Colon Cancer Is Rising Fastest in People Under 50
Danielle was 46, a nurse, and she had been experiencing intermittent rectal bleeding for approximately eight months.
She had mentioned it once. She was told it was almost certainly hemorrhoids—which was statistically the most likely explanation. Danielle accepted that because she had developed hemorrhoids after her second pregnancy.
She was also having bouts of cramping and changes in her bowel habits, which she attributed to a stressful period at work. The previous year, laboratory testing had shown that she was slightly anemic, and she had been told to take iron.
Danielle finally pushed for a colonoscopy after her sister-in-law was diagnosed with colon cancer at 51.
The colonoscopy found stage II colon cancer.
Danielle is doing well after surgery. But she was 46, and current guidelines recommend that average-risk adults begin colorectal cancer screening at 45. Her symptoms also warranted diagnostic evaluation rather than routine screening.
The Screening Guideline Changed—and Many People Missed It
For decades, routine colorectal cancer screening began at age 50.
The American Cancer Society lowered the recommended starting age to 45 in 2018. The U.S. Preventive Services Task Force followed in 2021 for adults at average risk.
The reason is straightforward: colorectal cancer diagnoses have been rising among adults younger than 50 for years. The causes are still being investigated.
If you are between 45 and 50 and nobody has discussed colorectal cancer screening with you, you may be part of the screening gap.
That gap includes an enormous number of women.
Why Diagnosis May Be Delayed in Women
Several factors can overlap.
Symptoms Get Attributed to Other Causes
Rectal bleeding may be attributed to hemorrhoids, which women commonly develop during and after pregnancy.
Abdominal cramping and changes in bowel habits may be attributed to irritable bowel syndrome, which is diagnosed more frequently in women.
Fatigue and anemia may be attributed to menstrual blood loss.
Every one of these explanations may be correct. That is exactly what can make them dangerous: the most likely explanation sometimes ends the evaluation before another condition is ruled out.
Right-Sided Tumors Can Be Less Obvious
Women are more likely than men to develop tumors on the right side of the colon.
These tumors may be less likely to cause visible rectal bleeding. Instead, they can present with:
Iron-deficiency anemia
Fatigue
Vague abdominal discomfort
Changes that are easy to overlook or attribute to another cause
That is why the connection to iron matters.
Unexplained iron deficiency in a woman without heavy periods—and in any woman after menopause—requires proper evaluation.
Preventive Care Often Focuses Elsewhere
Women’s preventive care is heavily oriented toward breast and cervical cancer screening.
Both are important. Neither replaces colorectal cancer screening.
You Do Not Have to Start With a Colonoscopy
For average-risk adults without symptoms, there are several ways to screen for colorectal cancer.
Only one requires bowel preparation and sedation.
FIT: Fecal Immunochemical Test
Completed annually
You collect a small stool sample at home and mail it to a laboratory. The test detects human hemoglobin, which may indicate bleeding from the lower gastrointestinal tract.
No bowel preparation
No dietary restrictions
No sedation
No time away from work for a procedure
Stool DNA Testing
Typically completed every three years
This test looks for both blood and DNA markers shed by abnormal cells. It is somewhat more sensitive for detecting cancer than FIT, but it may also produce more false-positive results.
Colonoscopy
Typically completed every 10 years for adults at average risk
Colonoscopy is the most comprehensive screening option. It is also the only test that allows a clinician to identify and remove polyps during the same procedure.
If you are willing to complete a colonoscopy, do it.
But in practice, the best screening test is the one you will actually complete.
An annual at-home test completed consistently is better than a colonoscopy that remains on your to-do list for six years.
What a Positive Stool Test Means
A positive FIT or stool DNA result is not a cancer diagnosis. Most positive results do not mean that cancer is present.
However, a positive result does mean that a colonoscopy is needed—and it should be scheduled reasonably promptly.
A follow-up colonoscopy may find:
An advanced adenoma, which is a precancerous polyp worth removing
Colorectal cancer
Hemorrhoids or another benign source of bleeding
No significant abnormality
The mistake to avoid is repeating the stool test.
A second negative test does not cancel the first positive result. It only delays the appropriate follow-up.
Symptoms That Skip the Screening Schedule
Screening is intended for people who do not have symptoms.
The following require medical evaluation regardless of age:
Rectal bleeding
A persistent change in bowel habits lasting more than a few weeks
Unexplained iron-deficiency anemia
Unintended weight loss
Persistent abdominal pain
A persistent feeling that the bowel does not empty completely
If you have symptoms, an at-home stool test may not be the appropriate next step. Speak with a healthcare professional about diagnostic evaluation, which may include a colonoscopy.
If you were given an explanation for ongoing symptoms but the cause has not been confirmed, that explanation remains a hypothesis.
What Bastion Clinicians Tell Every Woman Over 45
Colorectal cancer is one of the few cancers for which screening does more than find the disease early.
Screening can prevent it.
Removing a precancerous polyp removes the tissue that could have developed into cancer years later.
Routine screening should generally begin at 45 for adults at average risk. It may need to begin earlier for people with:
A first-degree relative with colorectal cancer or advanced polyps
Inflammatory bowel disease
A known hereditary colorectal cancer syndrome
A personal history of colorectal polyps
The appropriate starting age and testing schedule depend on the individual risk factor and should be determined with a healthcare professional.
If you have symptoms, do not accept the most likely explanation without appropriate follow-up.
Danielle’s hemorrhoids were real. She also had cancer.
Both things were true—and the first one hid the second for eight months.
Take the First Step
For average-risk adults without symptoms, Bastion’s at-home colon cancer screening kit ships directly to you and requires no bowel preparation or time away from work.
Your results are reviewed by a licensed provider who can promptly arrange a colonoscopy referral if the test comes back positive.
Order Your At-Home Screening Kit
Experiencing symptoms or unsure which next step is appropriate? Talk to a Bastion Care Coordinator.
