The Changing Face of Bowel Cancer: Rethinking Screening for a Younger Generation

Posted on 2025-09-01

Bowel cancer, also referred to as colorectal cancer, is cancer of the colon or rectum. In 2023, the World Health Organization stated that Bowel Cancer is the third most common cancer globally; responsible for roughly 10% of all cancer cases (1). Despite these concerning figures, the frequency of cases and mortalities have declined since the 1970’s. However, when incidence rates are studied in more detail, there seems to be another concerning trend which has become apparent.    

Over the last few decades, there has been a gradual increase in incidents for those aged under 50. It is estimated that between 1990 and 2021, global incidence of bowel cancer in the under 50’s increased by around 50% (2). It is theorized that the modern, ‘western’ lifestyle may be partly to blame for this emerging trend, with alcohol consumption, diet and obesity all being considered risk factors (3). However, there is ultimately not a definitive cause for the trend that is being observed thus limiting the ability for preventative action.   

While the root cause of this emerging trend remains unclear, there is potential to adapt diagnostic approaches to reduce mortality and improve outcomes, particularly in individuals under the age of 50. Currently, the gold-standard diagnostic method for bowel cancer is colonoscopy; a semi-invasive procedure that can be both financially and operationally demanding. It is also an uncomfortable experience for patients, requiring adherence to a strict preparatory diet and temporary lifestyle modifications in the days leading up to the procedure (4). Therefore, regardless of patient age, these factors may contribute to delayed diagnosis. 

Additionally, when we look at the screening procedure that is in place, the consensus is that younger patients are considered less at risk due to their age and may not even be offered a colonoscopy despite presenting with tell-tale symptoms of bowel cancer. Some evidence has even suggested that early-onset bowel cancer patients in the United States have waited an average 6 months for a diagnosis from when symptoms first presented themselves (5). However, with the large number of resources required to carry out a colonoscopy, screening a wider age group is likely an unfeasible option.   

One potential approach to improve outcomes in early-onset bowel cancer is the identification of factors that place individuals at higher risk, thereby enabling more targeted screening. Easily identifiable indicators, such as a family history of bowel cancer, can help pinpoint those who may benefit from earlier or more frequent diagnostic testing (6). In addition, recent advances in genomics have led to the identification of specific genetic predispositions associated with increased risk (7). These developments could support the implementation of more focused screening programmes and allow healthcare resources to be allocated more efficiently to those at greatest risk. 

An alternative avenue for advancement lies in the development of less invasive diagnostic approaches and the identification of reliable biomarkers for early detection. The faecal immunochemical test (FIT) for haemoglobin currently represents the most widely implemented biomarker-based screening tool (8). However, it has notable limitations, such as it being more suitable as a ‘rule-in’ method due to potential false negatives (9). Additionally, these common non-invasive tests are generally more effective at detecting disease at more advanced stages, at which point therapeutic interventions are less effective (10). The discovery and validation of novel biomarkers across stool, blood, and alternative biological sample types may therefore be essential for enhancing diagnostic sensitivity and specificity. Such innovations hold the potential to improve clinical outcomes while offering more cost-effective and resource-efficient strategies for bowel cancer detection. Even more importantly, progress in this area may play a pivotal role in reducing mortality among younger patients. 

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References

1. World Health Organization. (2023). Colorectal Cancer. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/colorectal-cancer  

2. Meng, Y., Tan, Z., Zhen, J., Xiao, D., Cai, L., Dong, W., & Chen, C. (2025). Global, regional, and national burden of early-onset colorectal cancer from 1990 to 2021: a systematic analysis based on the global burden of disease study 2021. BMC medicine, 23(1), 34. https://doi.org/10.1186/s12916-025-03867-9  

3. Brenner, H., & Chen, C. (2018). The colorectal cancer epidemic: challenges and opportunities for primary, secondary and tertiary prevention. British journal of cancer, 119(7), 785–792. https://doi.org/10.1038/s41416-018-0264-x   

4. Zygulska, A. L., & Pierzchalski, P. (2022). Novel Diagnostic Biomarkers in Colorectal Cancer. International journal of molecular sciences, 23(2), 852. https://doi.org/10.3390/ijms23020852  

5. Burnett-Hartman, A. N., Lee, J. K., Demb, J., & Gupta, S. (2021). An Update on the Epidemiology, Molecular Characterization, Diagnosis, and Screening Strategies for Early-Onset Colorectal Cancer. Gastroenterology, 160(4), 1041–1049. https://doi.org/10.1053/j.gastro.2020.12.068  

6. Connell, L. C., Mota, J. M., Braghiroli, M. I., & Hoff, P. M. (2017). The Rising Incidence of Younger Patients With Colorectal Cancer: Questions About Screening, Biology, and Treatment. Current treatment options in oncology, 18(4), 23. https://doi.org/10.1007/s11864-017-0463-3  

7. Matsuda, T., Fujimoto, A., & Igarashi, Y. (2025). Colorectal Cancer: Epidemiology, Risk Factors, and Public Health Strategies. Digestion, 106(2), 91–99. https://doi.org/10.1159/000543921 

8. Krishnamoorthy, A., & Arasaradnam, R. (2023). Colorectal cancer diagnostic biomarkers: Beyond faecal haemoglobin. Best practice & research. Clinical gastroenterology, 66, 101870. https://doi.org/10.1016/j.bpg.2023.101870  

9. Fraser C. G. (2018). Faecal immunochemical tests (FIT) in the assessment of patients presenting with lower bowel symptoms: Concepts and challenges. The surgeon: journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 16(5), 302–308. https://doi.org/10.1016/j.surge.2018.01.004 

10. Bagheri, R., Ghorbian, M., & Ghorbian, S. (2024). Tumor circulating biomarkers in colorectal cancer. Cancer treatment and research communications, 38, 100787. https://doi.org/10.1016/j.ctarc.2023.100787