No one told Rick Rivers that his grandfather had died of colorectal cancer until Rivers was diagnosed at 31. In his family, cancer was a taboo subject — especially cancers involving the bowels — while illnesses like diabetes were openly discussed. “There’s a shame factor to talk about certain areas of your body,” Rivers says. He lives in Williamstown, N.J., and is a father of three.
Colorectal cancer is rising, especially among younger adults, and is now the leading cancer killer of people under 50. The trend puzzles gastroenterologist Dr. Neil Parikh of Hartford Hospital because colorectal cancer is largely preventable: tumors develop slowly, and colonoscopies or stool tests such as FIT and Cologuard can detect precancerous polyps or early cancers when treatment is straightforward. “If you find a polyp — a little pimple on the inside — and you remove it, you can prevent it,” Parikh says. Yet rates keep climbing.
Barriers to screening include insurance limits and lack of awareness, but Parikh stresses another major obstacle: stigma. Many people are embarrassed to talk about bowel habits, bloody stools, or other warning signs, and younger adults are particularly reluctant. “We need to talk more about poop,” Parikh says, noting the odd double standard — children giggle about farting, yet adults avoid discussing normal bowel function, and older relatives sometimes overshare. Clinically, this silence means symptoms in people in their 30s and 40s are less likely to be reported, delaying diagnosis.
The Colorectal Cancer Alliance reports younger patients’ symptoms are often ignored, and three out of four colorectal cancers diagnosed in young people are found at a late stage. Michael Sapienza, the alliance’s CEO, urges self-advocacy: if you are under 45 and have symptoms or a family history of colorectal cancer, ask for testing. Federal preventive screening guidelines generally start at age 45, but clinicians can order diagnostic colonoscopies for symptomatic or high-risk younger patients. That testing may be billed differently, could incur out-of-pocket costs, or require prior authorization, but it can be lifesaving.
Many younger adults skip testing because of competing responsibilities — work, childcare — and because asking for a diagnostic exam often requires talking about symptoms people find embarrassing. Rivers, who underwent major surgeries and now is cancer-free 13 years after his diagnosis, works to normalize screening among peers. He brings up testing in contexts that matter to people — for example, emphasizing family responsibilities when talking to parents — and says tailoring the message to what someone values can be persuasive.
Rivers has persuaded several acquaintances, including fellow parents and members of his judo dojo, to get screened. Both clinicians and advocates say breaking the silence about bowel health, encouraging open conversations about symptoms, and making it easier for younger and high-risk people to access testing are key steps to catching colorectal cancer early and reducing preventable deaths.