Too young for cancer: Colorectal cases surge to become top killer of younger adults
Gabrielle Teiner
COLUMBIA, Mo. (KMIZ)
It can happen to anyone.
Forty-eight-year-old Jennifer Brooks didn’t think being out of breath would lead to a Stage 4 cancer diagnosis.
“I was a little out of breath, my heart was racing a little bit, so I was thinking maybe it was perimenopause or menopause,” said Brooks. “It just didn’t seem like anything too bad.”
In 2021, Brooks had an allergic reaction and doctors came to find out her blood count was severely low. In the midst of figuring that out, while at home, her little dog jumped on her lap, giving her terrible pain in her abdomen.
This is when she knew something really wasn’t right.
“We started thinking maybe, either it was uterine or ovarian cancer, or something of that nature, but it ended up being colon cancer that had already unfortunately spread,” said Brooks.
Now she is stable, but has metastases (spots where cancer has spread throughout the body) in her lungs. Brooks has to do chemotherapy once every three weeks to keep them at bay and gets a CT scan once every three months.
“Once you have Stage 4, the possibility of it coming back is just always there,” said Brooks.
Sadly, Brooks’ diagnosis is becoming more and more common in adults under 50.
“I knew nothing about colon cancer as far as, like, at 48, I wasn’t thinking anything about that because I’d always heard you get screened at 50,” said Brooks. “For me, I wasn’t looking at it because I didn’t think it applied to me.”
Once considered to be a disease more common in older people, colorectal cancer has now been designated as the No. 1 cause of cancer-related deaths in adults under 50 in the United States, leaving doctors and researchers stumped as to why this is happening.
“Honestly, we really don’t know”, said Dr. Nick Davidson, professor and chief of the Division of Gastroenterology at Washington University Medicine. “The answer is not one single reason that this is happening, it’s multiple.”
What is colorectal cancer?
Colorectal cancer starts in polyps, which are clusters of abnormal cells that grow in the lining of the colon or rectum and typically are non-cancerous at first, but can turn malignant.
Symptoms include:
Blood in stool
Rectal bleeding
Changes in bowel movements (constipation or diarrhea)
Unintentional weight loss
Low blood count
Intense fatigue
But sometimes, there are no symptoms at all. That means the cancer is often caught later, when it’s harder to treat.
“Early colon cancer doesn’t cause any symptoms at all,” said Dr. Jean Wang, professor of medicine in the Division of Gastroenterology at Washington University Medicine. “Someone can be walking around with a large precancerous growth or even an early colon cancer and not feel anything at all.”
Wangs says if colon cancer is detected early in Stage 1, a person has a 95% chance of being cured, but the longer a person waits to get screened, the deadlier it becomes.
“The survival rate is only about 15% in people who have had metastatic colon cancer,” said Wang. Metastatic colon cancer means it has spread to other organs in the body, like the liver, lungs and large intestine.
More deaths at younger ages
Doctors and researchers noticed this trend in younger adults, and in May 2021, the United States Preventive Services Task Force lowered the screening recommendation for colorectal cancer from 50 years old to 45 years old.
Doctors say the most concerning thing right now isn’t just the cancer itself, but who it’s affecting.
“I was diagnosed in May of 2021, and three days after I found out, the colon cancer screening went down to 45. I was 48,” said Brooks. “It was three days after my diagnosis when I could have, and I would have gotten screened because I have a lot of cancer in my family.”
According to data from the American Cancer Society, more than 158,000 people are projected to be diagnosed with colorectal cancer this year, with 3,200 of those diagnoses being Missourians.
From 1970 to 2023, death rates from colorectal cancer declined about 1.5% a year for men and women for older adults, but death rates for people younger than 55 have gone up about 1% a year since the mid-2000s.
Today, 1-in-5 colorectal cancer diagnoses occur in a person under 55.
Nationwide new cases projected in 2025
Missouri new cases projected in 2025
Nationwide projected deaths in 2025
Missouri projected deaths in 2025
154,270
3,010
52,900
1,260
Men: 82,460
Men: N/A
Men: 28,900
Men: N/A
Women: 71,810
Women: N/A
Women: 24,000
Women: N/A
Source: American Cancer Society
While experts are trying to figure out the root cause of this epidemic in younger adults, they can partially attribute it to family history, smoking, excessive alcohol consumption, diabetes, lack of exercise, high intake of red meat and ultra-processed foods.
“The ironic part about it was I was kind of like in the best shape of my life when I got diagnosed,” said Brooks. “I was gluten-free, dairy-free, sugar-free, I did all of that, and I was just doing it because I thought it was the right thing to do.”
There is also research being done to see whether a microbe called colibactin, which can alter DNA in the colon and rectum, could be a factor in this increase among younger adults.
Davidson is part of a research team that looks at multiple factors to better understand this epidemic.
“We’re looking at the social factors, food consumption, lifestyle habits,” said Davidson. “We’re also part of a study that is taking patient samples, and transferring them into the research lab, and separating the cancer cells into small tissues called organoids that we can grow indefinitely.”
Naomi Sonneck, organoid core technical director at Washington University Medicine, is in charge of breaking down those cells. She is the only person tasked with doing this, as the work is tedious and must be precise.
“I’m essentially breaking them up to encourage them to expand, it’s kind of like lifting weights in a way, you’re causing minor muscle damage to encourage your muscles to grow bigger,” said Sonneck. “So it’s kind of like those muscles, you want to break them up just enough, but not so much that you’re actually insulting them and killing them.”
Sonneck says they receive samples from all around the world to study and research, and sees firsthand the unique way that each sample of cells grows and responds.
“The shapes of these cells tell us whether these tumoroids are going to continue to proliferate or if they’re about to die,” said Davidson.
Sonneck breaks down the cells about every three to four days to encourage growth, but she has to be fast, or all that research goes down the toilet.
Once she gets the cells to grow, she sends them off to the lab to be studied.
“We all have our roles to play, and it’s a very efficient use of expertise,” said Sonneck.
Davidson says the research allows them to characterize the genetic abnormalities and mutations found in those samples to find weak spots in the DNA to design personalized therapies for patients.
“There is something very distinctive about the growth properties of cancers in young people, and we think that that might be a clue to finding targeted vulnerabilities in those cancers,” said Davidson.
This also allows researchers to monitor how fast the cells grow. So far, the work has indicated malignant cells are growing more slowly in samples from younger adults than older ones.
“This tells us that we haven’t yet found the optimal conditions to make them grow fast, which is what they’re doing in the body, but that’s the process of trying to replicate cancer biology in a person to cancer biology in the lab,” said Davidson.
The Show-Me-State is at the forefront of not only trying to understand colorectal cancer better, but also multiple other cancers as well.
Every year, more than 75,000 people are treated at Siteman Cancer Center in St. Louis, including more than 12,000 who are newly diagnosed, making it one of the five largest cancer centers in the country. Siteman Cancer Center receives more than $185 million per year in basic and clinical oncology research grants, including $66 million in funding from the National Cancer Institute, which funds more than 1,400 research projects.
Wang says a team of researchers at Siteman Cancer Center at Barnes-Jewish and Washington University Medicine was recently awarded a $25 million from the United Kingdom and the National Cancer Institute to look at certain environmental factors that could play a role in a person developing colorectal cancer in their lifetime.
Siteman Cancer Center is also one of nine centers across the state leading the national Vanguard Study, which is a study looking at multi-cancer detection tests. One of those tests is a blood test that can detect more than 50 cancers, including colorectal cancer.
The Vanguard study is a five-year study and is in its early stages, having started about a year ago.
“We are focusing on the rural communities and Missouri with this study, so we think it’s going to be a great way to increase access to those rural communities for earlier cancer detection,” said Wang.
While this could change the game in terms of early cancer detection, Davidson’s true goal is to detect precancerous cells before they become cancer.
“They are less effective at detecting the precancerous lesions that we call adenomas,” said Davidson. “The real goal, in my view, is to be able to detect these precancerous tumors before they develop into cancers.”
As for Brooks, her doctors don’t have a concrete answer as to why she developed her cancer.
“I guess maybe I think I could have when I was having those sensitivities, which we talk about all the time, you know, gastro sensitivities or things, I think I did go to see a gastroenterologist at the time, but I don’t think there was anything significant,” said Brooks.
Many cases of colorectal cancer are preventable, but not always predictable.
Wang says most colorectal cancer patients don’t have a family history of it. Brooks had a couple of family members die from various cancers, but not colorectal.
For some people, like Brooks, who didn’t really have any symptoms, that’s why screening is so important, no matter the age.
“Screening really is the best way to prevent getting this deadly disease,” said Wang. “It’s thought that up to 85% of colorectal cancers could be preventable if people follow the screening guidelines.”
This cancer can target everyone. Big names in Hollywood like James Van Der Beek, 48, and Chadwick Boseman, 43, have lost their lives to colorectal cancer.
“These are young men who are in their 40s and in the prime of their lives, and they develop this deadly disease,” said Wang. “That definitely makes us surprised and makes us want to be motivated to find out the reasons behind this rise in colorectal cancer.”
Wang has even seen patients in their late 20s and early 30s be diagnosed with colorectal cancer. Wang says in those cases, the patient had thought, for example, that blood in their stool was just hemorrhoids, so they brushed it off.
“Even when they went to their primary care doctor, their primary care doctor thought they were too young to get cancer, so they also thought it was just due to hemorrhoids,” said Wang. “So it took a long time for these patients to actually come to see me and then have a colonoscopy done to get diagnosed.”
Screening
The gold standard in the medical field for screening patients with symptoms for colorectal cancer is a colonoscopy, no matter a person’s age or lifestyle.
“A colonoscopy really isn’t that hard to do, and it’s really a shame whenever I see someone come in with colon cancer who had not followed up with colon screenings, and you just know that if they had come in 10 years earlier, it could have all been prevented,” said Wang.
Wang says the hardest part of getting a colonoscopy is the preparation involved. A patient has to take a laxative the day before and the morning of the procedure to clean out the colon so doctors have a crisp look at exactly what’s going on inside.
From Brooks’ experience, she recommends using a good flavor of Gatorade to make the laxative taste better.
“Make it as best as you can,” said Brooks. “It’s only, like, 24, 48 hours of your life, so you can do it.”
The day of, a patient comes in, gets sedated so they don’t feel anything, and doctors put a tube with a camera on the tip inside the colon to see if there are any polyps. If they see one, doctors can remove it right then and there and send it off to a lab to see if it is cancerous. Wang says the colonoscopy takes about 30 minutes, and the patient can go home once they wake up.
“Some people are afraid of doing that colon cleanout the day before, but I tell people, you know, it’s really not a big deal, and it’s definitely easier to do that than to get colon cancer,” said Wang.
A colonoscopy is recommended to be done every 10 years.
There are other options for screening. Starting at 45, a person can do an at-home stool test. The fecal occult blood test looks for small amounts of hidden blood in the stool, which could be a sign of polyps in the colon or rectum. Then there is the multitargeted stool DNA test, which looks for hidden blood and cells in the stool. The cells are checked for DNA changes shed from the polyps or cancer. These tests should be done every three years.
Another test option is the fecal immunochemical test, which uses antibodies to find hemoglobin in the stool. The test specifically looks for blood from the lower digestive tract, but not the upper. This test is recommended to be done once a year.
Wang says if you do a stool test at home, it is critical to follow up and get a colonoscopy.
“It’s very important to follow up when we tell you the recommended time, usually in three years or five years or seven years, to come back for that follow-up colonoscopy,” said Wang. “We know that people who have pre-cancerous polyps at one point tend to grow them again in other areas of the colon later on.”
Wang says it takes about 10 years for a precancerous growth to turn into cancer, and by following up with your doctor, they can find the small growths and remove them before they turn into cancer.
“There is kind of a stigma that goes along with colon and all of that, but hey, it’s part of life, and we want to live,” said Brooks. “I have made it so that all my children have to get a colonoscopy a full 10 years before my diagnosis, so I was diagnosed at 48; they should be getting a colonoscopy by 38.”
If the cancer has spread to other organs, like in Brooks’ case, chemotherapy and surgery would be the next step. Brooks had a third of her colon, her uterus and other organs removed.
As simple as it may sound to get these screenings done, there are barriers.
Wang says she sees more late-stage colorectal cancer in patients from rural areas where people have to travel farther to get a colonoscopy. Siteman Cancer Center recently launched a community van that goes to rural communities and offers free at-home stool tests. If the results are abnormal, Siteman will guide the patient through the process of getting a colonoscopy.
The Missouri Colorectal Cancer Roundtable, a statewide organization partnered with the Missouri Department of Health, as well as nonprofit groups like the American Cancer Society and patient advocacy groups, is working with pharmacies in rural communities to give out home screening tests.
Experts expect 2026 to see a slight increase from 2025, when 3,010 new cases were projected across the state and 154,270 were projected nationwide. Men and women get the disease at about the same rate.
Nationwide, more than 55,000 colorectal cancer deaths are projected, representing around 30,000 men and around 25,000 women. In Missouri, 1,280 deaths are projected for 2026, according to the American Cancer Society.
But for patients like Brooks, those numbers are more than just statistics.
When she was told she had cancer, she was fearful, but she tried to take a look at it from a different perspective.
“I didn’t think fear would help me. I thought it would be better to just deal with it head-on and say, ‘Okay, ‘So what is the process? What do we have to do?” said Brooks. “I think that positive mental attitude helps a lot. I’m not saying you can’t get a diagnosis and not be a little scared; that’s normal, but I think what you do with it from there is really important.”
Brooks is not only a colorectal cancer patient, but she is also a mother, a wife, a daughter and a sister. She says her family, church friends, work colleagues, and more were all crucial in supporting her during her treatments. She also started a Facebook page detailing her colorectal cancer journey.
“I created that page to support people if they had questions because I felt like I’m not a medical doctor, but I can tell you what I’ve experienced and what I’ve done,” said Brooks.
After being on this cancer journey for nearly five years now, Brooks says she still has good days and bad days.
“This weekend wasn’t the greatest, but most of the time I can predict how I will feel, and then, going along on that journey where I’m looking for the clinical trials, I have been accepted to either three or four, I’m just waiting for a spot,” said Brooks.
Her best piece of advice to others going through what she has and is is to be in tune with their bodies and pay attention to anything that may seem abnormal.
Brooks has a genetic mutation that blocks immunotherapy cancer treatment from working, so she is looking into clinical trials to see if that could help keep the cancer at bay or eradicate it.
While her life has changed dramatically, her positive outlook on life hasn’t.
“I still have a good quality of life, I have bad days, I have good days, but everybody has those, so why not stay positive?” said Brooks. But she still has questions about what’s to come.
“Our life expectancy in the United States should be way, way higher than that, so we just got to figure out how to treat patients who have colorectal cancer. And what is it? What can they do? What can the medical professionals do?” said Brooks.
Patients, family members, doctors, researchers and more all want to figure out why this epidemic is happening. And while Brooks waits for these answers, she has a personal goal she wants to achieve.
“I’m hopeful to be the longest living colon cancer survivor. I hope I can be that person,” said Brooks.
