Early onset colorectal cancer, meaning colorectal cancer diagnosed in adults younger than 50, is one of the clearest shifts in cancer patterns of the past three decades. Rates have been climbing steadily in younger adults at the same time they have been falling in people over 65, and that divergence is the reason national screening guidelines moved the starting age for average-risk adults from 50 down to 45. This guide explains what early onset colorectal cancer is, how much it has actually increased, why the symptoms are so often attributed to something else, and what the change in screening age means for you if you are in your forties in Northern Virginia.
This article is general education, not medical advice. Any persistent change in bowel habits or rectal bleeding should be evaluated by a physician who can consider your full history.
What early onset colorectal cancer means
Colorectal cancer is cancer of the colon or the rectum, and it usually begins as a polyp, a small growth in the lining of the bowel that can become cancerous over a period of years. That underlying biology is the same at any age, and our guide to colon polyps and colorectal cancer in Northern Virginia covers it in detail.
What makes early onset colorectal cancer a distinct topic is not different biology but a different situation. A person in their thirties or forties is not usually being screened, does not usually expect the diagnosis, and is often reassured that their symptoms are hemorrhoids, stress, or an irritable bowel. The result is a group of patients whose cancers are found later than they would have been in someone older, and the numbers reflect that clearly.
How much early onset colorectal cancer has increased
The American Cancer Society publishes a detailed statistical report on colorectal cancer every three years, and the 2026 edition puts numbers on the trend. During 2013 to 2022, colorectal cancer incidence rose by about 3% per year in adults aged 20 to 49 and by 0.4% per year in adults aged 50 to 64, while it fell by about 2.5% per year in adults 65 and older.
Two figures from that report show how much the overall picture has shifted:
- Nearly half, 45%, of new colorectal cancer diagnoses are now in adults younger than 65, up from 27% in 1995.
- Colorectal cancer mortality rates have increased by about 1% per year in adults under 50 since 2004, at a time when they have been falling by roughly 2% per year or more in adults 65 and older.
The increase is not confined to one group. The report describes early onset rates rising across every racial and ethnic group measured, ranging from about 2% annually in Black people to about 4% annually in Hispanic people. For context on the overall scale of the disease, an estimated 158,850 new colorectal cancer diagnoses and 55,230 deaths are expected in the United States in 2026. The full figures are published by the American Cancer Society.
Why screening now starts at 45
In 2021 the U.S. Preventive Services Task Force lowered its recommended starting age. Its current recommendation is to screen adults aged 45 to 49 for colorectal cancer, a grade B recommendation, and to screen all adults aged 50 to 75, a grade A recommendation. For adults aged 76 to 85 it recommends screening selectively, weighing overall health, prior screening history, and personal preference. In explaining the change, the Task Force cited a rise of almost 15% in colorectal cancer incidence among adults aged 40 to 49 between 2000 to 2002 and 2014 to 2016. The American Cancer Society likewise recommends that people at average risk begin at age 45. The recommendation statement is published in full by the U.S. Preventive Services Task Force.
That change matters more than it might appear, because half of all colorectal cancer diagnoses under age 50 occur in people aged 45 to 49, the exact group the new guideline covers. In other words, a large share of early onset colorectal cancer is now, in principle, screen-detectable before it causes symptoms.
In practice it often is not. Screening prevalence among adults aged 45 to 49 is about 37%, which means roughly two out of three people in the newly eligible group have not been screened. If you turned 45 in the last few years and no one has raised it with you, that gap is worth closing. Our guide to colon cancer screening options in Northern Virginia compares colonoscopy, stool-based tests, and blood-based tests, and how insurance covers a colonoscopy answers the cost questions that often come next.
To talk through whether screening makes sense for you now, you can reach our Arlington office at (703) 522-7476 or our Annandale office at (703) 560-6106.
Where early onset colorectal cancer tends to develop
The rise in younger adults is not spread evenly through the bowel. The American Cancer Society report describes the increase in adults under 65 as dominated by tumors in the distal colon, particularly the sigmoid colon, and in the rectum. Among adults under 50, incidence rates have nearly doubled since 1998 for both sigmoid colon cancer, from 2.1 to 3.7 cases per 100,000, and rectal cancer, from 3.6 to 6.6 per 100,000. Rectal cancer incidence overall has been rising by about 1% per year since 2018 after decades of decline, and rectal cancers now make up about a third, 32%, of colorectal cancer diagnoses.
This has a practical consequence. Tumors low in the colon and in the rectum are more likely to produce visible bleeding and changes in the shape or frequency of stool, which are precisely the symptoms most easily attributed to hemorrhoids in a young adult.
Symptoms of early onset colorectal cancer that are easy to dismiss
There is no symptom that is specific to colorectal cancer, and most people with these complaints have a benign explanation. The problem is not that these symptoms are alarming. It is that in a healthy 38-year-old they are commonly assumed to be benign without being checked. Symptoms worth raising with a physician include:
- Rectal bleeding, or blood in or on the stool, including blood a person has attributed to hemorrhoids
- A persistent change in bowel habits, such as new constipation, new diarrhea, or a change in the caliber of the stool
- Abdominal pain or cramping that does not resolve
- A feeling that the bowel does not empty completely
- Unexplained weight loss
- Unexplained iron deficiency anemia, often found on routine bloodwork before anything else is noticed
Duration and change are what matter. A symptom that is new for you and has persisted for weeks deserves evaluation regardless of age. Our guides to blood in the stool and rectal bleeding and unexplained weight loss go through the range of possible causes, most of which are not cancer.
It is also fair to advocate for yourself. If rectal bleeding has been treated as hemorrhoids without anyone looking, asking whether the colon should be examined is a reasonable question, not an overreaction.
Why early onset colorectal cancer is often found late
The consequence of screening that does not apply and symptoms that get attributed elsewhere shows up in the stage at diagnosis. Three out of four colorectal cancers in adults younger than 50 are advanced stage at diagnosis, meaning regional or distant spread, and 27% are distant-stage disease.
That statistic is the whole argument for taking the topic seriously, and it is also why the tone here is not meant to frighten anyone. Colorectal cancer found early is among the more treatable cancers, and treatment has improved substantially: five-year relative survival across all colorectal cancers has risen from 50% in the mid-1970s to 65% during 2015 to 2021. Screening changes which of those situations a person is in, because it can find and remove a polyp before it ever becomes cancer at all.
Colorectal cancer also frequently causes no symptoms in its early stages, which is the reason screening exists as a concept. Our guide to silent digestive conditions in Northern Virginia covers the broader set of conditions that develop quietly.
Why rates are rising, and what is known about risk
The honest answer is that the cause of the increase is not established. The American Cancer Society states plainly that colorectal cancer is rising among people younger than 50 and that the reason for this remains unclear. Research is active, and it would be misleading to present any single explanation as settled.
What is better established is the general set of risk factors for colorectal cancer at any age. The American Cancer Society groups them into factors that can be changed, including excess body weight, type 2 diabetes, a diet high in red and processed meats, smoking, and moderate to heavy alcohol use, and factors that cannot, including age, a personal history of polyps or colorectal cancer, inflammatory bowel disease, a family history of the disease, and inherited syndromes such as Lynch syndrome.
Two of those matter especially for younger adults. People with inflammatory bowel disease follow a different surveillance schedule than the average-risk population. And a family history of colorectal cancer or advanced polyps can move the recommended starting age earlier than 45, sometimes considerably, which is a conversation to have with a gastroenterologist rather than to work out from a general guideline. General patient information on the disease is also available from the National Institute of Diabetes and Digestive and Kidney Diseases.
Screening for early onset colorectal cancer in Northern Virginia with GC of NoVA
Gastroenterology Center of Northern Virginia sees patients across Arlington, Annandale, and the surrounding communities who are in their forties and newly eligible for screening, as well as younger patients with symptoms that need an explanation. Our physicians can review your personal and family history, help you choose a screening approach that fits your situation, and evaluate bowel symptoms rather than assume they are benign because of your age. We see patients at our Arlington office, next to VHC Health, and at our Annandale office in the Woodburn Medical complex.
If a colonoscopy is part of the plan, our guides to what to expect during a colonoscopy and your first gastroenterology visit explain how the process works. To schedule, contact our Arlington office at (703) 522-7476 or our Annandale office at (703) 560-6106, or learn more at gcofnova.com.
Frequently asked questions about early onset colorectal cancer
What is early onset colorectal cancer?
Early onset colorectal cancer refers to colorectal cancer diagnosed in adults younger than 50. The disease itself is the same, but it is typically diagnosed in people who are not yet being screened, which is why it is more often found at a later stage.
Why did colorectal cancer screening move to age 45?
Because incidence has been rising in younger adults. The U.S. Preventive Services Task Force lowered the starting age in 2021, citing an increase of almost 15% in colorectal cancer incidence among adults aged 40 to 49 between 2000 to 2002 and 2014 to 2016. It now recommends screening adults aged 45 to 49, and the American Cancer Society also recommends starting at 45 for people at average risk.
How fast is colorectal cancer increasing in younger adults?
According to the American Cancer Society's 2026 colorectal cancer statistics report, incidence rose by about 3% per year in adults aged 20 to 49 and 0.4% per year in adults aged 50 to 64 during 2013 to 2022, while falling by about 2.5% per year in adults 65 and older. Nearly half of new diagnoses are now in adults younger than 65, up from 27% in 1995.
What symptoms should a younger adult not ignore?
Rectal bleeding, a persistent change in bowel habits, ongoing abdominal pain, a sense that the bowel does not empty, unexplained weight loss, and unexplained iron deficiency anemia. Most of these have benign causes, but a symptom that is new and has lasted for weeks should be evaluated rather than attributed to hemorrhoids or stress because of age.
Why is early onset colorectal cancer often diagnosed at an advanced stage?
Because screening has not typically applied to the age group and symptoms are commonly attributed to other causes. Three out of four colorectal cancers in adults younger than 50 are regional or distant stage at diagnosis, including 27% that are distant stage.
Do we know why rates are rising in younger people?
No. The American Cancer Society states that the reason for the increase in adults younger than 50 remains unclear. Established risk factors for colorectal cancer at any age include excess body weight, type 2 diabetes, a diet high in red and processed meats, smoking, alcohol use, inflammatory bowel disease, a personal or family history of polyps or colorectal cancer, and inherited syndromes such as Lynch syndrome.
This article is for general education and is not medical advice. Talk with a qualified gastroenterologist about your symptoms, diagnosis, and treatment options.
