Early-onset CRC deaths rising fast, analysis finds

Mortality from early-onset colorectal cancer is rising among US adults younger than 45, with the steepest increases seen in rectal cancer and among Hispanic and White patients, according to a national analysis of data from 1999 to 2023 with projections through 2035.

“This is a drastic shift from prior generations, and it’s concerning because these individuals are not routinely screened,” the study’s lead author, Mythili Menon Pathiyil, MBBS, a gastroenterology fellow at SUNY Upstate Medical University, Syracuse, said during a press briefing in advance of Digestive Disease Week® (DDW) 2026.

Research indicates that young adults take about seven months on average to seek treatment after their first symptoms appear, she added, while older patients typically do so within about one month. “This delay can be the difference between an early and a late-stage diagnosis, which is one of the reasons why we wanted to dig into these trends,” she said.

Using CDC WONDER data, Pathiyil and colleagues assessed age-adjusted mortality rates in patients ages 20 to 44 and examined trends by sex, race and ethnicity, region, and age group. They used joinpoint regression to estimate average annual percentage change and an autoregressive integrated moving average model to generate forecasts.

Across most subgroups, mortality increased over the study period. Colon cancer mortality rose more in males than females, with average annual increases of about 0.4% versus 0.2%. By 2035, deaths are projected to reach 834 in males and 667 in females, representing increases of 42 and 19 deaths compared with 2023. Deaths from rectal cancer rose faster in both men and women, increasing by about 1.8% each year. The number of deaths is expected to reach 459 in men and 304 in women, which is about 90 more and 60 more than before, respectively.

Differences by race and ethnicity were observed. Hispanic patients had the fastest increases in mortality, with colon cancer rising by about 1.1% annually and rectal cancer by 2.2%, corresponding to projected increases of 35 and 31 deaths by 2035. White patients also had sustained increases, with colon cancer rising 0.7% annually and rectal cancer 1.7%, translating to projected increases of 94 and 108 deaths. In contrast, colon cancer mortality declined among Black patients and Asian or Pacific Islander patients, with annual decreases of about 0.8% and 0.6%, respectively. However, both groups experienced rising rectal cancer mortality, increasing about 0.8% in Black patients and 1% in Asian or Pacific Islander patients.

Regional patterns showed the West had the steepest increases in both colon and rectal cancer mortality, rising about 0.9% and 2% annually, respectively. The Northeast showed declining colon cancer mortality but rising rectal cancer mortality, increasing about 1.2% annually. The Midwest and South had modest increases in colon cancer mortality but substantially higher rectal cancer mortality trajectories, with annual increases of about 2% and 1.1%, respectively.

Age-specific analyses indicated a shifting burden toward older patients within the younger cohort. Patients ages 35 to 39 and 40 to 44 had the highest increases in mortality. Colon cancer mortality rose about 0.7% and 0.6% annually in these groups, while rectal cancer mortality increased about 1.8% and 1.7%. In contrast, colon cancer mortality declined among patients ages 20 to 24 years and 25 to 29 years, and rectal cancer mortality declined only in the 25 to 29 age group.

Overall, rectal cancer mortality was two to three times higher than colon cancer mortality across most subgroups, highlighting a disproportionate burden. Loren Laine, MD, a gastroenterologist at Yale University School of Medicine, who moderated the briefing, asked Pathiyil what might be driving this trend. She suggested the increase may stem from a combination of factors. Symptoms like rectal bleeding are frequently misattributed, often to hemorrhoids, leading to missed or delayed diagnoses.

Patient behavior also plays a role, particularly among men under 50, who may lack a primary care physician, insurance, or may delay seeking care until symptoms become severe. In addition, broader gaps in the healthcare system “is one of the reasons why Hispanic populations have such a higher rate,” Pathiyil said. “All of this together, just this critical delay in this diagnosis in itself, might be one of the contributing factors about the rise in mortality, despite all advances in therapy.”

She concluded that the overall findings “reinforce that rectal cancer is striking younger Americans earlier and killing faster, and it is doing so at an accelerating pace. This is just simply not a problem we can afford to ignore, which is why we need to revisit screening strategies, especially in high-risk subgroups. We [also] need to change how clinicians think about symptoms in younger patients. Rectal bleeding in people less than 45 years old should not be automatically attributed to hemorrhoids.”

Similarly, she added, changes in bowel habits in individuals younger than 45 “should not be assumed to be due to stress. These are warning signs that deserve a full workup.”

CDC Wonder is limited by death certificate data and lack of clinical detail, including stage at diagnosis and treatment patterns.

Dr. Pathiyil reported having no disclosures.

DDW is AGA's annual meeting, jointly sponsored by AGA, AASLD, ASGE, and SSAT. Learn more at ddw.org.