By GEORGE BEAUREGARD
Fifteen months ago, I wrote in The Health Care Blog about the “incoming tide” of early-onset cancer.
At that time, the global rise in the incidence of early-onset cancer in younger people that had occurred over three decades had been noticed and was being monitored by researchers, scientists, and other healthcare professionals. Articles on research discoveries in this topic sporadically appeared in top medical journals such as Nature, The New England Journal of Medicine, and The Lancet.
From 2005 to 2011, some early warning articles surfaced in generalist publications in mainstream media outlets like The Wall Street Journal and The New York Times. Those stories were framed as tragic “one-offs” or medical mysteries. Following a landmark study published by the American Cancer Society (ACS) in 2017 (1), the narrative shifted 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 one month before my son, Patrick, who was 32 years old. Patrick was featured in a WSJ article in January 2024.
Since then, other reputable national publications like Time magazine and The Economist, and major media news outlets have featured stories about the growing situation. Stories about it have even appeared in some popular supermarket tabloids.
Over the past year, articles about the potential causative roles of diets high in ultra-processed foods, obesity, environmental factors, sedentary lifestyle, and a gut bacterium’s genotoxin remnant mutagraph, so-called Colibactin, have appeared.
The recently released ACS report Cancer Statistics, 2026, presents a jarring “good news, bad news” dichotomy and has garnered wide attention. The good news: overall, five-year survival rates for people with cancer have increased from 50 percent to 70 percent since the mid-70s. A 40 percent increase. Certainly a cause for celebration. (Mary Lasker would be smiling.)
But a dark reality persists.
Colorectal cancer rates and deaths in young people are still rising. For adults under 50, incidence rates are climbing nearly 3 percent per year (up from the 1 to 2 percent annual increase reported in the previous decade). Of greater concern is the fact that CRC is now the top cancer killer in that age group.
Plainly speaking, it’s a surging tide that the medical community can no longer ignore.
In the recent JAMA Research Letter titled “Leading Cancer Deaths in People Younger Than 50 Years,” the graph illustrating the CRC mortality rates from 1990 to 2023 shows a significant upward trend. On that mortality graph, the line for CRC is a stark, rising red streak; the four other cancers shown are in retreat.
That red line quickly becomes the only line one sees on the graph. And not from applying any shallow depth of field technique.
It’s not surprising, as it’s known that young patients are more likely to present with advanced (stage III – IV) disease, which is less amenable to treatment.
Action must follow awareness. The U.S. House of Representatives recently passed the bipartisan Nancy Gardner Sewell Medicare Multi‑Cancer Early Detection Screening Coverage Act (H.R. 842), a major step toward enabling Medicare to decide coverage of multi‑cancer early detection (MCED) tests, which have the potential to detect more cancers earlier for better outcomes. A historic step as this is the farthest this bill has ever gotten in the legislative process. It now needs to cross the finish line.
Even if enacted, these diagnostic tests face a steep climb into routine clinical practice. Many researchers argue that without data from large-cohort clinical trials proving their utility, these tools are insufficiently vetted and not yet ready for 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 gold-standard Randomized Controlled Trial (RCT) takes years we don’t have. Even with favorable results, physician skepticism often creates a bottleneck; historically, it takes an average of 17 years for clinical trial evidence to achieve widespread adoption.
We can’t afford to wait five years, let alone nearly two decades. These tests provide a vital chance to engage “screening-refusers”—those who consistently decline colonoscopies or stool-based kits. To bridge this gap, we should position these novel tests as essential complements to a colonoscopy and encourage physicians to move beyond standard practices by conducting deeper levels of lifestyle and environmental assessments, and more. Research indicates that a polygenic risk score (PRS), derived from common genetic variants of CRC, along with an evaluation for typical CRC signs, can effectively identify average-risk individuals who are at risk for developing early- onset colorectal cancer (EOCRC). This approach would help prioritize those with heightened susceptibility to EOCRC for personalized screening or other intervention strategies.
Estimates are that 2,800 to 3,200 people under 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 that the Cancer Statistics, 2027, report will show another increase in the mortality rate in people younger than 50. (I hope I’m proven wrong.)
You’ve all heard the quote, “Insanity is doing the same thing over and over again and expecting different results.”
We cannot keep doing the same thing and expecting different results.
Current blood-based early detection tests provide sensitive methods of CRC detection but have low sensitivity rates for detecting advanced precursor lesions (APLs)—polyps. That might lead people whose test doesn’t have a positive signal to be falsely confident that they don’t have the disease, so they don’t need to undergo a colonoscopy, which would have visualized it and removed it. Also relevant to sensitivity is the anxiety and the number of nights of sleep lost due to worry about what might turn out to be a false positive result. The tests also have specificity rates that aren’t high enough, leading people who think they don’t have the disease to forego having a colonoscopy. Biological signal enhancements and algorithmic optimization will likely improve the accuracy of those tests over time.
We must stop letting perfect be the enemy of the good. If a blood test encourages a screening-averse patient to enter the system, it’s a win. If it prompts a physician to ask a 35-year old about fatigue or bowel habit changes instead of dismissing them because they are young and appear healthy, it is a win.
In the not-too-distant future, a validated blood or breath-based MCED test, or something else, will be available.
Preventing avoidable deaths and the lasting collateral damage to families that they cause is an imperative.
I look forward to the day when the Cancer Statistics report shows a decline in CRC mortality among people younger than 50.
Innovation lines the path to getting there.
George Beauregard, DO is an Internal Medicine physician & the author of Reservations for Nine: A Doctor’s Family Confronts Cancer. This came from his Substack
Publisher: Source link
