Early Onset Colorectal Cancer: Incidence, Detection, and Disparities

Authors

Aerielle B. Sibert, University of LynchburgFollow

Specialty

Gastroenterology

Advisor

Dr. Kilgore

Abstract

ABSTRACT

This review investigates the rising incidence of early-onset colorectal cancer (EOCRC) in individuals under 45—a demographic historically excluded from standard screening protocols. While colorectal cancer (CRC) rates have declined overall due to widespread screening among older adults, individuals under 45 now account for over 11% of colon and 18% of rectal cancers diagnosed annually. This concerning trend highlights an urgent need to re-evaluate current screening approaches and public health strategies.

A narrative review of PubMed-indexed literature (2014–2025) was conducted, focusing on EOCRC risk factors, diagnostic delays, and evolving detection strategies. Evidence reveals that younger adults frequently experience delayed diagnoses due to provider bias, under-recognition of symptoms, and systemic barriers such as limited access to care. These challenges often lead to advanced-stage detection and poorer clinical outcomes. Despite recent updates lowering the screening age to 45, many at-risk individuals remain unscreened, particularly those with atypical presentations or limited healthcare access.

Emerging non-invasive modalities—such as circulating tumor DNA (ctDNA) blood tests, stool DNA assays, and gut microbiome profiling—offer promising avenues for earlier detection. These technologies could support personalized, risk-based screening strategies, potentially improving outcomes in younger populations. Current guidelines, however, may not adequately reflect the increasing burden of EOCRC and the need for targeted early detection strategies.

This review underscores the need to modify existing screening recommendations to better serve younger adults at risk for CRC. Expanding access to innovative diagnostic tools and lowering screening thresholds could reduce morbidity and mortality in this population. Furthermore, the paper identifies gaps in current research, particularly the reliance on retrospective data, and emphasizes the importance of future prospective studies focused on real-world implementation, cost-effectiveness, and equitable policy reform.

Recommended Citation

Sibert AB. Early Onset Colorectal Cancer: Incidence, Detection, and Disparities. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2025; 7(3).