The cancer now killing more Americans under 50 than any other… and why it’s still being caught too late

‘Alarming’ research finds colon cancer is now the leading cause of cancer deaths in young Americans.

Past research has shown that colorectal cancer (CRC) has been on the rise in young people nationwide over the past two decades, rising from 8.6 cases per 100,000 people in 1999 to 13 cases per 100,000 people in 2018.

The incidence among people under 50, who have historically been considered less likely to contract the disease, has increased by about two percent each year since 2004.

For many young patients, CRC symptoms are mild, such as traces of blood on toilet paper or persistent abdominal pain, and in some cases there are no symptoms at all, leading to later diagnoses and more advanced, harder-to-treat tumors.

Now researchers at the American Cancer Society have found that the outlook for young CRC patients may be much worse than for other types of cancer.

The ACS team found that deaths from eight types of cancer decreased in people under age 50 for all but CRC. The disease is the leading cause of death from cancer in people under 50, having been the fifth leading cause of cancer deaths in the early 1990s.

Colorectal cancer is also the leading cause of cancer death in men under 50 and the second-leading cause of cancer in women of the same age, behind only breast cancer.

While rates of breast cancer and leukemia have also increased in people under 50, the team found that deaths in this age group have slowed since the 1990s.

The graphs above show cancer death rates among people under 50 from 1990 to 2023. Data show that deaths from all cancers except colorectal cancer are decreasing in young Americans.

Dr. D., a cancer epidemiologist and co-director of the Early Onset Cancer Program at Northwell Health in New York, who was not involved in the research. Christine Molmenti said: ‘I think this is a very effective and well thought out and executed study. It brings to light the major public health issue we are dealing with in the United States and globally.

The fact that colorectal cancer is now the leading cause of cancer deaths in men under the age of 50 and the second leading cause of cancer deaths in women under the age of 50, after breast cancer, is extremely worrying.

‘This is something we need to consider from a screening perspective and an awareness perspective as it relates to patients and providers.’

The findings were published in the journal JAMA As a research letter, a peer-reviewed publication is shorter and less detailed than a full study.

Using figures from the National Cancer Institute from 1990 to 2023, the most recent data available, the team examined trends in CRC, lung, breast, brain, uterine and pancreatic cancers, as well as leukemia and non-Hodgkin’s lymphoma, in men and women under 50.

From 1990 to 2023, nearly 1.2 million Americans under the age of 50 died of cancer, and 53 percent of them were women. The overall age-standardized death rate decreased by 44 percent, from 25.5 to 14.2 deaths per 100,000 people.

The team also found that from 2014 to 2023, annual deaths decreased by 0.3 percent for brain cancer, 1.4 percent for breast cancer, 2.3 percent for leukemia and 5.7 percent for lung cancer.

Meanwhile, CRC increased by 1.1 percent per year from 2005 to 2023. From 1990 to 1994, CRC was the fifth leading cause of death from cancer in Americans under 50, but it became the leading cause in 2023.

Co-author and chief scientist of the American Cancer Society Surveillance Study, Dr. Nikita Wagle told the Daily Mail: ‘What surprised us most was how clearly colorectal cancer is now differentiated from other cancers seen in young people. Colorectal cancer was the only cancer with increased mortality.’

The team also found that CRC was the leading cause of cancer deaths in men under 50 and the second leading cause of death in women under 50.

Karina Ureña, 30, was diagnosed with stage 4 colon cancer after vomiting five times during her first half marathon. Pictured above

Dr Molmenti said more research was needed on gender differences, but men ‘have some risk factors that create problems for colorectal cancer’.

‘They may drink more alcohol than women, they may smoke more, they may have more behaviors that may lead to an increased risk of colorectal cancer,’ she added.

But women may be more likely to ignore CRC warning signs, he noted.

‘For example, many of their symptoms occur as menstrual cycle findings. “So if there is bleeding or abdominal pain, the symptoms can be ignored due to the menstrual cycle,” he said.

‘They may also be mistakenly diagnosed with haemorrhoids, especially if they have children.’

Lung cancer and leukemia dropped from first to fourth and from third to fifth, respectively. Breast cancer remains the second leading cause of cancer deaths overall and the leading cause in women.

Cervical cancer, which affects women, remained stable, ranking as the third leading cause of death among young people between 1990 and 2023.

Dr Wagle notes that the increasing number of deaths in young people with CRC ‘reflects missed opportunities such as earlier diagnosis, timely treatment and missed changes to recognize symptoms’ due to symptoms being ignored or negative stigma associated with the disease.

Liz Healy, pictured here, was diagnosed with stage four colon cancer and stage two kidney cancer following imaging following a skiing accident in 2022.

‘Almost three in four patients under the age of 50 are diagnosed with advanced-stage disease, where treatment can be difficult and survival is poorer,’ he told the Daily Mail.

He warned that deaths ‘could remain high’ if this continues.

‘The hopeful sign is that we now have clear levers to change this,’ he added. ‘We need to remove the stigma around this disease and its symptoms so people can feel comfortable discussing their concerns with their doctor.

‘There are certain red flags in people under 50 that should not be ignored, such as rectal bleeding and abdominal pain.’

He emphasized that colorectal cancer screening should be done by colonoscopy starting from the age of 45 and repeated every 10 years, but people with a family history should be screened at an earlier age.

The exact risk factors for colorectal cancer are still being studied, but recent research suggests that a diet rich in processed or fried foods, alcohol consumption, a sedentary lifestyle, and early exposure to antibiotics may be to blame.

However, Dr Molmenti points out: ‘We see what happens in many patients who are diagnosed; they do not meet most of these criteria. They say they are healthy. They say they eat well and are generally fit and active.

‘And so we have a conundrum of what is the phenotype where the risk factors kind of set the picture for this disease, and then what do some of our patients look like when they present to the clinic? And I really think that’s something that needs to be explored further.’