
Stool-based tests are noninvasive and can be completed at home. These include the fecal immunochemical test (FIT) and guaiac-based fecal occult blood test (gFOBT), which look for hidden blood in the stool, as well as FIT-DNA tests, which detect both blood and abnormal DNA linked to cancer or polyps. These tests are typically repeated every one to three years, depending on the method used. A positive result requires follow-up with a diagnostic colonoscopy.
Visual exams allow clinicians to directly examine the colon. Colonoscopy, considered the most comprehensive option, enables providers to detect and remove precancerous polyps during the same procedure and is usually performed every 10 years for average-risk adults. Other options include flexible sigmoidoscopy and CT colonography, also known as virtual colonoscopy, which are performed at shorter intervals.
Advocacy efforts
The increase in colorectal cancer among younger adults is shifting public health toward earlier screening, better symptom recognition and risk-based approaches, said Anjee Davis, CEO of Fight Colorectal Cancer, an organization that works to empower individuals, influence policy, and accelerate breakthroughs that improve prevention, care and outcomes.
Fight CRC’s efforts include educating providers and the public, expanding digital navigation tools, and advocating for coverage reforms so people ages 45 to 49 and symptomatic younger patients are identified and tested promptly.
Fight CRC’s advocacy program mobilizes patients, caregivers and supporters to influence public policy at both the federal and state levels. Through initiatives such as Call-on Congress and the State Catalyst Program, advocates receive training and tools to engage lawmakers on issues including access to screening, affordability of care and research funding. These efforts ensure that colorectal cancer remains a visible priority in health policy discussions.
Fight CRC also plays a significant role in advancing research and innovation. The organization supports research focused on prevention, early detection and treatment, while emphasizing patient involvement in the scientific process. Its Research Advocacy Training and Support (RATS) program equips advocates to participate in clinical trial design, advisory panels and funding decisions, helping ensure that research reflects real-world patient needs.
In addition, Fight CRC offers a range of education and support resources for patients and caregivers navigating a colorectal cancer diagnosis. These include medically reviewed educational materials, community connections, and digital tools such as ChatCRC, an AI-powered chatbot designed to provide personalized guidance on screening, treatment options, and survivorship.
Community engagement and awareness are further strengthened through national campaigns and events, including United in Blue during Colorectal Cancer Awareness Month and signature fundraising initiatives like Climb for a Cure.
Together, these programs reflect Fight CRC’s comprehensive approach: driving policy change, accelerating research, and supporting patients at every stage of their journey. As colorectal cancer rates continue to rise, particularly among younger adults, the organization’s multifaceted strategy aims to ensure that progress keeps pace with the growing need.
Addressing disparities and gaps
Disparities in colorectal cancer risk and outcomes across different populations or regions are both large and avoidable, said Fight CRC’s Davis. Black, Hispanic, rural, low income and uninsured communities shoulder a disproportionate burden.
“Fight CRC advances health equity by targeting resources and culturally appropriate education to clinics and communities that need them most and by pushing state and federal policy to close coverage and access gaps,” she said. “This is evident in places with constrained or limited access to endoscopy.”
Davis said barriers to care for younger patients are practical and solvable: cost, access, awareness, provider recommendation and follow up after abnormal tests.
“Fight CRC pushes systemic solutions such as mailed outreach, patient navigation, no cost follow up for diagnostic colonoscopy and state level quality measures so that noninvasive testing translates into timely diagnosis and care,” she said. “These barriers are most acute where Medicaid expansion and coverage policies vary.”
At the national level, the CDC’s Colorectal Cancer Control Program (CRCCP) is driving measurable increases in colorectal cancer screening by partnering with clinics, hospitals and other health care organizations to implement proven strategies that help detect cancer early and save lives.
The CRCCP targets adults aged 45 to 75, particularly in clinics where fewer than 60% of patients are up to date on screening – often in lower-income or medically underserved communities.
At the heart of the program are evidence-based interventions recommended by the Guide to Community Preventive Services. These include regular assessment and feedback to healthcare providers on their screening recommendations, electronic or written provider reminders for due or overdue tests, and targeted patient reminders via mail, email or phone.
The CRCCP also works to remove structural barriers that can hinder screening access. Efforts range from extending clinic hours and offering stool tests in nonclinical settings like vaccination sites to providing patient navigation services, transportation, childcare and simplified paperwork, all aimed at making screening more accessible and less burdensome.
By collecting and analyzing clinic data, the CDC says it can identify where screening gaps remain and adjust strategies to maximize impact. Public health evaluations indicate that these interventions have increased screening rates, particularly in clinics serving underserved populations, though challenges remain in closing gaps across all regions.
Health officials emphasize that increasing colorectal cancer screening not only saves lives by detecting precancerous conditions early but also reduces long-term health care costs, lost wages and the burden on patients, employers and insurers.
In a compelling example of the CRCCP’s real-world impact, a free clinic in West Virginia dramatically increased its screening rate through tailored interventions supported by CDC funding. At Wheeling Health Right, only 9% of eligible patients were screened initially, largely because the clinic relied on an older fecal occult blood test that many patients found inconvenient. By switching to the easier fecal immunochemical test (FIT), training staff on screening guidelines, updating electronic records, and implementing follow-up phone reminders, the clinic saw its screening rate jump first to 53% in 2017 and then to more than 67% in 2018 – a 58% overall increase over two years. Staff calls alone boosted FIT return rates by nearly 40%, underscoring the power of patient engagement and simple systemic changes in improving health outcomes. Despite progress, about one-third of patients still need screening, and clinic leaders plan to continue adapting strategies to raise rates even further.
In another example of the CRCCP’s influence, a public health clinic in St. Petersburg, Florida, more than doubled its colorectal cancer screening rate by adopting a series of targeted outreach and follow-up strategies. Before partnering with the Florida Department of Health’s Colorectal Cancer Control Program, only about one-third of eligible patients were being screened. With CDC support, the clinic hired a full-time patient navigator, developed daily electronic reports of screening needs, and implemented a robust reminder system that combines pre-visit and follow-up calls and letters.
One especially effective innovation allowed clinic staff to collect stool samples while patients were already visiting for other services, escorting them to the restroom and providing results the same day. These combined efforts helped boost screening from 34% to over 75%.
80% in Every Community
Another major health equity campaign is gaining momentum across the United States with a shared aim: get at least 80% of eligible adults screened for colorectal cancer in every community nationwide. The initiative, 80% in Every Community, is led by the American Cancer Society National Colorectal Cancer Roundtable (ACS NCCRT) – a coalition of health systems, community organizations, employers, health plans and other partners committed to reducing colorectal cancer deaths through increased early detection.
The 80% in Every Community campaign builds on earlier national efforts – including the original 80% by 2018 pledge – by focusing not just on overall national targets but on ensuring that every community, regardless of location, income or racial and ethnic makeup, reaches screening rates of at least 80%. This expanded focus on health equity aims to close persistent gaps in access to lifesaving colorectal cancer tests.
What counts as a “community” under the initiative is intentionally flexible: it can be a city, county, state, a patient population served by a particular health system, a workforce group, or a racial or ethnic community striving together toward higher screening rates.
ACS NCCRT encourages organizations to commit to the goal, adopt screening improvement strategies, share best practices and use a suite of available tools and resources to support their outreach work. There is also a social engagement aspect: partners and supporters share progress and stories using #80inEveryCommunity to help raise awareness and inspire action.
Success stories from participating organizations show that reaching 80% is achievable with coordinated effort, tailored outreach and systematic follow-up. A core part of the initiative’s strategy includes addressing barriers to care, particularly in underserved populations, and investing in data tracking to monitor progress.
As the campaign moves forward, its leaders emphasize collaboration and shared responsibility in eliminating colorectal cancer disparities and ensuring that everyone – regardless of where they live – can benefit from timely, life-saving screening.
Reversing the trend
Taken together, the data point to a clear and urgent message: while cancer outcomes for younger Americans have improved dramatically overall, colorectal cancer is moving in the opposite direction– and it does not have to. With effective screening tools, proven public health strategies and growing advocacy to expand access and awareness, experts say the means to reverse this trend already exist.
The challenge now is turning knowledge into action, ensuring that age, income, geography or insurance status no longer stand between patients and early detection. As researchers, clinicians, advocates and communities align around that goal, the hope is that colorectal cancer will soon follow the same downward trajectory as other cancers – and that fewer lives will be lost to a largely preventable disease.
Whether at the national or local level, Fight CRC’s Davis said simplicity is key to effective screening strategies. “Simple, well-designed systems work: mailed noninvasive tests, patient navigation, and programs that remove cost and logistical barriers,” she said.
An AI-enabled patient chat for colorectal cancer patients and caregivers
Davis said technology will make screening and diagnosis more accurate, less invasive, and more personalized. Even initial outreach efforts can be boosted by the latest advances in communication tools.
Fight Colorectal Cancer’s AI-enabled patient chat, ChatCRC, is an artificial intelligence–powered chatbot created to support people affected by colorectal cancer – including patients, caregivers and clinicians – by providing accurate, accessible information and personalized responses related to colorectal cancer prevention, screening, diagnosis, treatment and care management.
ChatCRC delivers 24/7 interactive support, helping users ask questions and receive immediate answers about topics like risk factors, screening options, treatment side effects, wellness strategies and available resources. It’s designed to remove complex medical jargon so information is easier to understand, and it can even be accessed by SMS text message for users without internet access.
While the tool provides tailored information and connects users with educational resources, clinical trial info and support groups, it does not offer medical advice or replace consultation with a healthcare provider.
Polyps in the colon or rectum
Most colorectal cancers start as a growth on the inner lining of the colon or rectum. These growths are called polyps.
Polyps are quite common, especially as you get older. Most polyps are benign, or noncancerous. Some types of polyps can change into cancer over time (usually over many years). The chance of a polyp turning into cancer depends on the type of polyp it is. There are different types of polyps.
- Adenomatous polyps (adenomas): These polyps sometimes change into cancer. Because of this, adenomas are called a precancerous condition. The 3 types of adenomas are tubular, villous, and tubulovillous. Tubular adenomas are the most common type of adenomatous polyps. Villous adenomas are the least common type of adenomatous polyps, but are more likely to change into cancer.
- Hyperplastic polyps and inflammatory polyps: These polyps are more common, but in general they are not precancerous. Some people with large (more than 1cm) hyperplastic polyps might need colorectal cancer screening with colonoscopy more often.
- Sessile serrated polyps (SSP) and traditional serrated adenomas (TSA): These polyps are often treated like adenomas because they have a higher risk of changing into cancer.
Source: American Cancer Society