Rising Colon Cancer in Young Adults: Why Screening at 45 Matters
- Stuart Akerman, MD
- 14 minutes ago
- 5 min read
You're in your mid-40s, busy with work, family, maybe shuttling kids around the Dallas-Fort Worth area, and feeling pretty healthy overall. A colonoscopy? That seems like something for older people, right?
Here's the thing: the landscape of colon cancer has changed dramatically over the past decade, and not in a good way. As a gastroenterologist practicing in Plano, I'm seeing something that would have surprised doctors just 20 years ago. Colorectal cancer rates are rising in adults under 50, and we're not entirely sure why.
That's exactly why the medical community changed its recommendations. Starting at age 45 is now the new standard for colorectal cancer screening, not 50. Let's talk about why this matters for you and your family here in the DFW Metroplex.
The Alarming Rise of Early-Onset Colorectal Cancer
The statistics are sobering. Since the 1990s, colorectal cancer rates have been increasing by about 1-2% per year in adults under age 50. We're diagnosing patients in their 30s and 40s with advanced colon cancer, people who never imagined they were at risk.
I'll admit, when I first started practicing gastroenterology, seeing someone in their 40s with colon cancer was unusual. Now? It happens more regularly. These aren't people with strong family histories or known genetic syndromes. They're average-risk individuals who simply didn't know they should be screened.
The good news is that when we catch colorectal cancer early through screening, it's highly treatable. The American Cancer Society reports that the five-year survival rate for localized colorectal cancer is 90%. But here's the catch: we have to find it early.
Why Did the Guidelines Change?
In 2021, major medical organizations including the American College of Gastroenterology officially lowered the recommended screening age from 50 to 45 for average-risk adults. The U.S. Preventive Services Task Force followed suit, and insurance companies now cover screening starting at 45.
This wasn't a casual decision. It came after years of data showing:
Rising incidence in younger adults: Early-onset colorectal cancer has increased significantly
Later-stage diagnoses: Younger patients are often diagnosed at more advanced stages because they weren't being screened
Improved outcomes with early detection: Studies show that screening at 45 catches more cancers when they're most treatable
Recent research published in 2025 confirms what we hoped: lowering the screening age to 45 is working. More cancers are being found early, and more lives are being saved.
What Does "Average Risk" Mean?
You might be wondering if you're actually at average risk. Here's what that means:
You're considered average risk if you:
Are 45 years or older
Have no personal history of colorectal polyps or cancer
Have no family history of colorectal cancer
Don't have inflammatory bowel disease (like Crohn's disease or ulcerative colitis)
Don't have a known genetic syndrome
You're at higher risk if you:
Have a first-degree relative (parent, sibling, child) with colorectal cancer
Have had polyps removed previously
Have IBD
Have certain genetic conditions
If you're in the higher-risk category, you may need to start screening even earlier than 45. This is something we can discuss during a consultation at my Plano office.
Screening Options: It's Not Just Colonoscopy (**For Average Risk Patients)
Sound familiar? Many patients tell me they've been putting off screening because they dread the prep or procedure. I get it. But here's what you should know: you have options.
The National Institutes of Health recognizes several effective screening methods:
Colonoscopy (Every 10 Years)
This is the gold standard. A colonoscopy allows us to see the entire colon, remove polyps during the procedure, and prevent cancer before it starts. Yes, the prep isn't fun (though I've written about ways to make it easier), but it's one day of inconvenience for 10 years of peace of mind.
Stool-Based Tests
FIT test (Fecal Immunochemical Test): Annual test you do at home
Cologuard (FIT-DNA): Every 3 years, also done at home
These are convenient options, but here's the million-dollar question: what happens if the test is positive? You'll need a colonoscopy anyway. Some patients prefer to skip the middle step.
Other Options
CT Colonography (Virtual Colonoscopy): Every 5 years
Flexible Sigmoidoscopy: Every 5-10 years
The best screening test is the one you'll actually do. That's not just a cliché. I'd rather you do a FIT test than skip screening entirely because you're nervous about a colonoscopy.
Why Location Matters: Screening in Plano and the DFW Area
Here in the Dallas-Fort Worth area, we're fortunate to have excellent healthcare resources. As a Plano gastroenterologist, I offer open access colonoscopy, which means you can schedule your screening without needing multiple office visits first.
For patients in Frisco, Allen, McKinney, Prosper, or anywhere in the DFW Metroplex, access to quality colonoscopy services shouldn't be a barrier to potentially life-saving screening.
What You Need to Know Right Now
Let me break this down into action steps:
If you're 45 or older and haven't been screened:
Schedule an appointment today. Don't wait.
Talk to your doctor about which screening option is right for you
Check your insurance coverage (screening colonoscopies should be covered as preventive care)
If you're under 45 but have symptoms:
Don't ignore red flags like rectal bleeding, persistent changes in bowel habits, unexplained weight loss, or abdominal pain
When should you see a GI doctor? When symptoms persist or worry you.
If you have a family history:
Tell your doctor. You may need screening before age 45.
Generally, screening should start 10 years before the age your family member was diagnosed, or at age 40, whichever comes first.
The Bottom Line
Look, I know talking about colon cancer screening isn't as fun as planning your next dinner at a Plano Tex-Mex restaurant. But here's what I tell my patients: this is one of the most preventable cancers we know. We can literally see precancerous polyps, remove them during the colonoscopy, and stop cancer before it starts.
The fact that we're seeing more young people with colorectal cancer is concerning, but the fact that we can catch it early through screening is empowering. Age 45 is the new 50, and that guideline change is already saving lives.
Not always easy in our busy lives, I know. But taking one day for a colonoscopy or a few minutes for a stool test could be the most important thing you do for your health this year.
If you're in the Plano, Frisco, McKinney, Allen, or broader Dallas-Fort Worth area and you're 45 or older (or younger with risk factors), let's talk. Schedule an appointment, and let's create a screening plan that works for you.
Your future self will thank you.
References
https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21772
https://www.ons.org/news-and-views/study-finds-increased-colorectal-cancer-rates-in-younger-adults
https://www.statnews.com/2025/08/04/colon-cancer-screening-guidelines-age-45-new-studies/
https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults
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DISCLAIMER: Please note that this blog is intended for Informational Use only and is not intended to replace personal evaluation and treatment by a medical provider. The information provided on this website is not intended as a substitute for medical advice or treatment. Please consult your doctor for any information related to your personal care.
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