Colorectal cancer rates are rising across nearly all age groups in the United States, according to a study published in NEJM Evidence on October 27, 2026, with increases observed in individuals up to 65 to 69 years old. The study analyzed data from the National Cancer Institute over a 20-year period, revealing that incidence rates fell from 55.2 per 100,000 in 2000 to 36.7 in 2022 but rose to 38.3 in 2023, marking the first increase in the overall rate since national tracking began in 2000. The sharpest annual rise—12.76%—occurred among those aged 45 to 49 from 2019 to 2023, likely driven by expanded screening guidelines lowering the recommended starting age from 50 to 45. However, the study’s authors noted that screening alone cannot explain the broader trends, citing unknown risk factors that may be offsetting screening gains.
According to the American Cancer Society’s 2026 Colorectal Cancer Statistics, rectal cancer now accounts for nearly one-third of all colorectal cancer diagnoses, with incidence rates among those under 50 rising by approximately 83% since 1998. The study’s lead author, Caitlin Murphy of the University of Chicago, emphasized that while increased screening has led to earlier cancer detection, the overall rise in incidence across multiple age groups suggests underlying factors beyond screening. Rates are also climbing among older adults, including those aged 65 to 69, who have historically benefited from regular screenings.
Screening Explains Part of the Rise, Not All
The study’s lead author, Caitlin Murphy of the University of Chicago, emphasized that while increased screening has led to earlier cancer detection, the overall rise in incidence across multiple age groups suggests underlying factors beyond screening. Rates are also climbing among older adults, including those aged 65 to 69, who have historically benefited from regular screenings.
Unanswered Questions About Causes
The study’s authors acknowledged that the exact causes of the rising rates remain unclear, with a potential “birth cohort effect” influencing individuals born in the 1960s and later. The study also noted that public health is at risk because colorectal cancer is now the leading cause of cancer-related deaths among people under 50 in the U.S.
Screening Drives Rise in Cases Among Younger Adults
The study’s data showed that screening likely accounts for the steep rise in cases among 45- to 49-year-olds, but not the increases in older adults. Symptoms such as rectal bleeding, blood in the stool, or unexplained weight loss should prompt immediate medical evaluation, regardless of age.
Specialized Expertise in Rectal Cancer Treatment
Dr. Avo Artinyan, a surgical oncologist, emphasized that rectal cancer treatment involves vastly different strategies and surgical challenges compared to colon cancer, with the desire for cure and preservation of function often competing goals.
Expert Perspectives on Rising Rates
Dr. Avo Artinyan noted that rectal cancer incidence has increased significantly in younger adults, with the distinction between colon and rectal cancers critical for treatment approaches. He highlighted that up to 25% of patients with early-stage rectal cancer historically received colostomies, a figure he considers excessive. “Rectal cancer treatment is not a one-size-fits-all proposition,” he said, stressing the need for personalized care that balances oncologic and functional outcomes. The study’s authors also pointed to the importance of specialized expertise, as rectal cancer demands highly individualized treatment based on tumor location, stage, and other patient factors.
