‘One explains the other’: ACS studies show related, promising trends in early-onset CRC (2025)

Key takeaways:

• Early-stage CRC diagnoses in adults 45-49 doubled from 2019-2022, linked to a 62% rise in screening.
• Experts say the trend supports starting CRC screening at age 45.

Two recent studies led by the American Cancer Society, or ACS, and published in JAMA indicate promising trends in earlier detection of colorectal cancer, or CRC, in adults aged 45 to 49 years.

One of the studies showed disruption of a 15-year trend of stable diagnoses of local-stage CRC in the younger adult population between 2019 and 2022 in the United States. The study showed a doubling in diagnoses of local-stage CRC, including a 50% relative increase observed between 2021 and 2022.

In keeping with these findings, a second ACS-led study reported an increase by 62% in CRC screening among adults aged 45 to 49 years between 2019 and 2023.

Early-onset CRC is an area of ongoing concern in the U.S., with CRC projected to become the leading cause of cancer deaths among individuals aged 20 to 49 years before 2030.

According to researcher Rebecca Siegel, MPH, a cancer epidemiologist, and senior scientific director of surveillance research at the ACS, this increase in local-stage CRC detection is very encouraging “after 15 years of flat rates.”

“I have been doing this research on early-onset CRC since the late 2000s, and I have never had good news to talk about, so this is thrilling for me,” Siegel told Healio. “This supports the recommendations by the ACS and the U.S. Preventive Services Task Force to begin CRC screening at age 45 years. When we first recommended this change, there was a lot of criticism, but this is clear evidence that screening is beneficial, specifically in people under age 50.”

‘So meaningful’

In the first study, researchers reviewed data from the National Cancer Institute’s Surveillance, Epidemiology and End Results program to identify CRC cases diagnosed between 2004 and 2022 among adults aged 20 to 54 years in 21 geographic areas of the U.S. They sorted cancers by age, location of cancer and stage at diagnosis. They adjusted incidence rates for delays in case reporting and age-standardized these rates to the 2000 U.S. standard population.

The study found a steady increase in CRC incidence, with a 1.6% annual increase reported since 2004 among adults aged 20 to 39 years. Similarly, the study showed a 2% to 2.6% annual increase since 2012 among adults aged 40 to 44 and 50 to 54 years.

Notably, in individuals aged 45 to 49 years, the 1.1% annual increase (95% CI, 0.3-1.6%) observed between 2004 and 2019 jumped to 12% annually (95% CI, 6.5%-14.6%) between 2019 and 2022.

The pronounced increase was attributable to increased detection of local-stage tumors (annual percentage change, 21.8%; 95% CI, 13.8%-26.2%), which increased from 9.4 per 100,000 in 2019 to 11.7 per 100,000 in 2021 (a 25% relative increase) and to 17.5 per 100,000 in 2022 (a 50% increase in relation to 2021). These increases were seen after stable rates from the period between 2004 and 2019.

Increased rates of local-stage diagnoses were similar during 2019-2022 for colon cancer (annual percentage change, 18.8%; 95% CI, 6.9%-25.3%) after a period of stable rates, and for rectal cancer (annual percentage change, 25.1%; 95% CI, 17.8%-29.3%) after a declining trend.

“This is so meaningful, because previously rates were stable for localized stage disease, and the reason is that localized disease is usually asymptomatic,” Siegel said. “That’s why it’s so exciting for me to talk about, because it means that now, one in three people who are age 45 to 49 are being diagnosed with early-stage disease, which has a 5-year survival rate of 94%.”

An ongoing effort

Siegel discussed the interrelatedness of this study’s findings and those of the second ACS-led study published in JAMA, which assessed the increased uptake of CRC screening in patients aged 45 to 49 years between 2019 and 2023.

“Previously, most of these folks were being diagnosed with regional and distant-stage disease, and what explains this increase is, of course, the drop in the recommended age to begin screening for CRC,” she said. “And that’s what we showed in the second study, a 62% increase in screening in this age group. So, ...one explains the other.”

In this study, researchers evaluated data on more than 50,000 people from the National Health Interview Survey and compared changes in CRC screening from 2019 to 2023 in people aged 40 to 44, 45 to 49, 50 to 54, 55 to 64 and 65 to 75 years. They adjusted the data for age, race/ethnicity, education and region.

This study found that among individuals in the 45-to-49-year age group, up-to-date screening prevalence increased from 20.8% in 2019 and 19.7% in 2021 to 33.7% (2023 vs. 2019 adjusted prevalence ratio, 1.62; 95% CI, 1.44-1.83). The prevalence of colonoscopy increased from 19.5% in 2019 and 17.8% in 2021 to 27.7% in 2023 (adjusted prevalence ratio, 1.43; 95% CI, 1.26-1.62). The prevalence of stool-based testing increased from 1.3% in 2019 and 2.7% in 2021 to 7.1% in 2023 (adjusted prevalence ratio, 5.37; 95% CI, 3.36-8.57).

Increases in CRC screening among individuals aged 45 to 59 were limited to individuals with higher education and insurance (college graduates, 24%-39.4% [adjusted prevalence ratio, 1.66; 95% CI, 1.41-1.96]; privately insured individuals, 21.6%-36.6% [adjusted prevalence ratio, 1.70; 95% CI, 1.49-1.95]).

Siegel emphasized that although these improvements are “phenomenal” and clearly making an impact, there is still substantial work left to be done in improving awareness around CRC screening.

“Right now, 37% of people aged 45 to 49 years are being screened, and that’s great, but we want to increase that number,” she said. “And for individuals who are under the screening age, under age 45 years, we want to increase awareness of symptoms, so those people can also be diagnosed earlier, because those rates are driven by advanced-stage diagnosis.”

Siegel noted that there is currently a great deal of research interest in understanding the drivers of increased CRC risk, not only in individuals currently younger than age 50 years, but in those born after the 1950s.

She encouraged increased awareness and reduced stigma around CRC symptoms, especially in young people, and urged clinicians to speak with their patients about consumption of a healthy diet, smoking cessation and regular exercise.

“CRC has the strongest relationship of any cancer in terms of reduction in risk with physical activity,” she said. “These are small changes we all have the power to make every day to reduce our CRC risk.”

References:

• American Cancer Society. Two new ACS studies report surge in colorectal cancer screening and early diagnosis in U.S. adults 45-49. Available at: https://pressroom.cancer.org/early-diagnosis-surge-for-CRC. Published Aug. 4, 2025. Accessed Aug. 13, 2025.
• Star J, et al. JAMA. 2025; doi:10.1001/jama.2025.10618.

For more information:

Rebecca Siegel, MPHcan be reached at rebecca.siegel@cancer.org.