Live Q&A Recap: Rising Colorectal Cancer Rates in Younger Patients

For Colorectal Cancer Awareness Month, Columbia University Irving Medical Center colorectal surgeon Beatrice Dionigi, MD, hosted a live Q&A to tackle a pressing question: “Why are more young people developing colorectal cancer?”

During the live chat, Dr. Dionigi explored the rising incidence of early-onset cases, explained the typical treatment journey, and shared practical insights on prevention, lifestyle strategies, and the role of genetics in colon and rectal cancer. 

The below recap is lightly edited for clarity. 

Colorectal cancer has long been considered a disease of old age, affecting people in the later years of their life. Today, however, colorectal cancer rates are rising in people under 45, alarming physicians and public health experts. 

We’ve started to see more attention from the public on this topic as several celebrities have unfortunately gone through this terrible disease. Most recently, we saw widespread attention and concern when James Van Der Beek passed away from colon cancer at 48, after publicly sharing his experience with diagnosis, treatment, and the impact on his family. 

It’s important to understand the risks for early-onset colorectal cancer - so I hopefully see less of you in the operating room. 

What do you tell patients who are concerned about colorectal cancer? 

Colorectal cancer is essentially a growth-cells in our body growing out of control in parts of the colon. If we catch it early, we can remove those cells and spare the colon, avoiding surgery and additional therapy. If we don’t, and we let it go for years, it can develop into a mass, or cancer. 

One of the main questions I get from patients is why they have this cancer and how they can prevent it. The main thing to know is that we can prevent it with colonoscopy screening. Colonoscopy can detect between 75 and 92 percent of adenomas and 97 percent of advanced adenomas, the ones most likely to develop into cancer.  

During the procedure, we can remove any polyps, examine them under a microscope, and make sure there’s no cancer forming. Afterward, you generally don’t need another one for three to five years.  

What should I be looking for when it comes to colon health? 

Symptoms you shouldn’t ignore, especially if you’re young, include rectal bleeding, abdominal pain, nausea, and vomiting that doesn’t resolve. Many people assume rectal bleeding is just hemorrhoids, but that’s not always the case. If you notice any bleeding, get checked out. You can’t determine whether it’s hemorrhoids without a thorough exam, both inside and outside the anus, so advocate for yourself. If hemorrhoids are ruled out, we can escalate to a colonoscopy to check for anything more serious. 

What if I am diagnosed with colorectal cancer? 

After a colorectal cancer diagnosis, whether you are a young patient or not, it’s normal to feel scared. The next steps involve your doctor explaining exactly what’s happening and listening to your concerns. Treatment usually starts with surgery to remove the cancer, which typically takes three to four hours. After that, the pathologist looks at the colon and lymph nodes to see if there are any other cancer cells. Once we have those results, you’ll meet with your oncologist to go over the next steps, which often include chemotherapy to remove cancer cells that have spread. 

Some patients’ tumors are also genetically tested, and a smaller group may be eligible for immunotherapy, though most will go through chemotherapy. 

What does the surgery and recovery involve? 

Surgery involves removing the cancer while keeping as much of the colon intact as possible. Recovery depends on a few factors. If you’ve had previous surgeries, robotic or laparoscopic approaches can be a bit trickier. With robotic surgery, most of the work is done inside, and the affected part of the colon is removed through a small incision. Hospital stays are usually two to five days, and recovery tends to be faster. Open surgery takes a bit longer to heal, but the pain is manageable, and most people recover well. 

Who needs a colonoscopy? 

Anyone age 45 or older should get a colonoscopy, regardless of symptoms. That’s supported by national guidelines and insurance. If you’re under 45 and have a relative with colorectal cancer, screening usually starts 10 years before the age your relative was diagnosed.  

Genetics play a big role. If you have a family history of colon or other cancers, you may have a genetic predisposition that puts you at higher risk, and you can get genetic testing to confirm this. Sometimes, genetic testing can even reveal other genes that increase the risk for different cancers or diseases- not just colorectal cancer. 

If I can’t get screened until 45, can I still get a colonoscopy if I notice symptoms? 

Yes. Even if you’re under 45, you can get a colonoscopy if you have a family history of colorectal cancer or if you notice symptoms like rectal bleeding. Patients with Crohn’s disease or colitis may need more frequent colonoscopies because they’re at higher risk. We suspect that, in the future, the screening age may be lowered even further, but for now, 45 remains the general starting point. 

If you don’t have any specific risk factors, can you do anything to lower your chances of getting colorectal cancer? 

Yes, your diet and lifestyle can help lower your risk. We’re seeing a link between red meat and colon cancer, so try to reduce your intake. Quitting smoking is critical—not just for lung cancer but for many cancers, including colorectal. Lack of exercise and obesity are also risk factors.  

In terms of diet, you don’t need to be vegan or vegetarian, but try to focus on leaner meats and incorporating more healthy foods into your meals. Drinking less alcohol can also help lower your risk for several cancers. Try to avoid cleanses and detoxes, which can cause electrolyte imbalances. Eating a balanced, healthy diet remains the best medicine! 

Can fiber supplements be used to lower colorectal cancer risk? 

Consuming enough fiber has been linked to a lower risk of certain types of cancer, particularly colorectal. You should aim for 20 to 35 grams per day. That’s a lot to get through food alone, so fiber supplements are often helpful.  

Soluble fiber is preferred, but pills or gummies are fine too. Taking it once a day also helps with regular bowel movements and reduces bloating. 

What other factors might be contributing to the rise in colorectal cancer? 

There’s a growing research interest in the connection between gut microbiome – and environmental factors like microplastics- and colorectal cancer, though the data is still catching up.  

Here at Columbia, we have a rigorous early-onset colorectal cancer research program exploring such connections, including the role of certain E. coli strains as a potential risk factor.