By: George Beauregard, DO
March is Colorectal Cancer (CRC) Awareness Month.
CRC is the second most common cause of cancer deaths in both sexes.
Factors that place individuals at high risk for developing CRC include having a family history of colon cancer, the presence of adenomatous polyps, and familial polyposis syndromes. People having those circumstances should screen sooner than the currently recommended starting age of 45.
Like other cancers, CRC, if found early, can be successfully treated. The overall 5-year relative survival rate for CRC in the United States is approximately 65 percent. The outlook depends significantly on how far the disease has spread at the time of diagnosis. For people with localized disease (confined to the bowel), it's 91 percent. For people whose cancer has spread regionally (to nearby lymph nodes), it drops to 74 percent. And for people who have distant spread (lungs and liver), it's a dismal 13 percent.
Once present, its progression is often silent, as oftentimes, people with developing CRC have no, or only mild, signs and symptoms.
So, early detection matters. The gold standard test for screening for CRC is a colonoscopy. Other tests recommended by the United States Preventive Services Task Force (USPSTF) include stool-based tests like the FIT (Fecal Immunochemical Test), which is done annually, or the every three-year Cologuard test.
As of early 2026, the national CRC screening rate for adults 45-75 was approximately 62 percent, well below the national goal of 80 percent set by the National Colorectal Cancer Roundtable (NCCRT). (Previously, the screening rate was higher; it declined when the screening age was expanded to 45 in 2021.)
The bottom line is that every average-risk person 45 and older should get a colonoscopy. People with common signs of CRC--blood in the stool, persistent abdominal pain and/or changes in bowel habits, fatigue, a new anemia--should seek medical attention as soon as possible. The presence of one of those signs increases the risk of having CRC 2-fold; having four signs increases the risk 6-fold.
These common signs are often dismissed by people having them--and by physicians evaluating them. The "I'm (You're) young and healthy, so this is probably nothing" mentality needs to change.
Particularly in light of the fact that the epidemiology of CRC is changing.
Historically, CRC was considered a disease of older people. While it's true that the incidence of CRC has been dropping in older adults (due to screening), it is rising by about 2.9 percent per year in those under 50. The steepest rise in incidence is being seen in people born in the 1980s and 1990s. Having recently surpassed breast cancer in women, CRC is now the top cancer killer of people in both sexes under 50.
It's estimated that, by 20230, one-third of all cases of CRC will occur in people under the age of 50. What's particularly worrisome is that, in most of these cases, there are no signs or symptoms that herald the presence of disease. So people are being diagnosed at higher stages, where treatment is less effective.
The unfortunate diagnosis of CRC in high-profile figures like Chadwick Boseman, the Princess of Wales, and James Van Der Beek has heightened awareness.
The cause of the rise in the incidence of cancer in younger adults has drawn considerable attention from medical professionals, scientists, and researchers. It is likely multi-factorial. Many potential causes include diets high in ultra-processed foods, obesity, sedentary lifestyle, breastfeeding, alcohol intake, sleep disruption, environmental factors (microplastics), overuse of antibiotics in newborns, children, and adolescents, changes in the gut microbiome, and others.
In principle, the central idea of early disease detection and treatment is simple. Early detection leads to a higher likelihood of a potential cure or prolonged survival.
Speak with your primary care clinician about getting screened and what the current testing options are.
At the end of the day, the best screening test is the one that gets done. Don't be complacent, get screened...and spread the word.