Up to 40% of India’s colorectal cancer patients are under 40: The profile of the country’s fourth most common cancer is shifting

Colorectal cancer (CRC) rates in young adults under 50 are rising globally, including in India. Several studies have highlighted the growing incidence of the silent killer especially among younger adults.
Early-onset colorectal cancer (eoCRC), defined as under age 50, has increased worldwide, particularly in high-income countries, with annual rises up to 7.9% in those aged 20-29 in Europe. In the US, diagnoses under 55 doubled over a decade, now comprising 20% of cases, often at advanced stages (III-IV). Indian studies report 21-48% of CRC cases in patients under 40, higher than Western rates of 3-15%, with steady proportions from 2014-2021.
In India, CRC incidence is rising, ranking fourth overall, with young cases (under 40) at 21-40%. This 2025 review from Tata Memorial Centre analyzes colorectal cancer (CRC) epidemiology in India, using GLOBOCAN 2022 data showing 64,863 cases (fourth most common cancer) and 38,367 deaths, with higher rates in males and urban areas. Incidence is rising, especially colon cancer in urban females (e.g., 10.4% in Trivandrum) and rectal cancer in southern /northeastern regions, projecting a doubling by 2050 amid lifestyle shifts.

Colorectal cancer still carries an old, stubborn label: “that’s an older person’s disease.” And that belief is a big reason awareness among young people is so low. When you’re in your 20s or 30s, cancer just doesn’t feel like something that belongs in your life. You’re busy building careers, paying rent, juggling relationships, and trying to stay healthy in the most basic ways. So when mild symptoms show up, they’re easy to brush off.

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And the symptoms themselves don’t help. Bloating, constipation, stomach pain, fatigue, or seeing a little blood once or twice? Most young people blame stress, bad food, long hours at work, or piles. Doctors do too, sometimes. If you’re young and look “healthy,” cancer isn’t the first thing anyone thinks of. That delay can cost time, and with colorectal cancer, time matters.
So awareness stays low, and silence fills the gap. Young people don’t talk openly about bowel habits or rectal bleeding. It feels awkward, embarrassing, or “too much information.”

Colorectal cancer is rising in younger adults, and ignoring that won’t make it go away. Awareness doesn’t mean panic. It means knowing your body, taking symptoms seriously, and not assuming youth equals immunity. Because cancer doesn’t always wait for middle age. And pretending otherwise is part of the problem.

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“Colorectal cancer is one of the most common types of cancer that often affects people above the age of 50 years. It is also the leading cause of cancer deaths among people worldwide. This type of cancer usually develops in tissues of the rectum or colon and arises from abnormal growths called polyps,” says Dr. C. Bharath Kumar, Senior Consultant – Medical Gastroenterology, Hepatology & Interventional Endoscopy, KIMS Hospitals Bengaluru.

“While this disease is traditionally considered to affect older adults, it is increasingly being diagnosed among younger generations. The primary reason behind this increased risk among younger adults is due to several factors like sedentary lifestyle, increased consumption of processed foods, obesity and chronic stress. Additionally, many individuals often consider minor bowel movements as harmless, which often leads to a delay in evaluation that further increases the risk,” Dr. C. Bharath Kumar told TOI Health.
The doctor says the early signs are subtle, many people consider them dietary, lifestyle, or temporary digestive issues, which can delay treatment. Furthermore, as younger individuals delay medical examination due to work pressure or stigma surrounding bowel movements, by the time they start experiencing severe symptoms, the disease has reached an advanced stage. This is also one of the factors why colorectal cancer is rising among young adults, he says and shares the symptoms one should be careful about.

• Modifications in bowel habits
• Increased abdominal pain
• Blood in stool
• Unexplained constipation or weight loss
• Diarrhoea
• Bloating and fatigue
• Iron deficiency
  
  

Dr. C. Bharath Kumar suggests consuming a balanced diet that is rich in fibre to avoid the onset of colorectal cancer. He also suggests incorporating exercise, maintaining optimal weight, and avoiding processed food in the diet. “Lastly, if you are experiencing persistent changes in bowel movements, rectal bleeding, or unexplained fatigue, you should immediately undergo a medical examination. Awareness is key to avoiding this disease, and proactive steps such as screening and timely consultation help ensure early intervention, reducing your risk and improving outcomes.
As per recent CDC guidelines people should begin screening for colorectal cancer soon after turning 45, then continue getting screened at regular intervals,” he recommends.

However, the doctor says, you may need to be tested earlier than 45, or more often than other people, if you have:

Inflammatory bowel disease such as Crohn's disease or ulcerative colitis.
A personal or family history of colorectal cancer or colorectal polyps.
A genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome).
Discuss with your physician if you feel as though you may have a higher risk of developing colorectal cancer: when you should start screening, which type of screening is most appropriate for you and how frequently should you be screened, he suggests.

“Screening for colon cancer through colonoscopy is very important in preventing colorectal cancer. It allows for early identification of "polyps," which are abnormal growths in the colon that can be removed at the same time that the colonoscopy is completed (to provide your family member with peace of mind that they will not develop colorectal cancer),” he recommends.

This article includes expert inputs shared with TOI Health by:
Dr. C. Bharath Kumar, Senior Consultant – Medical Gastroenterology, Hepatology & Interventional Endoscopy, KIMS Hospitals Bengaluru
Inputs were used to explain why colorectal cancer, India's fourth common cancer, is increasingly detected in younger adults. The doctor shared symptoms and preventive measures against colorectal cancer.