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Colon Cancer in People Under 45

Historically, if you were an adult with an average risk for colorectal cancer (colon and rectal cancer), also known as colon cancer, you would need to start getting colonoscopies when you turned 50. 

But in May 2021, the U.S. Preventive Services Task Force updated the guidelines. Now you’ll need a colonoscopy when you turn 45. But you should do it earlier if you have a family history of colon cancer. 

That’s because recent studies show that it’s on the rise among people under the age of 50.

“We’ve never seen more colorectal cancer happening in such young people. It’s the only demographic, people under age 50, where this disease is rising and becoming more deadly, not less common and less deadly,” says Mark Lewis, MD, director of gastrointestinal oncology at Intermountain Healthcare in Utah. 

More specifically, Lewis notes “women have a greater risk” of getting this cancer early.


Colon cancer is the second most common cause of cancer-related deaths among people in the U.S. In fact, it’s expected to cause about 52,000 deaths in 2023. And while there’s a downward curve in colorectal cancer among people over 50, it’s the opposite for people under 50. 

“In my practice, if you take the average age of all of my patients, the average age of all of my patients with a GI cancer is 68. And yet, 1 in 7 of my patients is a young adult with colorectal cancer, and I do see more women than men,” Lewis says. 

So, what’s the cause for this rapid rise in cases? Experts don’t know for sure. But lifestyle and changing environmental factors in recent times might have a role to play. 

This can include:

  • Obesity and overweight
  • Sedentary lifestyle 
  • Smoking
  • Drinking too many alcoholic beverages
  • Low-fiber diets
  • High-fat diets
  • Eating too many processed meats
  • Gut bacteria
  • Inflammation

According to the National Cancer Institute, if you’re obese, you’re 1.3 times more likely to get colon cancer. 


Most people don’t have noticeable symptoms during the early stages of colon cancer. But the irony is, it’s easily treatable during that time. 

Lewis says that you know your body well. So keep a close eye on any “out-of-proportion” symptoms. 

Signs and symptoms of colon cancer can include:

  • A consistent change in your bowel routine, such as diarrhea, constipation, or a different consistency of your stool
  • Blood in your poop (rectal bleeding)
  • Stomachache or discomfort, such as cramps, gas, bloating, or pain
  • You don’t feel as if you’ve emptied your bowels completely.
  • Weakness or fatigue
  • Unexplained weight loss

Unfortunately, Lewis notes that “you’re never too young to have cancer.” Especially colon cancer. 

If you notice these signs, talk to your doctor as soon as possible. Write down any patterns you may have noticed. Also, if you have a family history of colon cancer, be sure to bring it up during your doctor visit


According to Lewis, any gut-related symptoms that “don’t seem to fit what you understand about your body and your cycle, that merits investigation.”

But he also acknowledges that it’s very common for doctors to dismiss your concerns such as blood in your poop as “just hemorrhoids” or, for women, as a “gynecologic problem.”

So, what can you do? Lewis insists that young adults, especially women, should advocate for themselves.

“A, you’re the expert, the content expert, on your own body. You know what patterns are abnormal for you, and you should raise those to medical attention. B, you should know your family history. There is absolutely a component here of heredity,” he says. 

If you have a family history, as a general rule, your doctor will take the age of the youngest person in your family with colon cancer and subtract 10 years from that age. That’s the ideal age when you’ll need to start getting screened for colon cancer. 

If you have average risk, then start getting annual colonoscopies when you turn 45.

There are things you can do to take control and reduce your odds of colon cancer. First, get screened when you become eligible or notice early signs of gut cancer. 

A colonoscopy is one of the best screening procedures available to nip the cancer in the bud and prevent it from growing or spreading in your gut.

To get one, you’ll need to see a colonoscopist. This is usually a gastroenterologist – a gut specialist – or a general surgeon.  

During the procedure, they’ll insert a flexible tube with a lighted camera on the tip into your large intestine. If they see a polyp – a type of extra piece of tissue that grows like a skin tag inside your body – they’ll remove it. 

“You’ve interrupted that polyp’s disease trajectory. It can’t become cancer if it’s removed from your body,” Lewis says. “So, to sum up, know yourself, know your family, and know the age when you should start screening.”

Besides this, you should:

  • Eat a well-balanced diet with whole foods, fruits, and vegetables.
  • Add whole grains and fiber to your meals.
  • Cut down or quit smoking. 
  • Find ways to be more physically active. You can start with regular walks and work your way up to more rigorous exercises. 
  • Limit how much alcohol you consume.
  • Eat less red meat and processed foods in general.
  • Take calcium and vitamin D supplements if you’re deficient. Studies have shown this can lower your risk for colon cancer.



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