Bryce Ramsey was 33 years old when she noticed blood in her stool. She blamed the hemorrhoids she'd developed after her son's birth eight years earlier. It took a personal pledge — "if this happens the next time I go to the bathroom, I'm going to make a call" — to get her to a gastrointestinal clinic. Her doctor told her she would not normally scope someone of Ramsey's age. But something made her do it anyway.
"And thank God she did," Ramsey recalled to KFF Health News and Nashville Public Radio reporters Cara Anthony and Blake Farmer, "because she found a 5-centimeter polyp."
Ramsey had stage 3 colon cancer. She had surgery. She endured chemotherapy. She survived. Now 40, she volunteers for the Colorectal Cancer Alliance — because her story is no longer rare, and far too many versions of it are ending without the "she survived" part.
The KFF Health News investigation published June 16, 2026 documents a shift in the American cancer landscape that most people under 50 do not know has occurred: colorectal cancer is now the leading cancer killer of Americans ages 18 to 49, and more than a dozen cancer types are rising in people under the age of 50 — a trend that defies the historical association between cancer and old age and is demanding a fundamental recalibration of who gets screened, when, and why.
What the Data Shows — Colorectal Cancer Is Now #1 Under 50
The KFF Health News investigation, published as part of the HealthQ series (a collaboration between Nashville Public Radio and KFF Health News), draws on research published in JAMA documenting the trend. In the U.S., more than a dozen kinds of cancer are rising in adults under 50. Among those:
- Colorectal cancer has increased the most and is now the deadliest cancer for Americans ages 18 to 49 — meaning it kills more people in this age group than breast cancer, lung cancer, leukemia, or any other malignancy
- Breast cancer is the second cancer with the largest increase in under-50 incidence
- A 2026 American Cancer Society analysis found that mortality from four of the five leading cancers among under-50s was declining, but colorectal cancer was the exception , with mortality rising
U.S. News & World Report's June 17 coverage of the investigation notes that the driving factor behind colorectal cancer's mortality leadership in under-50s is not just rising incidence — it is that the cancer is being caught later in its progression in younger patients, because under-50 adults are not routinely screened and do not bring symptoms to medical attention as quickly.
| Early-Onset Cancer Data — KFF Health News Investigation June 16, 2026 | Detail |
| KFF Health News original publication | June 16, 2026 |
| Authors | Cara Anthony and Blake Farmer, Nashville Public Radio / KFF Health News |
| #1 cancer killer for Americans ages 18–49 | Colorectal cancer |
| Number of cancer types rising in under-50 adults | 12+ |
| Greatest increases among early-onset cancers | Colorectal cancer; breast cancer |
| ACS 2026 finding | 4 of 5 leading under-50 cancers: mortality declining. Exception: colorectal, rising |
| JAMA study cited | Siegel RL et al. "Leading cancer deaths in people younger than 50 years." JAMA. 2026;335(7):632-634 |
| Single cause identified | None — researchers unable to find one cause |
| Primary actionable risk factor | Family history (strongest known risk factor for early-onset cancers) |
| Current routine screening age start | 45 (ACS revised recommendation) |
| High-risk family history recommendation | Earlier than 45 — discuss with provider |
| Celebrity death that highlighted issue | James Van Der Beek died at 48 of colorectal cancer (December 2025) |
The Most Important Risk Factor — And Why Most People Haven't Discussed It
Researchers have been unable to identify a single cause for the rise in early-onset cancers. Multiple suspected contributors exist: ultra-processed food consumption, obesity, sedentary behavior, changes in the gut microbiome, environmental exposures, and possibly unidentified factors. But no single driver has been confirmed as sufficient to explain the entire trend.
What the KFF Health News investigation emphasizes — and what experts quoted across the coverage consistently agree on — is that the single most actionable risk factor in the early-onset cancer context is family health history.
Family history is critical for early-onset cancer risk because many early-onset colorectal cancers, breast cancers, and other malignancies have strong genetic or hereditary components. First-degree relatives (parents, siblings, children) with colorectal cancer significantly elevate a person's risk. Lynch syndrome — the most common inherited colorectal cancer syndrome — accounts for approximately 3% of all colorectal cancers but a disproportionate share of young-onset cases. Familial adenomatous polyposis (FAP) is another inherited condition associated with very early colon polyp formation.
NPR health correspondent Yuki Noguchi, in February 2026 coverage of the James Van Der Beek colorectal cancer death, put it directly: "There can be strong genetic or hereditary drivers of cancers, especially early-onset cancers. So if you're at a higher risk because of family history, getting screened earlier than age 45 is probably a good idea."
The problem is that most adults have never formally gathered or communicated their family health history to their physician. Genetic risk is not automatically captured during routine care. If a patient doesn't volunteer that a parent had colon cancer at 45, a physician ordering a first colonoscopy at 45 for a "routine" patient won't know to have started at 35.
Who Should Get Screened Earlier — and What Screening Actually Involves
The American Cancer Society's current recommendation calls for average-risk adults to begin colorectal cancer screening at age 45. This was updated from 50 in 2021 specifically to address the rising early-onset trend. People at higher-than-average risk — those with a family history of colorectal cancer or polyps, a personal history of inflammatory bowel disease, or a known hereditary syndrome — should begin screening earlier than 45, with timing guided by their specific risk profile.
The colonoscopy is the gold-standard screening test: it directly visualizes the colon, allows polyp removal during the procedure, and if negative, typically does not need to be repeated for 10 years. For people who want a less invasive option, annual stool-based tests (high-sensitivity FOBT, FIT test, or multi-target stool DNA test like Cologuard) are also accepted alternatives, though positive results on any stool test require follow-up colonoscopy.
Beyond colorectal cancer, the early-onset cancer trend has implications for other screening conversations:
- Breast cancer : Women under 40 with a first-degree relative who had breast cancer before 50 should discuss earlier mammography and genetic counseling with their provider. BRCA1/BRCA2 testing may be appropriate.
- Thyroid cancer : Among the fastest-rising early-onset cancers, though often highly treatable when caught early.
- Gastric and pancreatic cancers : Genetic syndromes can dramatically elevate risk; family history is the primary flag.
How to Have the Family History Conversation — With Family and With Your Doctor
Gathering family health history requires talking to relatives — sometimes about uncomfortable topics — before that information is lost. The Surgeon General's My Family Health Portrait tool provides a structured way to collect and organize this information digitally and share it with healthcare providers.
When gathering history, the most important information to collect includes: which relatives had cancer (specify type), their age at diagnosis, whether they had genetic testing, and the health histories of first-degree relatives (parents, siblings, children) and second-degree relatives (grandparents, aunts, uncles). This information should then be shared proactively with your primary care provider, who may refer you to a genetic counselor if the history suggests hereditary risk.
For Bryce Ramsey, the stage 3 colon cancer survivor who now volunteers for the Colorectal Cancer Alliance, the message is simple. "I never thought about cancer," she told KFF Health News. Her story is why younger adults need to start thinking about it.
Frequently Asked Questions
Is colorectal cancer really the leading cancer killer of people under 50?
Yes. According to the JAMA study cited in the KFF Health News June 16, 2026 investigation, colorectal cancer is now the leading cancer cause of death for Americans ages 18 to 49 — overtaking breast cancer, lung cancer, and all other malignancies in this age group. More than a dozen cancers are rising in under-50s, with colorectal and breast cancer showing the largest increases.
What caused the rise in early-onset cancers?
Researchers have been unable to identify a single cause. Suspected contributing factors include changes in diet (ultra-processed food, reduced fiber), rising obesity rates, changes in gut microbiome composition, sedentary behavior, environmental exposures, and possibly unidentified factors. No single driver has been confirmed as sufficient to explain the trend.
Who should get screened for colorectal cancer before age 45?
Anyone with a family history of colorectal cancer or colon polyps (particularly in first-degree relatives under age 60), a personal history of inflammatory bowel disease (Crohn's or ulcerative colitis), or a known or suspected hereditary syndrome (Lynch syndrome, FAP) should discuss earlier screening with their doctor. The American Cancer Society recommends average-risk screening beginning at 45.
What screening options exist for colorectal cancer?
Colonoscopy is the gold standard — it visualizes the entire colon and allows polyp removal. Annual stool-based tests (FIT test, high-sensitivity FOBT, or multi-target stool DNA like Cologuard) are non-invasive alternatives. Positive stool tests require follow-up colonoscopy. All are covered without cost-sharing for covered adults under ACA preventive care provisions.
How do I gather my family health history?
Talk to first-degree relatives (parents, siblings, children) about their health histories, especially any cancer diagnoses and the age at diagnosis. The Surgeon General's My Family Health Portrait tool (familyhistory.hhs.gov) provides a structured digital format. Share this information proactively with your primary care provider at your next visit.
