George Beauregard
Fifteen months ago, I wrote Healthcare Blog About the “rush” of early-onset cancer.
At the time, a three-decade rise in early-onset cancer rates among young people globally had drawn attention and was being monitored by researchers, scientists and other health care professionals. Articles on research findings on this topic appear sporadically in top medical journals, e.g. Nature, New England Journal of Medicine, and lancet.
From 2005 to 2011, some early warning articles appeared in comprehensive publications of mainstream media, such as wall street journal and this new york times. These stories are considered tragic “one-off events” or medical mysteries. Following the publication of a landmark study by the American Cancer Society (ACS) in 2017 (1), the narrative shifted from “anecdotal” to “epidemic.” The death in 2020 of actor Chadwick Boseman, 43, who was diagnosed with colorectal cancer, sparked mainstream media coverage of the situation. Chadwick died a month before my son Patrick, at the age of 32. In January 2024, Patrick was featured in an article in the Wall Street Journal.
Since then, other notable national publications such as time magazines and The Economistmajor media news organizations have featured reports on the evolving situation. Stories about it have even appeared in some popular supermarket tabloids.
Over the past year, articles have emerged regarding the potential causative role of a highly processed food diet, obesity, environmental factors, a sedentary lifestyle, and mutations in intestinal bacterial genotoxin residues (so-called colibactins).
Recently released ACS reports Cancer statistics, 2026A shocking “good news, bad news” dichotomy was presented and attracted widespread attention. The good news: Overall, the five-year survival rate for cancer patients has increased from 50% to 70% since the mid-1970s. An increase of 40%. This is certainly cause for celebration. (Mary Lasker would smile.)
But the dark reality remains.
Incidence and mortality from colorectal cancer continue to increase among young adults. For adults under 50 years of age, incidence rates climb nearly 3% per year (up from the 1% to 2% per year increase reported over the past decade). Even more worryingly, colorectal cancer is now the leading cancer killer in this age group.
To put it bluntly, this is a turbulent wave that the medical community can no longer ignore.
In a recently published JAMA Research Letter titled “People under 50 years of age experience the most cancer deaths,” graphs show a significant upward trend in CRC mortality from 1990 to 2023. On this mortality graph, the line for CRC is a distinct, rising red streak; the other four cancers shown are in regression.
That red line soon became the only line seen on the chart. Instead of applying any shallow depth of field technique.
This is not surprising, as it is known that younger 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), an important step toward Medicare determination of coverage for Multi-Cancer Early Detection (MCED) testing, which has the potential to detect more cancers earlier for better outcomes. This is a historic step as it is the most significant advance the bill has made in the legislative process. Now it needs to cross the finish line.
Even if enacted, these diagnostic tests face significant challenges in entering routine clinical practice. Many researchers believe that without data from large cohort clinical trials demonstrating their utility, these tools have not been adequately vetted and are not yet ready for use on the front lines of primary care. The debate between epidemiological rigors and early testing advocates will intensify.
While this caution is logical, it ignores a harsh reality: conducting gold-standard randomized controlled trials (RCTs) requires years that we don't have. Even when good results are achieved, physician skepticism often creates a bottleneck. Historically, it has taken an average of 17 years for clinical trial evidence to be widely adopted.
We cannot afford to wait five years, let alone nearly twenty years. These tests offer significant opportunities to engage “screen refusers” (i.e., those who consistently refuse colonoscopies or stool-based kits). To bridge this gap, we should position these novel tests as important complements to colonoscopies and encourage physicians to go beyond standard practice by conducting, for example, deeper lifestyle and environmental assessments. Research shows that a polygenic risk score (PRS) derived from common genetic variants in CRC and assessment of typical CRC signs can effectively identify average-risk individuals at risk for early-onset colorectal cancer (EOCRC). This approach will help prioritize those who are highly susceptible to EOCRC for personalized screening or other intervention strategies.
It is estimated that by 2026, 2,800 to 3,200 people under the age of 50 will die from colorectal cancer. While the statistical puzzle is complex, the human cost provides a sobering reality: These deaths are preventable.
I think it's fair to expect that the 2027 Cancer Statistics Report will show another rise in mortality among under-50s. (I hope I'm proven wrong.)
You’ve all heard the saying: “Insanity is doing the same thing over and over again and expecting different results.”
We cannot keep doing the same thing and expect different results.
Current blood-based early detection provides sensitive detection of CRC but is less sensitive for detecting advanced precursor lesions (APL) (polyps). This can lead people who don't test positive to mistakenly think they don't have the disease and therefore they don't need a colonoscopy, which can visualize and remove it. Also associated with sensitivity were anxiety and the number of sleepless nights worried about the possibility of false-positive results. The tests are also not specific enough, causing people who think they do not have the disease to forego colonoscopies. Over time, biosignal enhancement and algorithm optimization may improve the accuracy of these tests.
We have to stop letting perfect be the enemy of good. If a blood test encourages unwilling patients to get screened into the system, that's a win. If it prompts doctors to ask 35-year-olds about fatigue or changes in bowel habits rather than dismissing them because they're young and appear healthy, that's a win.
Validated blood- or breath-based MCED tests or other tests will be available in the near future.
The top priority is to prevent avoidable deaths and the lasting collateral damage they cause to families.
I look forward to the day when cancer statistics report a decrease in colorectal cancer death rates for people under 50 years of age.
Innovation is the way to achieve this goal.
George Beauregard, DO, is an internist and the author of Appointment Nine: A Physician Family Confronts Cancer. This comes from his substack
