Why Colon Cancer in Young Adults Demands Our Attention (And What You Can Do About It)
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It's February 11, 2026, and I'm sitting in my office reading the news about James Van Der Beek's passing. You probably remember him as Dawson from Dawson's Creek, a show that defined the late '90s and early 2000s for so many of us. James was 48 years old when colorectal cancer took his life, despite going public with his diagnosis in 2024 and fighting hard, even auctioning his memorabilia to fund treatments.
The loss hits differently when someone close to your own age dies from a disease you spend your days trying to prevent. As a gastroenterologist in the Dallas-Fort Worth area, I see patients every week who tell me they're too young to worry about colon cancer. And yet, here's the reality check we all need: colorectal cancer is now the number one cause of cancer death in people under 50.
Let that sink in for a moment.
The Alarming Trend We Can't Ignore
A recent study published in JAMA in 2026 showed something that should concern every one of us. While overall cancer deaths in people younger than 50 have dropped by 44% since 1990 (which is incredible news), colorectal cancer mortality has been moving in the opposite direction. It's climbed from the fifth-leading cause of cancer death in the early 1990s to the top spot in 2023.
Since 2005, colorectal cancer deaths in this age group have been increasing by 1.1% every single year. Meanwhile, lung cancer, breast cancer, and leukemia deaths have all been declining thanks to better treatments and earlier detection.
So what's happening with colon cancer? Why is it bucking this positive trend?
The truth is, we're still piecing together the full picture. Research points to a combination of factors: changes in diet, obesity rates, sedentary lifestyles, environmental exposures, and possibly the gut microbiome. But regardless of the "why," we need to focus on the "what now."
James Van Der Beek's Story Underscores the Message
James went public with his diagnosis not to scare people but to raise awareness. He stripped (literally) on The Real Full Monty TV special to bring attention to colorectal, prostate, and testicular cancers. He talked openly about the realities of treatment. And in doing so, he probably saved lives by getting people to finally schedule that screening they'd been putting off.
What strikes me most about his story is that he was diagnosed in his mid-40s, right around the age when screening becomes recommended for average-risk individuals. That's not a coincidence. That's exactly why the guidelines changed in 2021 to recommend starting screening at 45 instead of 50.
But here's what many people don't realize: if you have symptoms or a family history, you shouldn't wait until 45.
When Should You Actually Get Screened?
Let's clear up the confusion around screening ages, because this question comes up constantly in my practice:
For average-risk individuals: Screening should begin at age 45. This means no family history of colorectal cancer, no inflammatory bowel disease, and no concerning symptoms.
For those with a family history: If you have a first-degree relative (parent, sibling, or child) who had colorectal cancer, you should get your first colonoscopy either 10 years before the age they were diagnosed or at age 40, whichever comes first. So if your dad was diagnosed at 52, you should start screening at 42. If your mom was diagnosed at 38, you should start at age 28 (or at least by 40).
For those with symptoms: This is crucial. If you're experiencing persistent changes in bowel habits, rectal bleeding, unexplained weight loss, severe abdominal pain, or iron-deficiency anemia, don't wait for any arbitrary age. Get checked now, regardless of your age. These symptoms warrant a diagnostic colonoscopy, not just screening.
James Van Der Beek's story is a reminder that waiting for symptoms to become severe can be too late. By the time colorectal cancer causes noticeable symptoms, it's often more advanced.
The Marketing Maze: Blood Tests, Stool Tests, and Colonoscopy
Turn on your TV or scroll through social media, and you'll see ads for at-home colon cancer screening tests. Cologuard boxes showing up on your doorstep. Now, blood tests like Shield that promise cancer detection with a simple blood draw. It's never been easier to screen for colon cancer from the comfort of your home, right?
Here's the thing, and I want to be really clear about this: these tests have value, but they're not equivalent to colonoscopy.
Let's talk about what each test actually does:
Stool-Based Tests (FIT and Cologuard)
FIT (Fecal Immunochemical Test): This test looks for hidden blood in your stool. It's inexpensive, easy to do annually, and reasonably good at detecting cancer. However, it's not great at finding precancerous polyps, and lots of things can cause blood in stool that aren't cancer. Hemorrhoids, anyone?
Cologuard: This is a multi-target stool DNA test that looks for both blood and abnormal DNA markers. It has about 92% sensitivity for detecting colorectal cancer and roughly 42% sensitivity for detecting advanced precancerous polyps. That sounds pretty good until you realize it means it misses more than half of the advanced polyps that could turn into cancer down the road.
I've written extensively about what to do if your Cologuard test comes back positive, and the answer is always the same: you need a colonoscopy.
Blood-Based Tests (Shield)
The FDA approved Shield in 2024 as the first blood test for colorectal cancer screening. It detects 83% of colorectal cancers with 90% specificity. That's actually impressive for a blood test. But here's what the fine print shows: it only detects about 13% of advanced precancerous polyps.
Read that again: 13% sensitivity for advanced adenomas.
This matters because the real power of screening isn't just finding cancer. It's preventing it in the first place by removing polyps before they ever become cancer.
Colonoscopy: The Gold Standard
I know colonoscopy gets a bad rap. The prep isn't anyone's idea of a good time (though modern preps are much better than they used to be). You have to take time off work. You need someone to drive you home. It's invasive.
But here's what colonoscopy does that no other test can:
It visualizes your entire colon directly. No guessing, no indirect markers. We actually see what's there.
It detects up to 95% of cancers and large polyps. That's significantly better than any stool or blood test.
It prevents cancer. When we find polyps during a colonoscopy, we remove them right then and there. Those polyps never get the chance to turn into cancer. This is the key difference. Colonoscopy is both a screening and prevention tool.
It provides long-term reassurance. If your colonoscopy is normal, you typically don't need another one for 10 years (compared to annual or every-3-year testing with stool and blood tests).
Quality matters too. Research has shown that gastroenterologists with higher adenoma detection rates (meaning they find more polyps) have patients with lower rates of post-colonoscopy colorectal cancer. This is why I'm passionate about using AI-assisted colonoscopy technology in my practice. It helps us find even more polyps that might otherwise be missed.
So What's the Right Approach?
I get it. If someone absolutely refuses to do a colonoscopy, a Cologuard or blood test is better than nothing. Screening saves lives, period. But let's be honest about what we're trading off.
If you're at average risk and symptom-free, here's my professional recommendation:
Option 1 (Preferred): Get a colonoscopy at age 45 (or younger if you have a family history or symptoms). If it's normal, you're done for a decade.
Option 2: Do annual FIT testing or Cologuard every 3 years, understanding that if it comes back positive, you'll need a colonoscopy anyway. And remember, these tests detect cancer. They don't prevent it the way colonoscopy does.
Option 3: Consider blood-based testing if you absolutely won't do a colonoscopy or stool testing, but understand its limitations in detecting precancerous polyps.
For anyone with a family history or symptoms, colonoscopy isn't optional. It's necessary.
The Natural History of Colorectal Cancer: Why Timing Matters
Let me explain why we gastroenterologists are so obsessed with finding polyps. Colorectal cancer usually doesn't just appear overnight. It follows what we call the adenoma-carcinoma sequence:
Normal colon lining → Small polyp → Large polyp → Dysplasia → Cancer → Metastatic cancer
This progression typically takes 10 to 15 years. That's a huge window of opportunity to intervene. When we find and remove a polyp at any point in this sequence before it becomes cancer, we've prevented that cancer from ever happening.
This is why colonoscopy is so powerful and why stool and blood tests, while useful for detection, can't offer the same level of prevention. They might catch cancer early (which is still valuable), but they're not designed to remove the precursors.
Addressing the Elephant in the Room: The Prep
I've heard every excuse in the book for avoiding colonoscopy, and 90% of them boil down to fear of the prep. So let's demystify this.
Yes, you'll spend a day on a clear liquid diet. Yes, you'll drink a bowel prep solution (or take pills, depending on which prep your doctor prescribes). Yes, you'll be making frequent trips to the bathroom. It's not pleasant.
But here's the reality: the prep is one day. One uncomfortable day in exchange for potentially decades of life. And honestly? Most patients tell me afterward that they built it up in their minds to be way worse than it actually was.
I've put together a comprehensive colonoscopy prep guide that walks you through exactly what to expect and how to make it as tolerable as possible. Modern split-dose preps (where you take half the night before and half the morning of) are much easier on your system and lead to better results.
The actual procedure? You'll be comfortably sedated. Most people don't remember a thing. You're typically in and out in a couple of hours, and most return to normal activities the next day.
What Happens During and After Your Colonoscopy
During the procedure, I'm looking for polyps, inflammation, bleeding, or any other abnormalities. If I find polyps and they're not enormous, I remove them right then using tiny instruments passed through the colonoscope. Those polyps get sent to a lab where a pathologist examines them under a microscope to determine what type they are and whether they show any concerning features.
Within a week, you'll get your results. Based on what we find, I'll recommend when you should have your next colonoscopy:
Nothing found: 10 years
Small, low-risk polyps: Usually 5 to 10 years
Larger or higher-risk polyps: 3 to 5 years
Advanced findings: 1 to 3 years or sooner
This is personalized medicine at work. Your follow-up schedule is tailored to your specific findings and risk factors.
Taking Action in the Dallas-Fort Worth Area
If you're reading this and thinking "I really need to schedule that colonoscopy," I'm here to help. My practice serves patients throughout Plano, Frisco, Allen, McKinney, Prosper, and the broader Dallas-Fort Worth metroplex.
We offer two convenient options:
Schedule a consultation: If you have questions, concerns, or complex medical history, we'll sit down and discuss your individual situation, risk factors, and the best screening approach for you.
Open Access Colonoscopy: If you're due for routine screening and don't need a pre-procedure consultation, you can schedule your colonoscopy directly. This streamlined process gets you screened faster.
I've been practicing gastroenterology in the DFW area for over 10 years, and I'm board-certified with extensive experience in colonoscopy and polyp removal. More importantly, I understand the anxiety that comes with this procedure, and my team is committed to making your experience as comfortable and stress-free as possible.
The Bottom Line: Don't Wait for Symptoms
James Van Der Beek's death at 48 is a stark reminder that colorectal cancer doesn't discriminate by age anymore. The statistics are clear: this disease is on the rise in younger adults, and it's now the leading cause of cancer death in people under 50.
But here's the good news that should give us all hope: colorectal cancer is one of the most preventable cancers we know of. When detected at early, localized stages, the 5-year survival rate is about 91%. And when we remove polyps before they become cancer? We've achieved 100% prevention for that particular polyp.
Screening works. Colonoscopy works. And it works best when we do it proactively, before symptoms appear.
So if you're 45 or older and haven't been screened, make this the month you finally take action. If you have a family history or symptoms, don't wait. Get checked now regardless of your age. And if you've been relying solely on stool or blood tests, consider whether a colonoscopy might give you better peace of mind and more comprehensive prevention.
Your future self will thank you. Your family will thank you. And who knows? Your decision to get screened might inspire someone else to do the same, creating a ripple effect that saves more lives.
March is Colon Cancer Awareness Month, but awareness without action doesn't save lives. Let's turn awareness into appointments, and appointments into prevention.
Frequently Asked Questions About Colorectal Cancer Screening
When should I get my first colonoscopy?
For average-risk individuals, screening should begin at age 45. However, if you have a first-degree relative with colorectal cancer, start screening 10 years before their age of diagnosis (or at age 40, whichever comes first). If you have symptoms like rectal bleeding, persistent bowel changes, or unexplained weight loss, get screened now regardless of age.
Can blood tests or stool tests replace colonoscopy?
While blood tests (like Shield) and stool tests (like Cologuard and FIT) are valuable screening options, they're not equivalent to colonoscopy. These tests detect cancer but don't prevent it. Colonoscopy can find and remove precancerous polyps in the same procedure, preventing cancer before it starts. Blood and stool tests also have lower sensitivity for detecting advanced polyps compared to colonoscopy.
How often do I need to repeat screening tests?
This depends on which test you use and what's found. Colonoscopy is typically every 10 years if normal (or more frequently if polyps are found). FIT tests should be done annually, Cologuard every 3 years, and blood-based tests every 3 years. Any positive result on a stool or blood test requires a follow-up colonoscopy.
What if I have a family history of colon cancer?
Family history significantly increases your risk. Start screening earlier, typically 10 years before your relative's age at diagnosis or by age 40, whichever comes first. You'll also need more frequent colonoscopies (usually every 5 years instead of 10). Talk to your gastroenterologist about your specific family history to develop a personalized screening plan.
Is the colonoscopy prep really that bad?
Most patients say the anticipation is worse than the reality. Modern split-dose preps (taking half the night before and half the morning of) are much more tolerable than older preparations. The prep is one uncomfortable day in exchange for potentially life-saving prevention. Check out my colonoscopy prep guide for tips on making it easier.
What happens if polyps are found during my colonoscopy?
If I find polyps during your colonoscopy, I'll remove them right then (as long as they're not too large). They'll be sent to a pathology lab for analysis. Based on the size, number, and type of polyps found, we'll determine when you should have your next colonoscopy, typically anywhere from 3 to 10 years depending on the findings.
References
Siegel RL, Medhanie GA, Fedewa SA, Jemal A. Leading Cancer Deaths in People Younger Than 50 Years. JAMA. 2026. https://www.genspark.ai/api/files/s/ndBYR9os
Shaukat A, Kahi CJ, Burke CA, et al. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol. 2021;116(3):458-479.
Akimoto N, Ugai T, Zhong R, et al. Rising incidence of early-onset colorectal cancer—a call to action. Nat Rev Clin Oncol. 2021;18(4):230-243.
Schottinger JE, Jensen CD, Ghai NR, et al. Association of Physician Adenoma Detection Rates With Postcolonoscopy Colorectal Cancer. JAMA. 2022;327(21):2114-2122.
Song LL, Li YM. Current noninvasive tests for colorectal cancer screening: An overview of colorectal cancer screening tests. World J Gastrointestinal Oncol. 2016;8(11):793-800.
Guardant Health. Shield Blood Test Approved by FDA as a Primary Screening Option for Colorectal Cancer. July 2024. https://investors.guardanthealth.com/press-releases/press-releases/2024/
American Society for Gastrointestinal Endoscopy. ASGE Position on Blood-Based Colorectal Cancer Screening. 2025. https://www.asge.org/home/about-asge/newsroom/
Kanth P, Inadomi JM. Screening and prevention of colorectal cancer. BMJ. 2021;374:n1855.
Shah RR, Millien VO, da Costa WL Jr, et al. Trends in the incidence of early-onset colorectal cancer in all 50 United States from 2001 through 2017. Cancer. 2022;128(2):299-310.
Legacy.com. James Van Der Beek Obituary. February 2026. https://www.legacy.com/us/obituaries/legacyremembers/james-van-der-beek-obituary?id=60769930
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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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