CRC Becomes Leading Cause of Cancer-Related Death in Younger Adults, Highlighting Prevention Gaps

Colorectal cancer (CRC) became the leading cause of cancer-related deaths in 2023 among patients aged younger than 50 in the US, rising from the fifth-leading cause in the early 1990s, according to a research letter recently published in JAMA.¹

Cancer Mortality Exposes Gaps in Care for Adults Younger Than 50 Years

Several recent studies have reported increasing cancer incidence among younger adults. The researchers of the present study noted, however, that mortality trends better demonstrate progress against cancer and are less affected by detection bias.

Because of this, they conducted a study examining overall changes in US cancer mortality among individuals aged younger than 50 for the 5 leading causes of cancer-related deaths over the past 3 decades, which alternated among CRC, lung cancer, leukemia, breast cancer, and brain cancer; mortality trends were also stratified by sex.

The researchers obtained annual cancer death counts and age-standardized mortality rates per 100,000 males and females aged younger than 50 between 1990 and 2023 from SEER*Stat data reported by the National Center for Health Statistics. Mortality data were based on underlying causes of death recorded on death certificates filed across the US and classified according to International Classification of Diseases and Related Health Problems, Tenth Revision.

Trends in mortality rates were quantified using the Joinpoint Regression Program. The researchers defined trends as increasing or decreasing when the annual percent change (APC) or mean APC differed significantly from zero (P < .05), based on 2-sided tests.

CRC Rises to Top Cause of Cancer Deaths in Young Adults

From 1990 to 2023, 1,267,520 people in the US died from cancer before age 50, with females accounting for 53% of deaths. Over the study period, the age-standardized cancer mortality rate declined by 44%, decreasing from 25.5 to 14.2 per 100,000.

Regarding the 5 leading causes of cancer-related deaths, the mean annual decline from 2014 through 2023 was 0.3% (95% CI, –0.6% to –0.0%) for brain cancer, 1.4% (95% CI, –1.7% to –1.1%) for breast cancer, 2.3% (95% CI, –2.3% to –2.2%) for leukemia, and 5.7% (95% CI, –7.2% to –4.2%) for lung cancer.

In contrast, CRC mortality increased by 1.1% (95% CI, 0.9%-1.3%) annually beginning in 2005. As a result, CRC rose from the fifth-leading cause of cancer death from 1990 through 1994 to the leading cause in 2023.

“These findings are consistent with reports of increased CRC mortality among adults younger than 50 years overall and in most racial and ethnic groups and preempt projections that CRC would lead cancer deaths in those younger than 50 years by 2040,” the authors wrote.

By contrast, lung cancer declined from the leading to the fourth-leading cause over the study period, while leukemia fell from third to fifth. Meanwhile, breast cancer remained the second-leading cause overall and the leading cause among females. Similarly, despite a continuous decline in mortality, cervical cancer ranked third among females in both 1990 and 2023.

Additionally, although cancer mortality patterns among males largely mirrored overall trends, non-Hodgkin lymphoma ranked fourth in 1990 and pancreatic cancer ranked fifth in 2023.

Experts Call for Earlier Screening Amid Rising CRC Mortality

The researchers acknowledged that they limited their study by using national-level ecological data. However, they emphasized that the findings underscore the urgent need for improved CRC prevention and early detection in younger adults. Given that 3 in 4 patients aged younger than 50 are diagnosed with advanced CRC, the researchers noted that educating clinicians and the public about “red flag” symptoms could facilitate earlier screening, diagnosis, and treatment.^1,2

“…screening before 50 years of age has been associated with both early diagnosis and reduced incidence and mortality and is recommended to begin at age 45 years for people at average risk and earlier for people with a genetic or family history that increases risk,” the authors concluded.

References

1. Siegel RL, Wagle NS, Jemal A. Leading cancer deaths in people younger than 50 years. JAMA. Published online January 22, 2026. doi:10.1001/jama.2025.25467
2. Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233-254. doi:10.3322/caac.21772