Colorectal Cancer Becomes Leading Cause of Cancer Death Under 50 in the US: The Italian Perspective

A shift in cancer mortality among younger adults

In the United States, colorectal cancer became in 2023 the leading cause of cancer-related death among people under 50, overtaking lung, breast, brain cancers and leukemias. The finding marks a significant change in the epidemiology of cancer mortality in younger populations, where overall cancer death rates have otherwise continued to decline.

Findings from national mortality data

The analysis is based on mortality data from the National Center for Health Statistics and was published in JAMA by researchers led by Rebecca L. Siegel of the American Cancer Society. Between 1990 and 2023, a total of 1,267,520 deaths from cancer occurred before age 50 in the United States. Over the same period, the age-standardized cancer mortality rate declined by 44%, from 25.5 to 14.2 per 100,000.

Colorectal cancer moving against the trend

While mortality continued to decrease between 2014 and 2023 for brain tumors (–0.3% annually), breast cancer (–1.4%), leukemias (–2.3%) and lung cancer (–5.7%), colorectal cancer followed an opposite trajectory. Since 2005, mortality from colorectal cancer among people under 50 has increased by an average of 1.1% per year, rising from fifth to first place among causes of cancer death in this age group by 2023.

Late diagnosis as a key factor

According to the authors, approximately three quarters of colorectal cancers in younger patients are diagnosed at an advanced stage, limiting therapeutic options and survival outcomes. The study highlights the need for further etiological research to identify the drivers of early-onset disease and stresses the importance of earlier recognition of symptoms.

Screening coverage in the United States

In the US, colorectal cancer screening is currently recommended starting at age 45 for individuals at average risk. Despite this recommendation, screening uptake remains limited, with coverage in the 45–49 age group reaching 33.7% in 2023. The authors note that the use of national ecological data represents a limitation of the analysis.

The epidemiological picture in Italy

In Italy, colorectal cancer remains one of the most frequently diagnosed malignancies. It ranks as the third most common cancer in men and the second in women. According to Cancer Numbers in Italy 2025, an estimated 48,706 new diagnoses occurred in 2024, including 27,473 cases in men and 21,233 in women.

Survival and prevalence in the Italian population

Five-year survival following diagnosis is estimated at 65% in men and 66% in women. Approximately 442,600 people are currently living in Italy after a diagnosis of colorectal cancer, reflecting both disease burden and improvements in treatment outcomes over time.

Risk factors and disease development

Colorectal cancer often develops from benign lesions of the intestinal mucosa that may take years to progress to malignancy. Established risk factors include high consumption of red and processed meat, refined carbohydrates and sugars, overweight, physical inactivity, smoking and excessive alcohol intake. Additional risk conditions include inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, as well as hereditary syndromes including familial adenomatous polyposis and Lynch syndrome.

Screening strategies in Italy

The Italian National Health Service offers population-based screening programs with active invitation of eligible individuals. The primary test is the fecal occult blood test, performed every two years in people aged 50–69, with extension up to age 74 in some regions. A positive result is followed by colonoscopy, which also allows removal of precancerous polyps during the same procedure and subsequent risk-adapted surveillance.