Early-Onset Colorectal Cancer Is a Call to Action: Cathy Eng, MD, FACP, FASCO

Young patients should not be presumed free of colorectal cancer because they appear healthy or lack a family history, according to Cathy Eng, MD, FACP, FASCO, David H. Johnson Endowed Chair in Surgical and Medical Oncology and professor of medicine (hematology and oncology) at Vanderbilt. In an interview at the Patient-Centered Oncology Care® (PCOC) 2026 conference hosted by The American Journal of Managed Care^® in Nashville, Tennessee, September 24-25, 2026, Eng discussed the rising burden of early-onset colorectal cancer and the barriers to earlier diagnosis.

Why Early Onset Colorectal Cancer Demands Attention

Eng called it "eye-opening and alarming" that young patients are facing this malignancy. She noted that the average age of a patient with colorectal cancer in the United States is 66 years, but early-onset disease is a global issue. Although the recommended screening age has already been lowered to 45, projections had placed colorectal cancer as the leading cause of cancer death in patients younger than 50 in 2030. Literature published in 2026 covers data from 2023, which Eng said makes the trend even more alarming.

She said this should prompt clinicians to act on what young patients report. "We have to pay attention to the signs and symptoms that young patients may be having, and we shouldn't presume that they look too healthy," Eng said. "They don't have a family history, and as a result, there's no way that they could have colorectal cancer. Because in fact, many of these patients look extremely healthy."

Barriers to Earlier Screening

Eng noted that she does not sit on the gastroenterology societies that approve changes to screening parameters. She explained that any further lowering of the screening age would need to show statistical significance and cost-effectiveness. Patients younger than 50 years remain a smaller proportion of the overall patient population, which complicates that case.

However, she said this framing overlooks a key point about how these patients present.

"The majority of patients are presenting with stage four disease, and that's because many of them are too young to be screened, and/or they've been ignoring their symptoms, or they've been misdiagnosed," Eng said. "Many of these young patients have gone to multiple providers before they're diagnosed."