Screening Delays, Overlooked Symptoms Worsen CRC Outcomes in Younger Adults: Jordan Karlitz, MD

Rising from the fifth-leading cause of cancer-related death among US adults younger than 50 years in 1990, colorectal cancer (CRC) became the leading cause in 2023, according to a research letter published last month in JAMA.¹

While mortality rates for the 4 other leading causes of cancer-related death declined over time, CRC mortality increased by 1.1% (95% CI, 0.9%-1.3%) annually beginning in 2005. Shortly after these findings were published, Jordan Karlitz, MD, spoke with The American Journal of Managed Care^® to discuss what is driving this shift, the key risk factors and symptoms to recognize, and strategies to prevent or detect CRC early.

Karlitz is the senior medical officer of screening at Exact Sciences and holds a voluntary teaching position in the gastrointestinal division at the University of Colorado School of Medicine. He previously served as chief of the gastroenterology and hepatology division at Denver Health Medical Center.

In part 1 of the interview, Karlitz explained the factors contributing to rising CRC-related deaths among younger adults and what this population should know about their risk.

A primary contributor is delayed screening, he emphasized, as many individuals are not being screened at the recommended starting age of 45 years. Additionally, those with a family history of cancer are often unaware that they may need to begin screening even earlier. Karlitz underscored that delayed screenings lead to delayed diagnoses, with treatment then beginning at more advanced stages.

He also highlighted modifiable risk factors associated with increased CRC risk, including a Western-style diet and a sedentary lifestyle. In addition, key warning signs are rectal bleeding, abdominal pain, and changes in bowel habits. Karlitz explained, however, that these symptoms are often dismissed as something minor in younger people, further delaying appropriate evaluation.

“We need to be vigilant about risk factors,” he concluded. “We need to take symptoms seriously and get workups done quickly.”

Reference

McCormick B. CRC becomes leading cause of cancer-related death in younger adults, highlighting prevention gaps. AJMC^®. January 26, 2026. Accessed February 13, 2026. https://www.ajmc.com/view/crc-becomes-leading-cause-of-cancer-related-death-in-younger-adults-highlighting-prevention-gaps