Colorectal Cancer Becomes Leading Cause of Cancer Death in US Adults Younger Than 50 Years, Study Finds

Colorectal cancer is now the leading cause of cancer-related death among people younger than 50 years in the US, driven by steadily rising mortality over the past 2 decades, according to a new research letter published in JAMA. In contrast, mortality from other leading cancers in this age group has declined over the same period.¹

The analysis examined national mortality trends from 1990 through 2023 for the 5 leading causes of cancer death in individuals younger than 50 years, using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program and the National Center for Health Statistics. Mortality trends were assessed using the Joinpoint Regression Program ), “which uses permutation analysis to fit a series of straight lines on a logarithmic scale to observed rates to estimate annual percent change (APC),” first author Rebecca L. Siegel, MPH, of the American Cancer Society, and colleagues wrote.¹

Overall mortality trends

Between 1990 and 2023, a total of 1 267 520 people younger than 50 years died from cancer in the US. Over this period, the age-standardized cancer death rate declined by 44%, from 25.5 to 14.2 deaths per 100 000 population, reflecting substantial progress in cancer treatment and prevention overall, according to the results.¹

From 2014 through 2023, mortality continued to decline for most major cancer types in this age group, including breast cancer, lung cancer, leukemia, and brain cancer. Mean annual declines during this period ranged from 0.3% for brain cancer to 5.7% for lung cancer.¹

Diverging pattern for colorectal cancer

In contrast, colorectal cancer mortality increased by an average of 1.1% per year from 2005 through 2023. This rise advanced colorectal cancer from the fifth-leading cause of cancer death among people younger than 50 years in the early 1990s to the leading cause by 2023, surpassing breast and lung cancer.¹

The increase was observed in both men and women. Among men, colorectal cancer mortality increased by 1.3% annually from 2004 through 2023, while it increased by 0.8% annually among women over the same period. Breast cancer remained the second-leading cause of cancer death overall and the leading cause among women, despite continued declines in mortality.¹

Shifts in cancer rankings

During the study period, lung cancer and leukemia dropped in rank among leading causes of cancer death in younger adults, reflecting sustained reductions in mortality. Cervical cancer mortality also declined steadily, although it remained among the top causes of cancer death in females. Pancreatic cancer emerged as a top-five cause of cancer death among males by 2023.¹

Clinical implications

The authors noted that increasing colorectal cancer mortality in younger adults is consistent with prior reports of rising incidence and disproportionately advanced-stage diagnoses in this population. Approximately 3 in 4 patients younger than 50 years are diagnosed with advanced colorectal cancer, underscoring challenges in early detection.^1,2

The findings highlight the importance of clinician awareness of early-onset colorectal cancer, including attention to red-flag symptoms such as hematochezia and abdominal pain. Current guidelines recommend average-risk colorectal cancer screening beginning at age 45 years, with earlier screening for individuals with a family history or other risk factors.¹

Although limited by the use of national-level ecological data, the study identifies an urgent need for continued etiologic research, improved symptom recognition, and effective screening strategies to address rising colorectal cancer mortality among younger adults.¹

References:

1. Siegel RL, Wagle NS, Jemal A. Leading cancer deaths in people younger than 50 years. JAMA. Published online January 22, 2026. doi:10.1001/jama.2025.25467
2. Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73(3):233-254. doi:10.3322/caac.21772