The recent death of actor James Van Der Beek has renewed attention on a troubling health trend: colorectal cancer is rising among younger adults.
Colorectal cancer — cancer that develops in the large intestine, including the colon and rectum — was once considered primarily a disease affecting people over 50. But doctors say that’s no longer the case.
“Colorectal cancer is becoming an increasingly common cancer in patients under 50, which is a new trend we’ve seen over the last 10 to 15 years,” said Dr. Bryan Kleinman, a board-certified gastroenterologist and internist at Crystal Run Healthcare. “And so it’s very important because of this increase that we make people aware of it as well as provide more information about screening recommendations.”
Van Der Beek, best known as the titular character on “Dawson’s Creek,” died at 48, according to a Feb. 11 statement from his family posted on Instagram. Van Der Beek shared in 2024 that he was receiving treatment for colorectal cancer.
A significant shift in who’s at risk
The rise in diagnoses among younger adults has been steady — and concerning.
“This trend is pretty significant,” Kleinman said. “About four to five years ago now we saw the national screening recommendations change where the recommendations used to be to start routine colonoscopies at age 50.”
Those guidelines were lowered to 45. But even that may not fully address what doctors are seeing. “And even since that time we’ve seen patients in their early 40s that are developing advanced polyps and colorectal cancer,” he said. “And so there’s been about 2.9% increase per year over the last like 10 years or so that we’ve seen in people under 50.”
Researchers are still working to understand why. Kleinman points to several possible contributors: diets lower in fiber and fruits and vegetables, higher consumption of processed and ultra-processed foods, obesity, alcohol use and tobacco. Scientists are also studying whether changes in the gut microbiome — the bacteria that live in the digestive tract — may play a role.
Why colonoscopy remains the “gold standard”
As awareness grows, so does the need for screening. Colonoscopy remains the most reliable test. During the procedure, “a thin flexible camera with a light on the end is passed through the anus and around the entire colon, which is about 5 feet long,” Kleinman explained. Doctors can view the entire colon and identify polyps — growths that can sometimes become cancerous.
“During the colonoscopy, we have the opportunity to identify and also remove those polyps so that they don’t become bigger and potentially more serious in the future,” he said.
The procedure is typically done under sedation. “Patients that undergo a colonoscopy do not experience pain or discomfort during the procedure,” Kleinman said. “It’s a very short-acting sedative. So the recovery time is minimal.” Most patients leave within an hour and return to normal activity the next day.
Addressing fear and hesitation
Despite its effectiveness, screening rates remain below national targets. “I think the most common fear I have is that people are nervous about the prep,” Kleinman said. The preparation involves avoiding solid foods for 24 hours and drinking a laxative solution the night before.
“A lot of patients will come in for the procedure and they’ll tell me I was so nervous about the prep. It really wasn’t so bad,” he said. “Those are small things to do in terms of what we could potentially prevent by actually getting the colonoscopy done. It’s one day or a day and a half out of your life, and hopefully, are able to prolong that life by detecting polyps.”
Family history and earlier screening
For people with a family history of colorectal cancer, screening often needs to begin sooner. “The typical recommendation is to start at age 40 or 10 years younger than when their relative was diagnosed with colon cancer,” Kleinman said.
Certain inherited conditions require even earlier and more intensive monitoring. For younger adults without symptoms but with concerns, Kleinman urges proactive conversations with primary care providers. “It’s important to certainly not ignore any symptoms,” he said. “But also just to discuss things like family history … and just their overall concerns, if they do want to better understand what their risks are and maybe what they can do to lower the risk.”
Prevention beyond screening
Screening saves lives — but lifestyle also matters.
“We know that obesity and lack of exercise as well as poor dietary choices definitely are not great in general for gut health and certainly it can increase … the risk,” Kleinman said.
He encourages diets high in fiber, fruits and vegetables, less processed meat, regular exercise and limiting alcohol and tobacco use.
Looking ahead, Kleinman hopes advances in research could lead to even earlier detection. “Everybody would love to see a blood test to detect any type of cancer,” he said. “Those things are potentially on the horizon in the future to help with early detection and increased screening.”
Image: James Van Der Beek arrives at the 71st Primetime Emmy Awards in Los Angeles on Sept. 22, 2019. (Photo by Richard Shotwell/Invision/AP, File)