For people in their 30s and 40s, the signs and symptoms of colorectal cancer might be easy to dismiss. After all, conditions like diarrhea and chronic abdominal cramping can be caused by plenty of other less-severe conditions, and colorectal cancer is only a risk for people over the age of 50, right?

Wrong, said Dr. Sarah Fox, a colorectal surgeon at Novant Health New Hanover Medical Center. In 2023, an estimated 19,550 people under the age of 50 will be diagnosed with colorectal cancer, the American Cancer Society states. A March 1 report indicates that the rate of new colorectal cases among Americans younger than 55 years increased from 11% of all cases in 1995 to 20% in 2019. What’s alarming, Fox said, is that most colorectal cases in young people are being diagnosed at late stages, after the cancer has metastasized, or spread, making them much more difficult to treat. This means young people are commonly ignoring symptoms, sometimes for years, at their onset and seeking medical attention only when they become severe.

Dr Sarah Fox
Dr. Sarah Fox

“In one study, 92% of the young people with colon or rectal cancer had symptoms,” Fox explained. “Two-thirds of them waited between three and 12 months to see a doctor for their symptoms, because they thought, ‘I'm young, not a problem.’ So it's actually a much bigger deal than I think the general public knows.”

It’s important for people under age 50 to have an awareness of the signs and symptoms of colon cancer, along with its risk factors, and imperative to request a colon cancer screening when experiencing symptoms. Here are Fox’s top three tips for colon cancer awareness, screening and prevention.

See a primary care provider about scheduling a colonoscopy screening.

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1. Recognize the symptoms

There’s one primary symptom that Fox said always warrants a trip to the doctor.

“Bleeding should never be ignored. That is the big message that I would like to get through,” she said.

The majority of young people who are diagnosed with colon cancer have a tumor on the left side of the colon, Fox explained. This is the descending colon, the section of the large intestine that passes waste downward. Bleeding from this section of the colon will appear bright red, and can be mistakenly self-diagnosed as blood from a hemorrhoid or anal fissure.

“Even if it's a little bit of blood, it needs to be investigated,” Fox said. “I cannot say that emphatically enough.”

Other symptoms of colorectal cancer include:

  • Unexplained change in bowel habits
  • Chronic diarrhea or constipation
  • Ongoing abdominal pain or cramps
  • Unexplained weight loss
  • Sudden onset of fatigue or iron deficiency anemia (caused by internal bleeding)

Can it be embarrassing to talk about issues with your backside? Sure, Fox acknowledged. But doctors’ only concern is to address your health issues and ensure your well-being – remember, your doctor is only there to help. Setting aside feelings of embarrassment is key to addressing and ultimately treating your symptoms.

“You need to really advocate for yourself if something is not right,” Fox said.

2. Request screening

A standard screening for colorectal cancers is a colonoscopy. This procedure allows doctors to examine the inside of the colon using a thin, flexible tube with a camera on the end. A colonoscopy takes about 30 minutes and the patient receives anesthesia, typically having little to no memory of the process. Prep for a colonoscopy involves following a specific diet for 24 hours before the procedure.

For people with average risk of colorectal cancers, meaning those without a family history of colorectal cancer, Crohn’s disease or ulcerative colitis, the U.S. Preventive Services Task Force recommends routine colonoscopy screenings between age 45 and 75. But anyone experiencing symptoms of colorectal cancer should request a colonoscopy right away, regardless of age.

A colonoscopy is the No. 1 recommended screening for colorectal cancer because it’s highly reliable for detecting polyps, clumps on wall of the inside wall of the colon that can turn into cancer, and can also be used to remove them. This means colonoscopy is not only a screening tool but a preventive one.

“We're going to look at your whole colon,” Fox explained. “If I see polyps, I'll take them out. If we remove that polyp, we remove the risk from that polyp.”

While colonoscopy is considered the gold standard for colorectal cancer detection and prevention, there’s still a lot of hesitancy among many communities to request it, particularly among Black men, Fox said. The American Cancer Society states that Black Americans are 40% more likely to die from colorectal cancer than most other groups. However, the current increase in early-onset colorectal cancers is prominent among Caucasians, with statistics from the American Cancer Society showing a steady increase in deaths from colon cancer in white Americans under age 54 since 2004. This is why Fox emphasizes that it’s important to talk about and normalize colonoscopies – among all communities, races, ethnicities and demographics.

“It’s part of taking care of you and your loved ones,” she said.

3. Lower your risk through diet

Researchers are still working to identify exactly why people in their 30s and 40s are being diagnosed with colorectal cancers in increasing numbers. One thing we do know, Fox said, is that the rise in diagnoses correlates with a rise in the consumption of processed foods. This means you can lower your risk of early onset colorectal cancer with a simple lifestyle change.

“One of the biggest risk factors that has been identified is the Western diet,” Fox said. “Specifically, high red meat consumption, processed meat and high sugar content.”

Key to lowering your risk of colorectal cancer through food is eating a diet that contains plenty of plants, Fox continued. This maintains a diversity of healthy gut microbes, the good bacteria that are critical for an overall healthy functioning immune system.

“The Western diet promotes unfavorable microbes,” Fox said. “Those cause inflammation in the lining of the intestine, and that inflammation is a risk factor for forming cancers. In contrast, if you look at people who follow a plant-based diet, they have a much more diverse gut microbiome. And that translates into an anti-inflammatory and anti-tumor response in the lining of the gut.”

Foods that are beneficial for colon health include:

  • Fish
  • Fruits
  • Non-starchy vegetables
  • Whole grains like brown rice, barley, oatmeal and quinoa
  • Nuts
  • Beans and legumes
  • It’s important not to forget about beverages, too, as these can be significant sources of sugar.

    “It's very in vogue to drink all these energy drinks and drink a ton of soda and sweet tea,” Fox said.

    But these, as well as alcoholic drinks, have been correlated with heightened risk for colorectal cancers. A 2021 study found that women who consumed more than two sugar-sweetened beverages a day had more than double the risk of developing early-onset colorectal cancer when compared with women who drank less than one sugary drink a week.

    Lifestyle choices like consuming a healthy diet and regularly exercising can have a significant impact on lowering the risk of cancer. Practicing a preventive lifestyle and advocating for yourself if and when you experience symptoms are key factors in colorectal cancer awareness.