The deaths of Chadwick Boseman and James Van Der Beek from colorectal cancer in their 40s put a spotlight on something the medical community has been watching with growing concern: rectal cancer is no longer a disease that mainly affects older people. It’s striking younger adults at alarming rates, and nobody quite knows why.
Here’s the uncomfortable reality. Colorectal cancer is now the leading cause of cancer deaths in adults under 50. Rectal cancer specifically is rising faster than colon cancer, and according to NBC’s reporting, if current trends continue, rectal cancer will become the top cause of cancer deaths in this age group by 2035.
The numbers tell the story. Since 1988, colorectal cancer rates in adults under 50 have jumped by 63 percent. That’s eight cases per 100,000 people back then versus 13 today. Younger generations are being hit harder too. Gen Z has higher rates than millennials born in 1991, who have higher rates than millennials born in 1981. Even teenagers are starting to show up in the data, though the absolute numbers remain small.
“It is now recognized that rates of colon and rectal cancer are rising dramatically in younger people,” said Dr. Jatin Roper, a gastroenterologist at Duke Health. “Such that it is unfortunately becoming common to diagnose cancers in individuals under the age of 50.” That phrase should grab your attention. What used to be uncommon is becoming routine.
The Symptoms Are Easy to Miss
Rectal bleeding is the most common sign of rectal cancer, and it’s especially prevalent in younger patients. That blood might be bright red or dark red, appearing in your stool or on the toilet paper when you wipe. Some people mistake it for hemorrhoids or, if they menstruate, for menstruation.
That confusion is dangerous. “I think the key message is that any change in your gastrointestinal tract should not be ignored,” Roper said. “Any change in your GI function should be investigated by a doctor.”
Other symptoms include abdominal pain, changes in bowel habits, constipation, thinner stools, fatigue, weight loss, and anemia. But here’s the kicker: some people with rectal cancer have no symptoms at all. That makes regular screening critically important.
Since the rectum is at the end of the colon, patients are more likely to experience thinner stools or blood in the stool compared to people with colon cancer elsewhere. Dr. Michael Foote, a gastrointestinal medical oncologist at Memorial Sloan Kettering Cancer Center, emphasized that rectal cancers are tumors that behave similarly to colon tumors in many ways, which is why they’re grouped under the umbrella term “colorectal cancer.”
Why Is This Happening?
Nobody has a definitive answer, and that’s what’s troubling. The spike started sometime between 1950 and 1990, and doctors don’t think it’s simply because people are getting screened more.
The leading theory points to changes in our food environment. From 1950 onward, fast food proliferated, preservatives became standard, and plastic food containers became ubiquitous. Our diets shifted toward what Foote calls “a Western diet: high animal fat, high carbohydrates, relatively lower vegetables, red and processed meat, and refined grains and processed sugars.”
But here’s where the puzzle gets interesting. Obesity is a risk factor for colorectal cancer, yet most young people who develop it aren’t obese. Same with diabetes. So weight alone doesn’t explain the trend.
Foote pointed to another possibility: microplastics in those plastic containers we’ve been using for decades. The data linking microplastics to colorectal cancer isn’t as clear, he cautioned, but it’s part of the mix being investigated.
Changes in our gut microbiome might also play a role. “The microbiome can be changing due to changes in our dietary habits in the last few decades or change in exercise habits,” Roper said. “It’s a little bit unclear.” That uncertainty reflects the honest truth: we’re still figuring this out.
What You Can Actually Do
Screening is your first line of defense. For people at average risk, routine colonoscopies or stool-based tests should start at age 45. If your birthday is approaching, Roper’s advice is practical: plan one year in advance to get scheduled.
Not everyone can manage a colonoscopy. Stool-based tests like Cologuard and fecal immunochemical tests (FIT) are solid alternatives. Just remember that a positive result means you need to follow up with a colonoscopy for proper investigation.
If you have a parent or sibling who had colon or rectal cancer, talk to your doctor about screening earlier than 45.
Beyond screening, dietary changes matter. Roper recommends following a Mediterranean diet, which emphasizes soluble fibers like beans, vegetables, fruits, seeds, and whole grains while minimizing animal fats and red meat. Foote suggests cutting out sugar-sweetened beverages and limiting alcohol.
Some people are moving away from plastic containers. While the science on microplastics and colorectal cancer isn’t ironclad, Foote acknowledged it’s “not such a bad idea.” If you have obesity or diabetes, medications or lifestyle changes to address those conditions could reduce your risk.
Don’t Ignore What Your Body Is Telling You
The biggest mistake young people make is dismissing symptoms. Blood in your stool isn’t normal. Persistent abdominal pain deserves investigation. A change in your bowel habits should prompt a conversation with a doctor.
“If you’re having symptoms, don’t just sit on them,” Foote said. And if your doctor doesn’t take those symptoms seriously, escalate the problem. Find another doctor. Being young doesn’t make you immune to cancer, and the rising rates in your age group mean physicians are increasingly alert to early signs.
Having an established relationship with a primary care doctor is worth more than most young people realize. Someone who knows your history, who you can check in with regularly, who will take your concerns seriously, can make the difference between catching something early and discovering it too late.
The fact that rectal cancer is climbing in younger generations suggests something significant changed in how we live and eat over the past 70 years. Until we identify exactly what that is, the best move is staying informed, staying screened, and staying honest with yourself about what your body is signaling.
