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Increase in colorectal cancer incidence in young adults - has Canada caught up to recent guideline changes?


Why should young adults care about colorectal cancer? 

Colorectal cancer is the third most commonly diagnosed cancer worldwide and the second leading cause of cancer death. In 2022 alone, approximately 1.9 million people were diagnosed and more than 900,000 died from the disease.1 


The majority of young adults do not consider themselves at a risk for colorectal cancer, and there is little awareness of symptoms that should prompt medical intervention. However in recent decades a new, dangerous, and less recognized trend in colorectal cancer cases has been on the rise. People under 50 years old are increasingly being diagnosed with early-onset colorectal cancer, often in later stages, due to very subtle symptoms or dismissing warning signs as something else . The reasons for this increase are not yet fully understood. Researchers believe it is probably multifactorial, with possible contributions from obesity, dietary patterns, physical inactivity, alcohol, smoking, early-life exposures and changes in the intestinal microbiome. 


In a large analysis of 50 countries and territories, rates of colorectal cancer among adults aged 25 to 49 increased in 27 countries during the most recent decade studied. Australia, Canada, New Zealand and the USA were among the first countries to report a rise in early onset colorectal cancer, and the cases have risen 2-4% annually since 2017.1 


Early-onset colorectal cancer accounts for 10-12% of CRC diagnosis, and is increasingly diagnosed at advanced stages and may consequently require more intensive treatment. However, younger age itself does not consistently predict worse cancer-specific survival once the stage of the disease is considered. 2 In Canada, colorectal cancer incidence has increased among adults aged 30 to 49, remained stable among those aged 20 to 29 and 50 to 54, and decreased among adults aged 55 and older.3 One of the biggest problems with colorectal cancer in young adults is that the disease is often diagnosed in late stages, which worsens patient outcome. This is largely because symptoms in young adults are often ignored, or attributed to hemorrhoids or IBS.4 


Advancements in colorectal cancer screening methods and guidelines have greatly improved patient outcomes, reducing the mortality rate and diagnosing cancer earlier. A combination of genetic and lifestyle factors shapes your risk of developing colorectal cancer. Prevention is one of the most effective strategies against colorectal cancer, and understanding your risk factors can help make informed decisions about where to start. 


Risk factors that may influence screening recommendations 

  1. Family history and genetics: 


Individuals with inherited genetic conditions such as Lynch syndrome, or familial adenomatous polyposis (FAP), are more likely to develop colorectal cancer. Having a personal or family history of colorectal cancer also places you at a higher risk for the disease. 


        2. Patients with inflammatory bowel disease: Chronic IBS, for example Ulcerative colitis and Crohn's disease, can increase                 colorectal cancer risk due to inflammation of the colon. 


          3. Individuals who have been exposed to abdominal radiation therapy.5 


Risk factors associated with lifestyle 

  • Excess body fat, with obesity being highly associated with colorectal cancer 
  • A diet high in red and processed meat expose the colon lining to carcinogens, resulting in an increased risk of colorectal cancer 
  • Many studies have shown an association between tobacco and alcohol intake and the risk of colorectal cancer.6 


Understand the symptoms 

Early symptoms of colorectal cancer are often hard to detect. It is important to pay attention to: 


  • Abdominal pain or cramping 
  • Unexplained weight loss 
  • Rectal bleeding 
  • Change in bowel movements (diarrhea, constipation) 
  • Iron-deficiency anemia 


The recognition of signs and symptoms may improve early detection and prognosis of patients. Knowing the warning signs may help encourage young adults to seek medical care so that they can catch and treat the disease at an earlier stage. 6 

In March 2026, the Canadian cancer society urged provinces and territories to lower the recommended initial screening age for CRC from 50 to 45. This change is in response to increasing evidence of higher rates of colorectal cancer in young adults across the country.8 So far in 2026, only Ontario and PEI have made the change to adopt the new screening recommendations.9 


By Milah Pipkey, student in biology, under the supervision of Dr Yahia Abdelali Lakehal, M.D., FRCPC, MPH.



Reference


  1. Sung H, Siegel R, Laversanne M et al. Colorectal cancer incidence trends in younger versus older adults: an analysis of population-based cancer registry data The Lancet Oncology, 2024; 26, 51-63, doi: 10.1016/S1470-2045(24)00600-4 
  2. Carbone F, Spinelli A, Ciardiello D, Realis Luc M, de Pascale S, Bertani E, Fazio N, Fumagalli Romario U. Prognosis of early-onset versus late-onset sporadic colorectal cancer: Systematic review and meta-analysis. Eur J Cancer. 2025 Jan 17;215:115172. doi: https://doi.org/10.1016/j.ejca.2024.115172. Epub 2024 Dec 7. PMID: 39681013. 
  3. Decker KM, Lambert P, Bravo J, Demers A, Singh H. Colorectal Cancer Incidence and Mortality by Age Group, Colon Location, and Histology in Canada. Am J Gastroenterol. 2026 Jul 22. doi: 10.14309/ajg.0000000000004141 
  4. Stukalin I, Gupta M, Buhler K, Forbes N, Heitman SJ, Ma C. Brief Report: Trends in Incidence, Mortality, and Disability-Adjusted Life Years for Early-Onset Colorectal Cancer in Canada Between 1990 and 2019. Current Oncology. 2024; 31(12):7765-7769. doi: 10.3390/curroncol31120571 
  5. Roshandel G, Ghasemi-Kebria F, Malekzadeh R. Colorectal Cancer: Epidemiology, Risk Factors, and Prevention. Cancers (Basel). 2024 Apr 17;16(8):1530. doi: 10.3390/cancers16081530 
  6. Fritz CDL, Otegbeye EE, Zong X, Demb J, Nickel KB, Olsen MA, Mutch M, Davidson NO, Gupta S, Cao Y. Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer. J Natl Cancer Inst. 2023 Aug 8;115(8):909-916. doi: https://doi.org/10.1093/jnci/djad068. 
  7. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, Published online 4 April 2024; https://doi.org/10.3322/caac.21834
  8. Canadian Cancer Society. "Canadian Cancer Society urges lowering colorectal cancer screening age to 45 as cases rise among people under 50." March 11, 2026. https://www.newswire.ca/news-releases/canadian-cancer-society-urges-lowering-colorectal-cancer-screening-age-to-45-as-cases-rise-among-people-under-50-858263122.html
  9. Ireland, Nicole. "Ontario becomes 2nd province to lower colorectal cancer screening age to 45." CBC News, July 1, 2026. https://www.cbc.ca/news/canada/toronto/colorectal-cancer-screening-age-july-1-9.7255215 

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