Colorectal Cancer Incidence Is Rising in Both Younger and Older Adult Groups

Colorectal cancer incidence is rising in both younger and older adult age groups, according to a study published in NEJM Evidence. Caitlin Murphy and colleagues used National Cancer Institute data to track incidence over a 20-year period. UChicago Medicine summarized the findings on 28 October 2026.

The national rate fell for two decades before reversing. The age-adjusted incidence rate, which corrects for shifts in the age structure of the population, dropped from 55.2 per 100,000 in 2000 to 36.7 in 2022, then rose to 38.3 in 2023. The increase is not confined to one cohort. Incidence is rising in every age group up to 65 to 69.

The steepest change sits in the 45 to 49 band, where incidence grew 12.76% annually from 2019 to 2023. Colorectal cancer now ranks first among cancers in adults younger than 50, and it is the second leading cause of cancer-related deaths overall in the U.S., according to the same report.

Screening policy has moved in parallel. U.S. recommendations lowered the age to begin colorectal cancer screening from 50 to 45. Screening volumes had largely recovered to pre-pandemic levels by January 2021, and adults aged 65 to 69 and 70 to 74 are about 80% up to date with screening. The authors reported that the increase persisted even when 2020 and 2021 data were excluded, which removes the most obvious pandemic-related distortion from the trend line.

American Cancer Society statistics for 2013 to 2022 show incidence among adults aged 20 to 49 rising 3% annually. Earlier UChicago Medicine reporting put the increase in people younger than 50 at 51% since 1994. A peer-reviewed article titled "Colorectal cancer statistics, 2026," by R.L. Siegel and colleagues, covers the same period. A Yale Cancer Center summary noted that the share of diagnoses in people under 55 rose from 11% in 1995 to 20% in 2019. In adults aged 50 to 64, incidence has increased by 0.4% annually, a far gentler slope than the one seen in the 40s.

Several JAMA Network publications narrow the picture further. One analysis found that after a stable 15-year trend, local-stage colorectal cancer incidence (tumors still confined to the organ where they began) rose steeply among adults aged 45 to 49 between 2019 and 2022. A SEER 18 analysis, using one-year age increments, found incidence jumped 46.1% between age 49 and age 50. A separate JAMA Network Open study found that epidemiological classification changes affected incidence only for patients aged 15 to 39.

The broader context here is a question of measurement as much as biology. Screening itself moves incidence counts, because an earlier colonoscopy detects lesions and cancers that might otherwise have surfaced years later, or never. The sharp step at age 50 coincides with the screening threshold that many readers will know well, and that coincidence makes it harder to separate a true rise in disease from a rise in detection. The local-stage findings for 45 to 49 are the more interesting thread for that reason, since they describe tumors caught before spread, which is the outcome screening is meant to produce.

In my view, the classification result deserves more attention than its brevity suggests. Ruling out coding changes as the driver for patients over 40 narrows the remaining explanations and makes the trend look less like a registry artifact.

Screening eligibility now starts five years earlier than it did. Single-year age data give programs a finer instrument for judging whether that change alters the stage at diagnosis in the cohorts it reaches. The same granularity lets researchers ask whether rising rates in younger adults reflect risk, detection, or both.

In my view, those answers will not come from one registry cut, but the measurement tools needed to pursue them are now in place.