The Increase of Early-Onset Colorectal Cancer - Article Commentary - New Insights and Emerging Hypotheses

Sep 22, 2026

Rising rates of early-onset colorectal cancer are highlighted as a growing worldwide public health concern. The commentary evaluates plausible causes of the young-onset colorectal cancer (YO-CRC) trend and discusses intervention opportunities. It summarizes global evidence from cancer registries, describes how YO-CRC incidence has increased in many countries while older-onset rates decline or stabilize, and examines risk factors and gaps in existing explanations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Abstract

Background and Epidemiology

Incidence Trends in Younger Adults

Screening and Public Health Implications

Global Registry Evidence

Risk Factors and Emerging Hypotheses

| The Increase of Early-Onset Colorectal Cancer: New Insights and Emerging Hypotheses | Cancer Control Volume 33: 1–5 © The Author(s) 2026 Article reuse guidelines:
[sagepub.com/journals-permissions](sagepub.com/journals-permissions)
[DOI: 10.1177/10732748261432271](DOI: 10.1177/10732748261432271)
[journals.sagepub.com/home/ccx](journals.sagepub.com/home/ccx)

| | --- | --- | | Isaac Lee, BS1 , Ezra Bernstein, MD, MPH1 , Benjamin Lebwohl, MD, MS1,2, and
Alfred I. Neugut, MD, PhD1,2
Abstract
Rising rates of early-onset colorectal cancer have been noted worldwide. This commentary addresses possible causes of this trend and opportunities for intervention.
Keywords
colorectal cancer, early-onset colorectal cancer, colorectal cancer screening, colonoscopy, fecal occult blood test, fecal immunochemical test
Received: 22 September 2025; Revised: 5 January 2026; Accepted: 13 February 2026
Rising rates of early-onset colorectal cancer (CRC), also known as young-onset colorectal cancer (YO-CRC), have become a growing concern for the public health community worldwide.1 Since the American Cancer Society (ACS) initially recommended screening for CRC in the 1970s, its age-adjusted annual incidence rate in the UShas declined by 49%, from a peak of 66.2 cases per 100,000 in 1985 to 33.5 per 100,000 in 2022.2 This decrease, predominantly in populations over 50 years, has been ascribed to more widespread implementation of colonoscopy-based screening, which allows for the removal of precancerous polyps.3 Indeed, by 2023, 72.6% of adults aged 50-75 years in the United States (U.S.) had received CRC screening – a sharp increase from the 38.2% of adults screened in 2000.4
However, a distinct and worrying trend has emerged over the past 3-4 decades: a dramatic rise in CRC incidence in those below age 50 years. From a nadir of 4.5 cases per 100,000 in 1987, the incidence rate in this population has more than doubled, reaching 9.4 per 100,000 in 2022. Younger adults are included in this trend; among those in the 15-39 age range, the incidence rate rose 47.5% in the same timeframe, with an annual percent change (APC) of 2% per year.2
CRC’s rise to prominence in the young, coupled with its decline in older populations, has resulted in a substantial shift in the CRC patient population. Of the 147,931 new colorectal cancers diagnosed in the United States in 2022, 20,422 cases (13 . 8%), were in patients younger than 50 years.5 By 2030, YO-CRC is projected to account for 11% of colon cancers and 23% of rectal cancers worldwide, affecting both men and women. While approximately 20% of cases are linked to hereditary cancer syndromes, most arise without an identifiable monogenic predisposition.6 Though updated ACS | | | 1Department of Medicine and Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
Corresponding author:
Alfred I. Neugut, MD, PhD, Division of Oncology, Columbia University Irving Medical Center, 722 West 168th Street, Room 725, New York, NY 10032, USA. Email: [ain1@cumc.columbia.edu](ain1@cumc.columbia.edu) | | Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ([https://us.sagepub.com/en-us/nam/open-access-at-sage](https://us.sagepub.com/en-us/nam/open-access-at-sage)). guidelines have moved the starting age for screening from 50 to 45 years, many of the patients with YO-CRC would still not be screened as per these updated guideline

FAQs

What trend is driving concern about early-onset colorectal cancer?

Early-onset colorectal cancer incidence has risen markedly over recent decades, while older-onset rates have generally declined. The shift has changed the overall patient population affected by colorectal cancer.

How do screening changes relate to the young-onset colorectal cancer problem?

Although screening recommendations have expanded, many individuals with YO-CRC would still not be screened under updated starting ages. This creates a need for further research into causes and for intervention strategies.

Why do existing risk factors fail to fully explain YO-CRC over time?

Non-modifiable factors (such as sex, race, and family history) can predict individual risk, but they do not explain the temporal rise. Modifiable exposures discussed in the literature are not sufficiently unique to young people or colorectal cancer, leaving hypotheses incomplete.

Sep 22, 2026

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