Colorectal cancer: Age doesn’t matter, but early screening does
James Van Der Beek/Wikimedia/Super Festival
For fans of the late 90s TV series Dawson’s Creek, the passing of cast member James Van Der Beek, who played the teenage aspiring filmmaker Dawson Leery, was a shock. It has also brought into the spotlight the fact that colorectal cancer is no longer a disease only affecting older adults. More personalities, regardless of ethnicity, who have been diagnosed with, undergone treatment for, or succumbed to this type of cancer are often not even in their 50s.
According to the Globocan 2020 report from the World Health Organization (WHO), colorectal cancer is the third most common cancer among men worldwide, accounting for 10.6% of all male cancers, and the second most common among women at 9.4%. In Malaysia, the latest National Cancer Registry Report (2017–2021) shows that colorectal cancer accounts for 14.1% of all cancer cases, making it one of the most prevalent cancers nationwide. It remains the most common cancer among men at 18.8% and the second most common among women at 13.7%.
Despite its high prevalence, screening rates remain low, especially among younger adults, largely due to fear, misunderstanding, and the belief that colorectal cancer only affects the elderly.
Rising number of young colorectal cancer patients
Dr Premjeet Singh of Ara Damansara Medical Centre
In Malaysia, once considered a disease of older adults, colorectal cancer is increasingly being diagnosed in much younger people. Doctors are now seeing patients in their 20s, 30s, and even teens presenting with the disease, often at a more advanced stage, when treatment becomes more complex and outcomes less certain.
Dr Premjeet Singh, Consultant General Surgeon, Endoscopist, and Minimal Access Surgeon at Ara Damansara Medical Centre, commented, “In my practice, I am increasingly seeing colorectal cancer in patients in their 30s and 40s. The youngest patient I have treated was only 13 years old. Age alone does not protect anyone from colorectal cancer.”
Why younger people are not immune
One reason colorectal cancer is frequently detected late in younger individuals is that early symptoms are often mild and easy to dismiss.
“Many young patients experience symptoms such as constipation, rectal bleeding, or mild abdominal discomfort, but they tend to brush these off,” Dr Premjeet explains. “Rectal bleeding is commonly assumed to be piles, while changes in bowel habits are often blamed on stress or a busy lifestyle.”
Cultural discomfort around bowel health also plays a role, with many patients delaying consultation due to embarrassment or fear of invasive tests.
Diet and lifestyle habits also contribute. “We are seeing younger adults consuming more processed foods and less fibre. Over time, this affects gut health and increases colorectal cancer risk,” Dr Premjeet says. Diets high in red and processed meats, combined with low intake of fruits, vegetables, and whole grains, are known to affect bowel health and, over time, increase colorectal cancer risk.
Because these symptoms do not significantly disrupt daily life, many delay seeking medical attention. By the time they consult a doctor, the disease may already be at an advanced stage, requiring more complex treatment.
No early symptoms
Colorectal cancer is particularly dangerous because it can develop quietly. In its early stages, many patients feel completely well and have no obvious warning signs.
“Colorectal cancer can remain silent for a long time. When symptoms appear, it usually means the cancer has already grown significantly,” says Dr Premjeet. This is why waiting for symptoms can be risky. Screening allows doctors to detect problems before cancer fully develops or while it is still highly treatable, even in people who feel perfectly healthy.
Early detection and screening make the difference
When the disease is found early, treatment is often simpler and less invasive. Surgery can frequently be performed laparoscopically using a thin tube with a camera inserted through small incisions, which allows faster recovery and fewer complications.
Some patients may even avoid chemotherapy. In contrast, those diagnosed at a later stage often face major surgery, chemotherapy, longer recovery periods, and a greater impact on quality of life. Dr Premjeet said that patients whose cancer is detected through screening generally have more treatment options and a stronger chance of long-term survival.
He recalls a woman in her early 40s who underwent a colonoscopy due to family history despite having no symptoms. A one-centimeter polyp was found and completely removed during the procedure, and laboratory tests later revealed cancerous cells within it. Because it was detected and removed early, she did not require surgery or chemotherapy, and follow up scans with a repeat colonoscopy confirmed that the cancer was gone, giving her an excellent prognosis. This case shows how early screening can detect cancer at an early stage and, in some cases, prevent it from progressing further.
Colonoscopy: more than just a diagnostic test
For many, the word “colonoscopy” can make people feel uneasy. Common fears include pain, embarrassment, or safety concerns, which often discourage individuals from getting screened.
“In reality, colonoscopy today is a very safe and routine procedure,” Dr Premjeet explains. “Patients are sedated, so most do not feel pain or even remember the procedure. The risks are very low, especially when compared to the danger of undetected cancer.”
Beyond diagnosis, colonoscopy also plays a preventive role. During the procedure, doctors can detect and remove polyps, small growths in the colon that may turn cancerous if left untreated. “Removing a polyp early is essentially stopping cancer before it starts,” he says.
Don’t wait till you’re in your 50s
While routine colorectal cancer screening is generally recommended from age 50, preventive action should begin much earlier, with priorities varying at each life stage.
For children and teenagers, the focus should be on healthy habits. A high fiber diet, maintaining a healthy weight, regular physical activity, and limiting processed foods can reduce long term risk.
Colonoscopy is usually unnecessary unless symptoms persist or there is a strong family history. In rare cases, inherited conditions such as Familial Adenomatous Polyposis, Lynch syndrome, Juvenile polyposis, or Peutz–Jeghers syndrome may require screening as early as 10 to 20 years old under specialist care.
Adults in their 20s and early 30s generally do not need routine screening without symptoms or family history, but should stay alert to bowel health. Persistent constipation, rectal bleeding, or changes in bowel habits should not be ignored, and medical advice should be sought if symptoms appear.
For those in their mid to late 30s and 40s, especially with family history or ongoing symptoms, earlier screening may be recommended. “In higher risk individuals, a colonoscopy may be advised every three to five years, depending on individual risk and findings,” says Dr Premjeet. He adds that screening should begin at least 10 years earlier than the age at which an immediate family member was diagnosed. Those without risk factors should still discuss colon health during routine check-ups, with screening possibly deferred until their 50s unless symptoms arise.
“Colorectal cancer is one of the few cancers that we can prevent or cure early through screening,” Dr Premjeet says. “Being proactive can save you from major treatment later and, more importantly, save your life.” Early screening is about taking control of your health, and being “too young” should never be a reason to delay care.
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