Lead: The death of actor James Van Der Beek at 48 has reignited concern about colorectal cancer in younger adults. Medical specialists say colorectal cancer incidence has risen among people in their 20s, 30s and 40s even as overall cancer mortality under 50 has fallen since 1990. Federal and major medical groups currently recommend routine screening beginning at age 45 for average-risk adults, but experts warn access, awareness and resource limits affect uptake. Clinicians urge that people with personal or family risk factors be evaluated earlier and that persistent gastrointestinal symptoms prompt immediate diagnostic testing.
Key Takeaways
- James Van Der Beek died at age 48; his diagnosis began with symptoms at 46 and was reported as Stage 3 colon cancer.
- Overall cancer death rates in people younger than 50 have declined 44% since 1990, yet colorectal cancer has become the leading cancer cause of death in that age group after decades of increase.
- The U.S. Preventive Services Task Force lowered the routine screening age from 50 to 45 in 2021; the American Cancer Society recommended 45 since 2018.
- Risk estimates: ages 40–44 ≈ 21 per 100,000; ages 45–49 ≈ 47 per 100,000, showing a more than twofold rise in that five-year span.
- Screening uptake is low: about 20% of people aged 44–49 are up to date with colorectal screening, per the American Cancer Society.
- Noninvasive tests vary in detection: Cologuard ~92% sensitivity for cancer and ~42% for precancerous polyps; Shield blood test ~83% for cancer and ~13% for polyps; FIT tests show 84–97% for cancer and 12–15% for polyps.
- Colonoscopy remains the gold standard; out-of-pocket costs without insurance can range roughly $1,250 to more than $4,000.
Background
Colorectal cancer arises in the colon or rectum and typically develops from adenomas or polyps that can take years to transform into invasive disease. Historically, incidence and mortality were concentrated in older adults, which guided screening ages of 50 and above for decades. Over the past 30–40 years, clinicians and researchers observed a steady rise in cases diagnosed in adults under 50, prompting debate about earlier screening thresholds and resource allocation.
Screening policy balances population-level benefits against harms, costs and system capacity. Task forces and societies review evidence on how many cancers and advanced lesions would be prevented, versus risks of procedures and the practical limits of endoscopy services. In 2018 the American Cancer Society recommended starting at 45, and in 2021 the U.S. Preventive Services Task Force adopted the same cutoff for average-risk adults amid evolving data.
Main Event
The public attention around screening resurfaced after reports that James Van Der Beek first noticed bowel changes in summer 2023 at age 46 and subsequently received a Stage 3 colon cancer diagnosis. His case is emblematic of a pattern clinicians have observed: younger patients presenting with symptoms that many attribute at first to benign causes such as diet or stress. When symptoms prompt a colonoscopy, diagnoses sometimes reveal advanced disease that earlier screening might have detected sooner.
Medical leaders, including colorectal specialists at major cancer centers, say they expect the trend of rising early-onset colorectal cancer to persist without preventive action. They highlight that the jump in risk between ages 40–44 and 45–49 (from about 21 to 47 per 100,000) helped drive the guideline change to age 45. Yet, not all clinicians or systems fully embraced earlier screening initially, and some still express caution about universal adoption.
Practical barriers affect implementation. There are limited numbers of gastroenterologists and endoscopy resources in many regions, so expanding screening to younger cohorts would increase demand for colonoscopies and could lengthen wait times. Insurance coverage commonly follows guideline age thresholds, so access and cost barriers remain for younger adults without elevated risk.
Analysis & Implications
The rising incidence among younger adults suggests environmental, behavioral and biological drivers that are not yet fully understood. Population-level changes since the 1980s—greater prevalence of obesity, sedentary lifestyles, diets higher in ultraprocessed foods and shifts in the gut microbiome—are plausible contributors supported by observational studies. Early antibiotic exposure and specific microbial changes have also been proposed but remain under investigation.
From a policy perspective, lowering the screening age reduces individual risk for those who participate but requires trade-offs. Expanding eligibility increases total procedures and costs, and health systems must weigh marginal benefits against the capacity to deliver timely, high-quality colonoscopies. Screening strategies that combine noninvasive tests (FIT, stool DNA, emerging blood assays) with colonoscopy triage can broaden reach but perform unevenly for precancerous lesions.
Economically, insurance coverage decisions hinge on guideline alignment; most insurers cover screening beginning at 45 for average-risk adults because of USPSTF and major society recommendations. However, out-of-pocket costs remain an issue for people seeking colonoscopy before covered ages or for diagnostic rather than screening indications. Public-health messaging must therefore combine guidance on screening age with clear red-flag symptom education to accelerate diagnosis when cancer is suspected.
Comparison & Data
| Test | Sensitivity for Cancer | Sensitivity for Precancerous Polyps |
|---|---|---|
| Colonoscopy | Highest (visual + biopsy) | High (detects and removes polyps) |
| Cologuard (stool DNA) | ~92% | ~42% |
| Shield (blood test) | ~83% | ~13% |
| FIT (stool test) | 84–97% | 12–15% |
Colonoscopy remains the benchmark because it combines visualization, biopsy and polypectomy in one procedure. Noninvasive tests can increase screening participation but have lower ability to find and remove precancerous polyps, which is crucial for long-term cancer prevention.
Reactions & Quotes
“We anticipate that this is going to be a continued trend.”
Van Karlyle Morris, MD Anderson (colorectal cancer section chief)
Morris emphasized expectations of continued early-onset increases and the strain that growth places on diagnostic services.
“There was a lot of pushback from the medical community; they thought it was too young.”
Rebecca Siegel, American Cancer Society (senior scientific director)
Siegel reflected on the debate when the American Cancer Society first recommended age 45, noting the complexity of guideline development and the tension between population benefits and practical constraints.
“Although colorectal cancer rates are rising among younger people, the overall incidents are still low.”
Dr. Andrew Chan, Mass General Brigham (gastroenterologist)
Chan urged perspective: rising rates do not translate to large absolute numbers in every age bracket, but vigilance and symptom awareness remain essential.
Unconfirmed
- The precise causes for the rise in early-onset colorectal cancer are not definitively proven; links to diet, microbiome, obesity and antibiotics remain hypotheses under study.
- Whether lowering the universal screening age below 45 would produce net public-health benefit across all populations is debated and not settled.
- Estimates of how quickly endoscopy capacity would be strained under broader screening eligibility vary by region and are model-dependent.
Bottom Line
Routine screening for average-risk adults beginning at age 45 is endorsed by major U.S. advisory groups because risk rises substantially in the mid-40s. Yet uptake among newly eligible younger adults is low, and resource constraints and insurance rules affect who receives timely colonoscopy. Individuals with personal or family histories of colorectal cancer, polyps, or unexplained anemia or persistent gastrointestinal symptoms should seek earlier evaluation and diagnostic testing regardless of age.
Public-health responses should combine expanded access to screening with targeted outreach, symptom education, and research into the underlying causes of early-onset disease. For clinicians and patients, the immediate priorities are awareness of red-flag symptoms, discussion of individual risk factors with a provider, and use of appropriate screening methods within existing guideline structures.
Sources
- NBC News — media report summarizing case and expert comments
- American Cancer Society — official guidance and surveillance (professional organization)
- U.S. Preventive Services Task Force (USPSTF) — federal screening recommendations (official)
- MD Anderson Cancer Center — colorectal cancer specialty center (academic medical center)
- Mayo Clinic — clinical information on colorectal cancer incidence (medical center)
- GoodRx — price survey data for colonoscopy costs (consumer pricing site)
- U.S. Food & Drug Administration (FDA) — approvals for stool and blood screening tests (regulatory)
- Mass General Brigham — expert commentary on screening and risks (academic medical system)
- People Magazine — interview reporting on James Van Der Beek’s symptoms and diagnosis (media)