A new study published Thursday in JAMA Oncology reveals a stark disparity in colorectal cancer mortality among younger Americans, with deaths concentrated almost entirely among those without a four-year college degree—raising questions about healthcare access, preventive screening, and socioeconomic factors affecting disease outcomes.
Researchers analyzing government data on more than 101,000 younger adults ages 25 to 49 who died of colorectal cancer from 1994 through 2023 found that overall colorectal cancer death rates in this age group rose from about 3 per 100,000 to about 4 per 100,000. However, the distribution was unequal: for people with only high school education, the rate climbed from 4 to 5.2 per 100,000, while the rate for those with at least a bachelor's degree remained flat at 2.7 per 100,000.
The Disparity and Its Scope
The study's findings underscore a troubling trend. Colorectal cancer is now the deadliest cancer in Americans under 50, accounting for around 7 percent of total colorectal cancer deaths—approximately 3,900 deaths annually. The American Cancer Society estimates that more than 158,000 cases of colorectal cancer will be diagnosed in the U.S. this year, with the disease expected to claim more than 55,000 lives in 2026, making it the nation's second leading cancer killer behind lung cancer.
Ahmedin Jemal, the study's first author, emphasized that the findings underscore the need for public awareness about colorectal cancer and for younger adults to heed screening recommendations. Symptoms can include blood in stool or rectal bleeding; changes in bowel habits such as diarrhea, constipation or narrowing of stool lasting more than a few days; unintended weight loss; and cramps or abdominal pain.
Dr. Paolo Boffetta, a researcher at Stony Brook Cancer Center in New York who was not involved in the work, noted that while the concentration of death risk among the less advantaged was not entirely unexpected, this was the first national study to actually demonstrate the connection. "The focus on education is really (due to) something which was available in the data," Boffetta said, pointing to the methodological constraints researchers faced.
Understanding the Root Causes
Experts view college degree status as a marker for broader socioeconomic conditions. People without degrees tend to earn less money, have poorer diets, exercise less, and get less medical care—factors that compound disease risk and reduce access to early detection and treatment. The article noted that risk factors for colorectal cancer include obesity, lack of physical activity, a diet high in red or processed meat and low in fruits and vegetables, and a family history of colorectal cancer.
Scientists do not yet know what is driving the overall increase in colorectal cancer deaths among younger adults. Earlier this year, cancer society researchers reported that colorectal cancer mortality in Americans under 50 had increased by 1.1 percent a year since 2005, making it now the deadliest cancer in that age group. Celebrity deaths, including Chadwick Boseman in the sixth year ago and James Van Der Beek earlier this year, have highlighted the increase in colorectal cancer deaths among younger adults.
Policy Response and Screening Guidelines
In response to rising mortality, the American Cancer Society changed its screening guidelines in the fifth year ago, lowering the age U.S. adults should start getting screened from 50 to 45. However, the effectiveness of this policy shift in reaching populations with lower educational attainment remains unclear.
Researchers acknowledge a methodological limitation: death certificates do not detail income, health insurance status, or most other aspects of a person's life, though they do note educational attainment. Other research has found that education data often aligns with statistics about income, health insurance, physical activity, and chronic disease, so education serves as a proxy variable—but cannot definitively speak to other factors such as whether a person had health insurance.
Why This Matters:
This study highlights a critical gap in health outcomes tied to socioeconomic status, raising questions about whether current public health interventions are effectively reaching vulnerable populations. The concentration of deaths among less-educated younger adults suggests that screening guidelines alone may be insufficient without addressing underlying barriers to healthcare access, preventive care, and lifestyle factors. The data underscores the importance of understanding how individual economic circumstances and educational background translate into measurable health disparities. Policymakers and health institutions must determine whether expanded government programs or market-based solutions—such as improved health literacy campaigns, employer-sponsored screening initiatives, or targeted outreach to underserved communities—represent the most effective path forward. The findings also raise questions about resource allocation in cancer prevention and early detection efforts, particularly whether current strategies adequately serve populations facing the greatest mortality burden.