The overall cancer death rate continues to decline, down more than a third between 1991 and 2023. However, a pattern has emerged: a gradual uptick in cancer patients who are younger than the historical norm.
From 2010 through 2019, 14 specific cancer types increased among Americans under 50, according to the National Cancer Institute (NCI). This includes malignancies traditionally associated with older adults, such as colorectal and breast cancer. However, some experts argue these trends partly stem from overdiagnosis and increased diagnostic scrutiny—such as more widespread screening and advanced imaging—rather than a true rise in incidence, prompting physicians across specialties to rethink their approach to risk assessment and patient complaints.
On Sermo, physicians are highlighting the importance of prevention in light of the uptick in cancer cases in under-50-year-olds. “I believe that all patients over 30 years old should maintain a routine of preventative care,” notes a general practitioner. ”I always tell my patients not to be afraid to ask questions, and if at any time, or during a self-exam, they detect something they don’t like, I recommend they make an appointment to be evaluated as soon as possible,” a family medicine doctor adds.
Several factors could be contributing to the increased cancer rates among this demographic. Read on to explore the latest data, screening implications and how early-onset cancer detection could help address the trend.
Which cancer types are increasing in adults under 50?
While the rates of some cancers among Americans under 50 have increased, the rates of other cancers among this group have decreased. An NCI-funded May 2025 study found that 14 cancer types increased in at least one age group under 50 (spanning ages 15 to 29, 30 to 39, and 40 to 49) from 2010 to 2019:
- Melanoma
- Cervical cancer
- Stomach cancer
- Plasma cell neoplasms
- Cancers of the bones and joints
- Colorectal cancer
- Pancreatic cancer
- Female breast cancer
- Uterine cancer
- Testicular cancer
- Kidney cancer
- Precurser B-cell non-Hodgkin lymphoma
- Diffuse large B-cell lymphoma (DLBCL)
- Mycosis Fungoides/Sézary Syndrome (MF/SS)
It’s worth noting that nine of these cancers also showed increases in older age groups. Furthermore, 19 cancer types decreased among people under 50, and the total rate of all cancers combined did not increase overall according to the 2025 study. Still, the specific cancers rising in younger adults present a significant clinical challenge.
Early-onset colorectal cancer is particularly concerning. Incidence has increased by 1.6% annually since 2004 among 20- to 39-year-olds in the U.S., a study conducted by the American Cancer Society (ACS) found. For those aged 40 to 44 and 50 to 54, the rate has climbed by 2.0 to 2.6% per year since 2012, according to the study. Researchers estimate that 10% of new colorectal cancer cases worldwide will occur in patients under 50 throughout the next decade. This has ultimately shifted daily practice for gastroenterologists. Since the ACS and US Preventive Services Task Force (USPSTF) lowered recommended screening age for colorectal cancer to 45 (in 2018 and 2021, respectively), screening among those ages 45 to 49 years increased nearly 10-fold.
Breast cancer is following a similar trajectory. It had a 1.4% annual increase in American women younger than 50 from 2012 to 2021, compared to a 0.7% increase in women over 50, according to ACS statistics. Globally, an estimated two-thirds of all cancers diagnosed under 50 are in women. OB/GYNs are encountering direct impacts to screening recommendations. In 2024, USPSTF updated its guidelines to recommend all women get screened every other year starting at age 40, whereas it previously recommended individual screening guidance for women in their 40s based on personal risk.
Anecdotally, physicians on Sermo report noticing rates of certain cancers in patients under 50. In a poll asking members which cancer types they see most frequently in the group, colorectal (28%), breast (26%) and pancreatic (9%) were the most common answers. “I have noticed an increase in cancer in young patients, for example in gastric cancer, which unfortunately does not have early detection protocols, so it is diagnosed when the disease is advanced, leading to a bad outcome,” reveals one general practitioner.
What is driving the rise in early-onset cancer rates?
Physicians and patients alike are wondering what’s responsible for the increase in early-onset instances of certain cancers. Currently, no single cause has been definitively established, but the May 2025 study notes that changes in screening guidelines may have something to do with it. “I’ve noticed a slight increase in cancer diagnoses among younger patients, which makes me question whether this is due to improved diagnostic tools or a true rise in incidence,” one general practitioner writes on Sermo. “When advising patients, I base screening recommendations on age, family history, and individual risk factors.”
A complex interplay of lifestyle factors, environmental exposures and genetics may also be at play. When asked what they believe is the most significant contributor to this rise, Sermo members most commonly pointed to lifestyle factors like diet and exercise (36%), environmental exposures (32%) and genetic predisposition (18%).
Lifestyle factors (e.g., diet, physical activity)
Most of the cancer types increasing among younger adults are associated with excess adipose fat, suggesting their rising rates may be due at least in part, to increased rates of obesity, according to the authors of one study. Likewise, “more than a few studies” indicate that obesity and heavy alcohol consumption are likely key contributors to the rising early-onset rates of some cancers, according to NCI.
“The rise in early-onset cancers is primarily driven by shifting environmental exposures and lifestyle changes since the 1990s, notably increased obesity rates, poor diet (high ultra-processed food), sedentary behavior, and alcohol consumption,” writes one general practitioner on Sermo. “These factors promote inflammation, hormonal changes, and gut microbiome alterations that accelerate carcinogenesis.”
Environmental exposures
NCI also notes that researchers are actively investigating potential effects of environmental exposures. Generational exposures to substances like endocrine disruptors and microplastics, may play a role. People in minorities are disproportionately exposed to environmental toxins, which may play a part in higher cancer incidence in these groups in general, the ACS notes in its 2026 cancer statistics report.
Genetic predisposition
While lifestyle and environment are critical, genetics also play a role. Researchers found that in a minority (about 18%) of early-onset cancer cases, patients had high-penetrance germline mutations, such as BRCA1/2 and Lynch syndrome genes, the American Association for Cancer Research (AACR) reports. This means that around 80% of early-onset cancer patients do not carry a germline mutation.
Early cancer detection and screening barriers in younger patients
As mentioned, in 2021, the USPSTF officially lowered the colorectal cancer screening age to 45, aligning with the ACS’s 2018 guidelines.
The change yielded clear results. Among 45- to 49-year-olds, colonoscopy screening increased by 43%, and stool-based testing increased more than five-fold from 2019 to 2023, according to the ACS. Shortly thereafter, local-stage colorectal cancer diagnoses in this age group jumped 50% from 2021 to 2022, according to the ACS. The five-year survival for early-stage colorectal cancer exceeds 90%, so first-time screenings could improve outcomes.
When Sermo polled physicians on how effective they think lowering the colorectal cancer screening age has been, 54% said “somewhat effective” and 22% said “very effective.”
However, barriers to screening remain. When Sermo polled members on the biggest barriers to early cancer detection in younger patients, 21% of physicians pointed to limited access to screenings.
Clinical strategies for frontline physicians
Here’s how you can adjust your practice in response to rising early-onset cancer rates:
Maintain a high index of suspicion
Research suggests younger patients are more likely to be diagnosed at advanced stages because symptoms are often attributed to benign conditions. Some physicians might reflexively attribute vague complaints like persistent bloating or changes in bowel habits to IBS or stress simply because a patient is young, rather than considering cancer as part of their differential diagnosis. “Unfortunately, many of us many times take the watchful waiting approach too often,” a pediatrician on Sermo states.
Develop risk-stratified screening strategies
No routine screening exists for many early-onset cancers like pancreatic or gastric cancer, but you can rely on detailed family histories. For breast cancer, consider earlier baseline imaging for women under 40 with significant family history or genetic predispositions. “Early screening Is the best advice for early diagnosis and best treatment,” writes an ophthalmologist on Sermo.
Address insurance and access gaps
Uninsured or underinsured younger adults often delay seeking care. Actively facilitate access by connecting patients to community health resources or federally qualified health centers. Document medical necessity clearly in specialist referrals to support insurance approval.
Stay informed on evolving trends
Discuss trends in early-onset cancer with your specialty peers, update your risk assessment tools and educate patients about their individual risks. “Over the past few years, I have indeed noticed more young adults being diagnosed with cancer… which makes me even more proactive about prevention,” notes a general practitioner on Sermo. Another general practitioner member feels similarly: “I counsel patients on cancer prevention by focusing on modifiable risk factors like avoiding tobacco, limiting alcohol, maintaining a healthy weight, exercising regularly, and staying up to date on recommended vaccinations and screenings.”
Where early-onset cancer research is heading
Rising cancer rates in young adults have brought up new research priorities. Polled Sermo members highlighted identifying root causes (24%), improving early detection methods (28%) and developing targeted treatments for younger patients (20%) as the most pressing research focuses.
These are the areas the medical field is focusing on, along with relevant prevention strategies:
Microbiome research
Gastroenterologist Robin Mendelsohn, M.D., co-director of Memorial Sloan Kettering Cancer Center’s Center for Young Onset Colorectal and Gastrointestinal Cancer, presented preliminary research on the microbiome of people with early-onset colorectal cancer in 2025. The studies found that early-onset patients with colorectal cancer have less microbiome diversity than those with later-onset colorectal cancer. However, another study in 2021 found that young-onset colorectal cancer was associated with more microbiome diversity.
While causal relationships are still being studied, you can counsel younger patients on fiber-rich diets and the harms of prolonged antibiotic use.
Generational exposures
As mentioned, researchers are investigating whether generational exposures to substances like endocrine disruptors and microplastics, may play a role in early-onset cancer rates. When seeing patients, you can broaden exposure history inquiries to include childhood proximity to industrial areas and ultra-processed food consumption to justify targeted lifestyle modification counseling.
Risk-stratified screening
With rising early-onset colorectal cancer rates, screening recommendation starting age could one day be adjusted lower than 45. You can develop simple risk-assessment tools capturing family history and genetics and discuss screening options for high-risk patients under 45.
Emerging biomarkers
Researchers are looking into biomarkers for early detection, which is especially important in cancers that lack population-level screening (such as pancreatic, gastric, kidney, etc.). You can consider referring high-risk patients to academic centers exploring emerging biomarkers for cancers lacking population screening.
Addressing disparities
Black and Indigenous Americans face the highest cancer mortality rates, according to the ACS. Future research could uncover how early-onset trends may compound these disparities. For now, you can audit screening rates by demographics.
Age-appropriate trial design
With rising rates of certain early-onset cancers comes a focus on expanding research to include younger patients. “We cannot continue to extrapolate data from older populations to 30-year-old patients whose pharmacokinetics and toxicity profiles… are fundamentally different,” writes a medical oncologist on Sermo.
Meet the clinical challenge of early-onset cancer
The rise in certain early-onset cancers requires heightened clinical awareness. While the causes aren’t completely clear, you can play a role in early detection by maintaining a high index of suspicion.
It’s easier to stay informed on evolving clinical guidelines when you have a trusted medical resource behind you. A free Sermo membership can grant you access to a community of more than 1 million physicians across 150 countries. Share clinical observations on early-onset cancer trends, solve challenging patient cases and stay informed on the research developments that matter most to your practice.
