2026 ACS Report Shows CRC Rising in Younger Adults Despite Overall Decline

Although overall colorectal cancer (CRC) incidence and mortality have declined in the US, rates are rising among individuals younger than 65, according to findings published yesterday in CA: A Cancer Journal for Clinicians to help kick off National CRC Awareness Month.¹

Every 3 years, the American Cancer Society (ACS) releases an updated CRC report. The latest edition, “Colorectal Cancer Statistics, 2026,” provides a comprehensive overview of US CRC data and estimates of new cases and deaths expected in 2026. It details incidence, survival, and mortality trends by age, race, and ethnicity, based on data through 2022 for incidence and 2023 for mortality. The report also includes CRC screening prevalence among eligible individuals nationwide.

Population-based data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program and the National Program of Cancer Registries were used to determine CRC occurrence whereas the CRC mortality data came from the National Center for Health Statistics.

Incidence and Screening Trends

The researchers estimate that 158,850 new CRC cases will be diagnosed in the US in 2026, with 55,230 related deaths. Overall CRC incidence has declined 45% from its peak between 1985 and 2022, largely due to increased screening and improvements in modifiable risk factors. However, the pace of decline has slowed from 1.3% annually between 2011 and 2017 to 0.6% annually between 2017 and 2022.

Despite these declines, CRC incidence is rising in adults younger than 65, increasing by 3% per year among patients aged 20 to 49 years and 0.4% per year among those aged 50 to 64 years. Consequently, 45% of new CRC cases now occur in this younger population, up from 27% in 1995.

This increase is primarily driven by cancers in the distal colon and rectum, with rectal cancer accounting for 32% of all cases. Notably, 3 in 4 CRCs in adults younger than 50 are diagnosed at an advanced stage. These trends reflect a birth-cohort effect, with higher CRC risk among generations born after 1950 and increasing incidence as these cohorts age. As a result, the patient population is shifting younger, with 50% of all CRC diagnoses younger than 50 years occurring in those aged 45 to 49 years, who are eligible for screening.

Screening via colonoscopy reduces incidence by about 40% and mortality by about 60%, with guidelines supporting screening beginning at age 45 years for average-risk adults. Stool-based tests and emerging blood-based tests also offer convenient screening options, especially for younger or marginalized groups; a timely colonoscopy after positive stool tests is essential but often delayed.

Despite its efficacy, screening uptake varies, with lower rates among recent immigrants, uninsured patients, and less-educated individuals. Therefore, state screening rates range from about 59% to 78%.

Rising Mortality in Younger Adults

Overall, CRC survival has improved, with 5-year relative survival rising from 50% in the mid-1970s to 65% from 2015 to 2021. The largest gains occurred in patients with distant-stage rectal cancer, where 5-year survival increased from 8% in the mid-1990s to 18%. As of 2025, there are more than 1.4 million CRC survivors in the US.

These improvements are linked to earlier detection through screening and routine exams, more accurate staging with advanced imaging, and better treatment methods. Stage at diagnosis remains the strongest predictor of survival, ranging from 91% for localized disease to 15% for distant disease.

Reflecting these gains, overall CRC mortality in the US has declined 56% over the past 5 decades, dropping from 29.1 per 100,000 in 1970 to 12.7 per 100,000 in 2023. Recent declines, however, have slowed; mortality decreased about 2% per year from 2005 to 2020 but remained stable from 2020 to 2023.

Although mortality continues to decline among adults aged 65 and older, it is rising among younger adults. Individuals younger than 50 years have experienced a 1% annual increase since 2004, and those aged 50 to 64 years have seen a 1.2% annual increase from 2019 to 2023. These patterns mirror the birth-cohort effect observed for CRC incidence, reflecting higher disease risk in generations born after 1950.

Rebecca L. Siegel, MPH, senior scientific director of surveillance research at ACS and lead author of the report, underscored the importance of clinicians understanding that the CRC landscape is changing rapidly in an interview with The American Journal of Managed Care^® (AJMC^®).

“Twenty years ago, it was people in their 70s being treated,” she said. “Now, it's people much younger… so really understanding that you are treating a different patient with unique needs, giving more information about treatment options and side effects of those treatments, like sexual dysfunction and infertility…it’s important for clinicians to understand this pain and make changes in their practice that address these younger patients.”

Geographic and Racial Disparities

CRC incidence and mortality vary widely worldwide, reflecting lifestyle, environmental, and structural influences. In the US, incidence ranges from 45 per 100,000 in Mississippi and Kentucky to 28 per 100,000 in Utah. CRC occurrence is highest in Appalachia, the South, and parts of the Midwest, and lowest in the Northeast and Western regions. Similarly, mortality ranges from 18 per 100,000 in Mississippi to 10 per 100,000 in Massachusetts and Connecticut.

CRC also varies widely across racial and ethnic groups in the US. American Indian/Alaska Native (AIAN) individuals have the highest incidence and mortality, followed by Black patients. Black-White incidence disparities have narrowed from 22% to 11% between 2013 and 2022, whereas AIAN-White disparities have widened from 39% to 48%.

Alaska Native individuals, in particular, have the highest CRC incidence and mortality globally, with rates more than double for incidence and nearly 2.5 times for mortality compared with White patients. Causes remain unclear but may include higher prevalence of risk factors, poor access to healthy foods, and limited endoscopic services.

“It isn't known why the rates are so high in Alaska Native people…and, unfortunately, there hasn't been funding available to support those research efforts, largely because it's a very small population,” Siegel told AJMC. “…that's why we need more research dollars to understand what's causing this, because the burden in this population is extraordinary. It's unlike any other disparities that we see, so it's likely low-hanging fruit for discovery.”

Raising Awareness About CRC

The publication of these statistics coincides with the beginning of National CRC Awareness Month. Recognized each March, it serves as a time to educate the public and encourage screening, especially now that CRC is the leading cause of cancer-related deaths in the US among patients younger than 50 years.²

AJMC recently spoke with Jordan Karlitz, MD, about key CRC risk factors and symptoms, as well as strategies for prevention and early detection.³ Karlitz is the senior medical officer of screening at Exact Sciences and holds a voluntary teaching position at the University of Colorado School of Medicine. He previously served as chief of the gastroenterology and hepatology division at Denver Health Medical Center.

Karlitz explained that the increase in CRC-related deaths in patients younger than 50 years is partly due to delayed or missed screening. Although CRC screening is recommended beginning at age 45 years for adults at average risk, individuals may need to start earlier depending on their family cancer history.

Beyond family cancer history, Karlitz highlighted several CRC risk factors putting individuals of all ages at higher CRC risk, including a Western diet high in processed foods, red meat, cold cuts, and sugar-sweetened beverages. Additional risk factors include higher body mass index, a sedentary lifestyle, smoking, and alcohol consumption. Importantly, he emphasized that many of these are modifiable risk factors that individuals can address to help lower their CRC risk.

“If people are aware of these risk factors, they may be able to make an impact, decrease those risk factors, and hopefully decrease the risk of developing polyps and CRC,” Karlitz said.

He also highlighted the issue of delayed diagnosis. Although CRC may be asymptomatic, symptoms can include rectal bleeding, abdominal pain, and a change in bowel habits. Karlitz noted that providers and patients, especially younger individuals, may not initially recognize the significance of these symptoms, which can delay diagnosis and lead to treatment at more advanced stages.

“You really need to act on symptoms,” he told AJMC. “You want to tell your provider about them, advocate for yourself as a patient, and try to get the workup you need to figure out what your symptoms are. You really do not want to delay diagnosis.”

He concluded by outlining 3 pillars for CRC prevention and early detection: getting screened on time, knowing your family cancer history, and acting promptly on symptoms.⁴ Karlitz underscored that education and public health messaging are critical to addressing gaps in any of these areas.

“These are the 3 pillars that everybody needs to be aware of, whether you’re a community member, a health care provider, or working in another role, because I think gaps in any of them could increase the risk of developing CRC and, unfortunately, lead to presenting with more advanced-stage disease,” he said.

References

1. Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;e70067. doi:10.3322/caac.70067
2. McCormick B. CRC becomes leading cause of cancer-related death in younger adults, highlighting prevention gaps. AJMC. January 26, 2026. Accessed March 3, 2026. https://www.ajmc.com/view/crc-becomes-leading-cause-of-cancer-related-death-in-younger-adults-highlighting-prevention-gaps
3. McCormick B, Karlitz J. Advanced-stage CRC increasing in younger adults, with disparities among Black, Hispanic populations: Jordan Karlitz, MD. AJMC. February 24, 2026. Accessed March 3, 2026. https://www.ajmc.com/view/advanced-stage-crc-increasing-in-younger-adults-with-disparities-among-black-hispanic-populations-jordan-karlitz-md
4. McCormick B, Karlitz J. 3 pillars of CRC prevention can curb rising mortality: Jordan Karlitz, MD. AJMC. February 26, 2026. Accessed March 3, 2026. https://www.ajmc.com/view/3-pillars-of-crc-prevention-can-curb-rising-mortality-jordan-karlitz-md