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Kimmie Ng, M.D., a Boston oncologist, started noticing an alarming trend in her work a few years ago. Men in their 20s, 30s, and 40s—runners, CrossFitters, lifelong nonsmokers—were streaming through her door at the Dana-Farber Cancer Institute. They all appeared lively and strong—yet there they were, battling colorectal cancers, a family of diseases that can start in the colon or rectum and are typically associated with older people and those with risk factors like family history and obesity.
Most troubling of all, many of them were coming in with advanced, metastatic disease. One patient, 46-year-old Dan Luers, an Ironman finisher who worked out close to two hours a day, was given a stage IV diagnosis. Every year, Dr. Ng’s concern grew. But the problem didn’t totally hit home until 2017, when a healthy-looking marine showed up in her office. Just 29 years old, “he was the youngest person I’d ever treated for this type of cancer who didn’t have a family history, and the model of perfect health—extremely fit and active and a healthy eater.” But he had stage IV colorectal cancer. For people whose cancers have spread to distant parts of the body, like his had, the five-year survival rate hovers around 14 percent.
Luers and so many of Dr. Ng’s other young patients have asked a haunting question: “How could I have prevented this?” She and dozens of researchers around the country are furiously trying to find the answer. Watching so many young men suddenly get hit, Dr. Ng says, “cemented my resolve to do something about it.”
Why early colon cancer is so alarming
Colorectal cancers are the third-most-frequent type of new cancer in men (right behind prostate and lung). And while they’re declining for older guys, the rates among younger Americans are on the rise. What doctors have been picking up on in their day-to-day work is only now being fully captured in medical research and in the news. In 2017, a large American Cancer Society-funded study of invasive colorectal cancers found that people born around 1990 have double the risk of developing colon cancer and quadruple the risk of developing rectal cancer compared with those born around 1950—a finding worrisome enough to prompt the ACS to lower its recommended screening age for people of average risk of colorectal cancers from 50 to 45. If the trend continues, a study in JAMA Surgery predicted, by 2030 the rate of colon cancer will rise by 90 percent and that of rectal cancer by a staggering 124 percent in people ages 20 to 34. Research published in January 2024 found that colorectal cancer is the leading cause of cancer death in men younger than age 50. That’s up from fourth place in the late 1990s.
It gets worse: New research suggests that early-onset colorectal cancers have distinctly different features from what doctors are used to seeing. These cancers tend to start in other places and mutate differently,