When I started private practice as an OB-GYN, one of the first physicians to introduce herself to me was a reproductive endocrinologist. She found me in the break room of our new office, and what started as small talk turned, almost immediately, into something much heavier.
She told me she had stage IV colorectal cancer.
We both cried right there, standing between the coffee maker and the microwave. She pulled out her phone and showed me pictures of her young twins. She talked about how hard she was working, despite weakness from the disease and treatment, because she wanted to leave her kids with as much financial security as possible. She told me she was enrolling in every clinical trial she could find, from Duke to MD Anderson. She was doing everything medicine could offer to prolong her life.
Over the year that followed, we spoke on and off. Each time I saw her, she was a little less herself. The woman I first met — warm, sharp, vibrant — slowly disappeared. Then, one day, I walked into my office and overheard two colleagues talking quietly about her “untimely death.”
Untimely. As if there were ever an appropriate time to die from this horrible disease.
I closed my office door and sat down. I went to her professional website, where her photo still showed her as I had met her: alive, strong, full. Then I looked at more recent photos — her face hollow, her body gaunt. A shell of herself. I cried for her children. For her husband. For her parents burying their daughter. And for her — the selflessness of working until the end to provide for her family, even when I didn’t fully understand how she could summon that strength.
This is what colorectal cancer looks like before age 50.
And it’s happening more often than it should.
The cancer that moved to the top — fast
A newly published JAMA analysis delivered a sobering statistic: Colorectal cancer has rapidly risen to become the leading cause of cancer death among men under 50 and the second among women, overtaking cancers that once dominated this age group. Not slowly or over many generations. In roughly 20 years, colorectal cancer had moved from fifth place to first, in terms of deadliness.
Unlike breast, prostate, and cervical cancers, mortality from early-onset colorectal cancer is increasing.
What makes that shift especially alarming isn’t just the rise in diagnoses — it’s how differently colorectal cancer behaves in younger adults.
Unlike breast, prostate, and cervical cancers — in which earlier detection and better treatments have steadily reduced mortality in younger populations — mortality from early-onset colorectal cancer is increasing. Younger patients are more likely to be diagnosed at advanced stages, often stage III or IV, when cure is no longer the goal and survival becomes the ceiling of hope. In fact, more than 60 percent of early-onset CRC patients present with an advanced form of the disease. This isn’t because younger people are biologically weaker — it’s because we aren’t looking soon enough.
The risk is hiding in plain sight
Here’s a number that deserves far more attention: Nearly 60 percent of colorectal cancer cases diagnosed under 50 occur between ages 45 and 49.
That matters — because 45 is now the recommended age to begin average-risk colorectal cancer screening.
Screening saves lives, and early detection transforms colorectal cancer from a lethal disease into a highly treatable one.
Yet many people don’t know this; others know but delay. Some are told, incorrectly, that they’re “too young” to worry. And many people, women in particular, are so busy caring for everyone else that preventative care falls to the bottom of the list. I can’t count how many patients have come to my office after their colonoscopy and said, without irony, “That was the best sleep I’ve had in years.” Which is funny, and also…deeply not.
If the best rest a woman gets is during twilight anesthesia while a scope is navigating her colon, we need to have bigger conversations about burnout, caregiving, and how profoundly women neglect their own bodies. But that’s another article.
For now, here’s what matters: Screening saves lives, and early detection transforms colorectal cancer from a lethal disease into a highly treatable one.
Why is this happening?
The most unsettling truth? We don’t yet know why early-onset colorectal cancer is rising so quickly.
By the time many of these patients are diagnosed, they are already fighting for their lives.
Researchers are investigating changes in diet, microbiome shifts, environmental exposures, metabolic disease, antibiotic use, sedentary lifestyles, and inflammatory pathways. But no single cause explains the magnitude or speed of this increase. What we do know is that this rise is real, consistent, and seen across the United States.
And because symptoms like rectal bleeding, abdominal pain, changes in bowel habits, fatigue, or unexplained anemia are often dismissed in younger patients — or attributed to stress, hemorrhoids, IBS, or postpartum changes — diagnosis is delayed until disease is advanced.
By the time many of these patients are diagnosed, they are already fighting for their lives.
The call we can’t ignore
Young-onset colorectal cancer doesn’t look like an abstract statistic. It looks like a mother planning for life after herself. It looks like children growing up with stories instead of memories. It looks like physicians, patients, and families blindsided by a disease that was never supposed to be on their radar.
Screening at 45 isn’t an inconvenience — it’s an intervention. Earlier screening for those with family history, genetic risk, inflammatory bowel disease, or concerning symptoms isn’t optional — it’s essential.
We may not yet have all the answers for why this is happening. But we are absolutely responsible for responding to what is happening.
Because every late diagnosis represents a moment we missed. And too often, it costs someone everything.
Sarah Berg, MD, is a board-certified OB-GYN and certified menopause practitioner who spent over a decade in clinical practice caring for women across all stages of life. She now focuses on evidence-based education and storytelling that helps women understand their bodies, prioritize preventative care, and navigate midlife health with clarity and confidence.
