The actor James Van Der Beek died on Wednesday at 48, less than two years after revealing he had been diagnosed with colorectal cancer, which has become more common among younger adults.
In the United States, the incidence of early-onset colorectal cancers diagnosed in people under 50 has increased by an average of 1 to 2 percent per year since the mid-1990s, according to the American Cancer Society. The steepest increases have occurred among the youngest age groups.
While deaths from cancer overall have declined significantly in recent decades, deaths from colorectal cancer have increased among adults under 50. The disease is now the leading cause of cancer-related death in adults in this age group, surpassing lung and breast cancer.
It’s not clear what’s driving this rise, but “we know that there is not one single cause,” said Dr. Aparna Parikh, a gastrointestinal oncologist who leads the Center for Young Adult Colorectal Cancer at Mass General Brigham Cancer Institute.
About 20 to 30 percent of early-onset colorectal cancers may be driven by inherited mutations, Dr. Parikh said, but environmental and lifestyle factors seem to be a more important driver for the rest.
For one, the change in colorectal cancer rates over time shows a pattern called a “birth cohort effect,” in which successive generations — in this case, starting with those born in the 1950s — show increased risk compared to the generation prior. This pattern suggests that lifestyle habits and exposures to things in the environment that have become more common in recent decades play a role. Scientists suspect those might include greater use of antibiotics; exposure to microplastics and so-called “forever chemicals”; less physical activity; or increased consumption of processed foods and sugar.
There is some evidence suggesting diets that are high in red and processed meats and sugar-sweetened beverages and low in fruits, vegetables and dietary fiber increase the risk of colorectal cancer. Such diets may disrupt the balance of “good” and “bad” bacteria in the gut and promote chronic inflammation. Alcohol and tobacco use are also well-established risk factors for colorectal cancer, as is obesity, which has specifically been linked to an increased risk of early-onset disease.
Some research also suggests that very early life exposures, for example E. coli infection in early childhood, may alter the genome and create a “fast-track” to cancer.
Notably, Dr. Parikh said, colorectal cancers in young people, compared with those in older people, are more likely to be found in the left side of the colon or in the rectum, which suggests there may be something different about how these cancers develop. They are also more likely to be diagnosed at an advanced stage.
Current guidelines recommend that people at average risk begin routine colonoscopies at age 45. People whose parent had a history of high-risk polyps or who have a family history of colorectal cancer should begin screening earlier, Dr. Parikh said. And anybody who has unusual symptoms should reach out to their primary care doctor, she added. These include changes to bowel habits, bleeding in the stool, unexplained weight loss or new anemia.
Mr. Van Der Beek had said he began experiencing bowel movement issues in 2023. When they didn’t resolve with changes to his diet, he said, he underwent a colonoscopy that revealed his cancer.
Nina Agrawal is a Times health reporter.
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