By GEORGE BEAUREGARD
Fifteen months ago I wrote in The healthcare blog on the “coming tide” of early-onset cancer.
At that time, researchers, scientists and other health professionals had noted the global increase in the incidence of early-onset cancer in younger people that had occurred over three decades and was being monitored. Articles about research discoveries on this topic appeared sporadically in major medical journals such as Nature, New England Journal of Medicine, and the lancet.
From 2005 to 2011, some early warning articles appeared in mainstream publications such as The Wall Street Journal and He New York Times. Those stories were framed as “exceptional” tragics or medical mysteries. Following a landmark study published by the American Cancer Society (ACS) in 2017 (1), the narrative went from “anecdotal” to “epidemic.” In 2020, the death of actor Chadwick Boseman, who was diagnosed with colorectal cancer at the age of 43, catalyzed mainstream media reporting on the situation. Chadwick died a month before my son Patrick, who was 32 years old. Patrick was featured in a WSJ article in January 2024.
Since then, other renowned national publications such as Time magazine and The economistand mainstream media outlets have published stories about the growing situation. Stories about it have even appeared in some popular supermarket tabloids.
Over the past year, articles have appeared on the possible causal roles of diets rich in ultra-processed foods, obesity, environmental factors, a sedentary lifestyle, and the mutagraph of genotoxin remains from an intestinal bacteria, so-called colibactin.
The recently released SCA report Cancer statistics, 2026presents a jarring dichotomy of “good news and bad news” and has attracted widespread attention. The good news: Overall, five-year survival rates for people with cancer have increased from 50 to 70 percent since the mid-1970s. A 40 percent increase. Without a doubt a reason for celebration. (Mary Lasker would be smiling).
But a dark reality persists.
Colorectal cancer rates and deaths among young people continue to rise. For adults under age 50, incidence rates are increasing nearly 3 percent per year (up from the 1 to 2 percent annual increase reported in the previous decade). More worrying is the fact that CRC is now the leading cause of cancer death in that age group.
Plainly speaking, it is a rising tide that the medical community can no longer ignore.
In the recent JAMA research letter titled “Main deaths from cancer in people under 50 years of age“, the graph illustrating CRC mortality rates from 1990 to 2023 shows a significant upward trend. On that mortality graph, the line for CRC is a sharp, rising red line; the other four cancers shown are declining.
That red line quickly becomes the only line seen on the chart. And not applying any shallow depth of field technique.
This is not surprising, since it is known that young patients are more likely to present with advanced disease (stage III – IV), which is less amenable to treatment.
Action must follow awareness. The U.S. House of Representatives recently passed the bipartisan Nancy Gardner Sewell Medicare Multiple Cancer Early Detection Detection Coverage Act (HR 842), an important step to allow Medicare to decide coverage of multiple cancer early detection (MCED) tests, which have the potential to detect more cancers earlier for better outcomes. A historic step as it is the furthest this bill has gone in the legislative process. Now you need to cross the finish line.
Even if implemented, these diagnostic tests face a steep climb toward routine clinical practice. Many researchers argue that without large cohort clinical trial data demonstrating their usefulness, these tools are under-vetted and not yet ready for use on the front lines of primary care. The dispute between epidemiological rigorists and early detection advocates will intensify.
While this caution is logical, it ignores a harsh reality: conducting a standard randomized controlled trial (RCT) takes years that we haven’t had. Even with favorable results, doctors’ skepticism often creates a bottleneck; Historically, it takes an average of 17 years for evidence from clinical trials to achieve widespread adoption.
We cannot afford to wait five years, let alone almost two decades. These tests provide a vital opportunity to engage “screening refusers,” those who consistently reject colonoscopies or stool-based kits. To close this gap, we must position these novel tests as essential adjuncts to a colonoscopy and encourage physicians to go beyond standard practices by performing deeper levels of environmental and lifestyle assessments, and more. Research indicates that a polygenic risk score (PRS), derived from common CRC genetic variants, along with an assessment of typical CRC signs, can effectively identify average-risk individuals who are at risk of developing early-onset colorectal cancer (EOCRC). This approach would help prioritize those with area EOCRC susceptibility for tailored screening or other intervention strategies.
It is estimated that between 2,800 and 3,200 people under the age of 50 will die from CRC in 2026. While the statistical conundrum is complex, the human cost offers a sobering reality: these deaths are preventable.
I think it’s fair to expect the 2027 Cancer Statistics report to show another increase in the death rate in people under 50 (I hope I’m proven wrong).
You’ve all heard the phrase: “Insanity is doing the same thing over and over again and expecting different results.”
We cannot continue doing the same thing and expecting different results.
Current blood-based early detection tests provide sensitive methods for CRC detection, but have low sensitivity rates for detecting advanced precursor lesions (APLs): polyps. That could lead people whose test doesn’t have a positive signal to be falsely sure they don’t have the disease, so they don’t need to undergo a colonoscopy, which would have visualized and eliminated it. Also relevant to sensitivity is anxiety and the number of nights of sleep lost due to worry about what a false positive result might result. The tests also have specificity rates that are not high enough, leading people who think they do not have the disease to forego having a colonoscopy. Improvements in biological signals and algorithmic optimization will likely improve the accuracy of those tests over time.
We must stop allowing the perfect to be the enemy of the good. If a blood test encourages a reluctant patient to enter the system, that’s a win. If this leads a doctor to ask a 35-year-old about fatigue or changes in bowel habits instead of dismissing them because they’re young and seem healthy, that’s a win.
In the not-too-distant future, a validated MCED test on blood or breath, or something else, will be available.
Preventing avoidable deaths and the lasting collateral damage they cause to families is an imperative.
I look forward to the day when the Cancer Statistics report shows a decrease in CRC mortality among people under 50 years of age.
Innovation leads the way to get there.
George Beauregard, DO is an internal medicine physician and author of Reservations for nine: a doctor’s family faces cancer. This came from his Substack
