2026 brings with it a mix of good and bad news when it comes to cancer-related deaths in people younger than 50.
Across the board, cancer deaths in people under 50 have dropped by 44% since 1990, reflecting advances in prevention and treatment. However, colorectal cancer death rates in those 50 and younger have increased by 1% every year since 2005, according to new research from the American Cancer Society. As of 2023, colorectal cancer became the leading cause of cancer-related death in people 50 and younger.
"It’s a clear sign that treatment and detection efforts for colorectal cancer are falling behind other cancers," says Christopher Lieu, MD, associate director of clinical research at the University of Colorado Cancer Center.
“There's got to be greater awareness that you're never too young to have colorectal cancer, and the research into why this is happening is only going to get more critical,” says Lieu, professor of medical oncology in the CU Anschutz School of Medicine. “We have to find ways to reverse this trend.”
Colorectal cancer rates among young people have been increasing for years — a trend that led to the U.S. Preventive Services Task Force dropping the recommended screening age for the cancer from 50 to 45 in 2021 — and the cancer already was on track to becoming the number one cancer killer in those under 50 by 2030. The new numbers show that the change happened years earlier than anticipated, Lieu says.
“Even though some other cancers are showing increasing rates, their death rates are falling,” he says. “It tells you about some of the advances that we really need to make in the treatment of colorectal cancer, but definitely in the detection.”
Though stool-based tests like Cologuard have increased in popularity and availability in recent years, the colonoscopy remains the gold standard for detecting colorectal cancer. That test comes with its own set of issues, Lieu says, including people avoiding it due to its invasive nature and daunting prep procedure. Though the lowered recommended screening age has led to an increase in the number of people getting colonoscopies, a number of patients captured in the new ACS data are younger than 45 and therefore ineligible for the standard recommended screening.
“The best way to treat a cancer is to prevent it, so we need age-appropriate cancer screening that takes into account somebody's family history,” Lieu says. “We also don't want people to ignore their symptoms. The things that always come up when diagnosing any colorectal cancer is blood in the stool, anemia, and unexplained abdominal pain.”
People experiencing those symptoms, no matter their age, should discuss their symptoms with their primary care provider, Lieu says.
Researchers don’t know the exact reason for the rise in colorectal cancer rates, though several causes are being studied, including changes in the gut microbiome, obesity, lack of physical activity, and ultra-processed foods.
“Even looking at those things, there's probably more to the story than that,” Lieu says. “The problem is that there are so many variables — there's a genetic component, there's a familial component, there's an environmental component — that it's going to be hard to pinpoint just one factor.”
Another reason for the rise in colorectal cancer-related deaths, Lieu says, is a lack of advanced treatment options similar to those used in other cancers.
“Right now, the standard of care for a lot of patients is a combination of surgery with chemotherapy and potentially radiation therapy,” he says. “Where we want the field to go is toward immune-based therapies — using the body's immune system to fight cancer. We know that in certain patients, we can even avoid surgery if the treatment is effective enough.”
The problem with doing that in colorectal cancer, Lieu says, is that colorectal cancer is largely considered to be an “immune desert” that is not nearly as responsive to immunotherapy as diseases like melanoma, lung cancer, and bladder cancer.
“A lot of the research now in colorectal cancer is focused on trying to change the immune desert — to unlock the code of immune-based therapies,” he says. “We are seeing advances in targeted therapies with KRAS inhibitors — that's a gene that's been very difficult to target, and we're going to start to see more and more advances there. And there are newer generation immunotherapies that are in clinical trials right now that are starting to show some potential benefit. Antibody-drug conjugates are like a smart bomb for colorectal cancer, and they are showing some promising activity as well.”
As difficult as the new ACS report on colorectal cancer deaths is for clinicians like Lieu, it also doesn’t come as a surprise, he says.
“These numbers reflect what we see in clinic — we see a lot of young patients who shouldn't have this cancer,” he says. “It’s disheartening, because we want fewer patients to get cancer, and we definitely want fewer patients to die from cancer. It's also a challenge, and it’s the reason why we need research into this. We want to ensure that we're offering every patient, regardless of age, the best possible multidisciplinary care, and we want to ensure that every patient with this disease gets the best care possible.”