CHICAGO — Colorectal cancer is now the leading cause of cancer deaths in people younger than 50. While routine screening is recommended beginning at age 45 for those at average risk, certain symptoms at any age warrant a conversation with a health care provider.
To encourage earlier conversations about colorectal cancer, the American College of Surgeons (ACS) has released free, publicly available educational materials and a checklist that help people identify potential warning signs and prepare for primary care visits.
“A lot of times when younger patients seek care for bowel symptoms, those symptoms are too often attributed to hemorrhoids or constipation and treated conservatively,” said Marylise Boutros, MD, FACS, FRCSC, FASCRS, a member of the ACS Patient Education Committee, and a colorectal surgeon and vice-chair of Digestive Diseases Research at the Cleveland Clinic Florida, who helped develop the new ACS educational materials. “As more young people are diagnosed with colorectal cancer, awareness of the subtle signs and symptoms of the disease can save lives. The ACS educational materials and checklist were created to help patients clearly raise concerns and keep conversations about colorectal cancer focused.”
Colorectal cancer remains more common in older adults — affecting approximately 1 in 25 men and women over the course of their lifetime. However, rates in younger people continue to rise. About 1 in 5 cases of colorectal cancer are now diagnosed in people younger than 54, compared with 11% (about 1 in 10) three decades ago, according to the American Cancer Society.
Colorectal Cancer Symptoms Not to Ignore
Early symptoms of colorectal cancer may be subtle but should not be ignored or left unevaluated. The ACS checklist highlights the following:
Persistent Bowel Changes
Ongoing constipation or diarrhea, narrow stools, or a noticeable change in bowel habits may signal a problem. Feeling that the bowel does not empty completely or experiencing rectal discomfort can occur if a tumor is causing obstruction or inflammation.
“In younger patients, these symptoms can sometimes be due to noncancerous conditions,” said Paula Denoya, MD, FACS, FASCRS, Commission on Cancer (CoC) State Chair of the Eastern Long Island–New York chapter, and a colorectal surgeon at Stony Brook University Hospital in New York. “However, any bowel change that is new or different for you deserves medical attention. An annual wellness visit is a good time to raise these concerns.”
Blood in Stool
Blood in the stool — especially if it occurs repeatedly — is a significant warning sign of colorectal cancer. Research presented at the ACS Clinical Congress 2025 found that among patients under 50 who underwent a colonoscopy due to symptoms, rectal bleeding was the strongest predictor of a colorectal cancer diagnosis, increasing odds by 8.5 times.
“Bleeding is the most common symptom of colorectal cancer but can also be caused by other diseases,” said James T. McCormick, DO, FACS, FASCRS, CoC State Chair of the Southwestern Pennsylvania chapter, professor of surgery at Drexel College of Medicine, and chair of the Colorectal Cancer Program at Allegheny Health Network in Pittsburgh, Pennsylvania. “People may notice bright red blood on the toilet paper or in the bowl, or it may cause a red or dark color when mixed in with the stool. Any amount of recurring blood should be evaluated, and colonoscopy may be indicated to determine the underlying cause.”
Changes in Stool Appearance
Bright red or dark, tarry stools, or the presence of mucus, may indicate bleeding in the gastrointestinal tract, colon, or rectum.
General Health Changes
Unexplained weight loss, fatigue, weakness, loss of appetite, nausea, or vomiting may signal underlying gastrointestinal conditions and merit medical evaluation.
Family History and Screening
The U.S. Preventive Services Task Force recommends that people at average risk of colorectal cancer begin screening at age 45. Those with a family history of colorectal cancer or conditions such as Crohn’s disease or ulcerative colitis may need earlier screening. Several screening options are available, but colonoscopy remains the gold standard because it can both detect cancer and remove precancerous polyps.
“Colorectal cancer is highly treatable when found early, and surgical advances continue to make treatment less invasive,” Dr. Boutros said. “I encourage patients to be proactive and use the checklist to start a conversation with their primary care provider about any concerning bowel changes.”
Access the ACS educational checklist and additional information about finding quality surgical care on the ACS website.
Journalists may contact pressinquiry@facs.org to connect with colorectal cancer experts.
