Rick Rivers, a father of three from Williamstown, N.J., learned only after his own diagnosis at 31 that his grandfather had died of colorectal cancer. In his family, discussions about the bowels were taboo while conditions like diabetes were openly talked about. Rivers says there’s shame tied to discussing certain body parts, a silence he now fights as a survivor and advocate.
Colorectal cancer rates are rising, particularly among younger adults, and it is now the leading cancer killer for people under 50. Doctors find this alarming because colorectal cancer is often preventable: tumors typically grow slowly, and screening tests — colonoscopy or stool-based tests like FIT or Cologuard — can find precancerous polyps or early cancers when treatment is much simpler. Removing a polyp can prevent cancer from developing.
Gastroenterologist Dr. Neil Parikh points to several barriers to early detection: insurance limits, low awareness, and a major but underappreciated obstacle — stigma. Many people are embarrassed to talk about bowel habits, blood in stool, or other warning signs. Younger adults are especially reluctant to bring up these symptoms, and that reluctance can delay diagnosis. Parikh notes the odd double standard: children laugh about farts, yet adults avoid talking about normal bowel function.
Advocates at the Colorectal Cancer Alliance say younger patients’ symptoms are often ignored, and three out of four colorectal cancers in young people are found at a late stage. Michael Sapienza, the alliance CEO, urges people under 45 with symptoms or a family history to ask for testing. While routine preventive screening typically starts at 45, clinicians can and do order diagnostic colonoscopies for symptomatic or high-risk younger patients. Those exams may be billed differently, require prior authorization, or lead to out-of-pocket costs, but they can be lifesaving.
Younger adults also skip testing because of competing responsibilities like work and childcare, and because seeking a diagnostic exam often means discussing embarrassing symptoms. Rivers, now cancer-free 13 years after treatment, works to normalize screening among his peers by framing the message around what matters to them — family responsibilities, being there for children — and by bringing up testing in everyday conversations. He has persuaded fellow parents and members of his judo dojo to get screened.
Clinicians and advocates say the path to catching colorectal cancer earlier is straightforward: reduce stigma, encourage open conversations about bowel health and symptoms, and make testing more accessible for younger and high-risk people. Normalizing ‘poop talk’ and lowering logistical and financial hurdles could lead to earlier diagnoses and fewer preventable deaths.