Delaware's public health agency is urging adults at average risk to begin colon cancer screening at age 45, launching a statewide campaign as the disease keeps rising among younger adults. The Delaware Division of Public Health announced the effort Sept. 21, noting that colon cancer is among the top four most commonly diagnosed cancers in the state and a leading cause of cancer deaths.
"With this new campaign, we want to raise awareness about the lowered colon cancer screening age and the different ways people can get screened," said Helen Arthur, the agency's section chief for health promotion and disease prevention.
The push reflects a national shift. Colorectal cancer is now the leading cause of cancer death in Americans younger than 50, and many adults in their mid-40s still do not know they are eligible for screening.
A Rise Concentrated in Younger Generations
The national numbers are stark. Colorectal cancer incidence climbed about 3% per year among adults ages 20 to 49 from 2013 to 2022, while falling 2.5% per year among adults 65 and older, according to the American Cancer Society's 2026 fast facts. Death rates among adults under 50 have risen about 1% per year since 2004.
The ACS estimates 158,850 new U.S. colorectal cancer diagnoses and 55,230 deaths in 2026, according to a society news release. The increases are driven mostly by tumors in the lower colon and rectum, and rectal cancer now makes up nearly one-third of all colorectal cancer diagnoses.
Part of the recent jump reflects more screening, not only more disease. Diagnoses of early, localized cancers in younger adults rose sharply from 2019 to 2022, a change tied to newly eligible 45- to 49-year-olds beginning screening, Becker's ASC Review reported. The rise in deaths, however, points to a real increase in disease.
What remains unknown is why. The reasons for rising rates in younger adults remain largely unexplained. The ACS estimates that more than half of all colorectal cancers are linked to modifiable risk factors such as smoking, diet, alcohol, physical activity, and body weight, but no single cause has been shown to drive the increase in younger people.
Screening Choices and What They Cost
Delaware's campaign stresses that people have more than one option. Colonoscopy remains the most thorough test and is typically repeated every 10 years if results are normal. Patients usually receive sedation, and doctors can remove precancerous polyps during the same procedure.
People who prefer to avoid a colonoscopy can use a fecal immunochemical test, or FIT, collecting a stool sample at home and mailing it to a lab. Stool tests must be repeated more often, and a positive result requires a follow-up colonoscopy. Other options, including other stool-based tests and CT colonography, can be discussed with a clinician.
Some people should start earlier or screen more often. Arthur said adults with past polyps, a family history of colon cancer, type 2 diabetes, or inflammatory bowel disease may face higher risk and should discuss timing with a clinician.
Cost can be a hurdle. Most private insurance plans must cover screening recommended by the U.S. Preventive Services Task Force for adults 45 and older without cost-sharing, though rules on follow-up tests can vary by plan. Delaware residents without insurance can ask about the state's Screening for Life program, and HealthyDelaware.org/colon connects residents to nurse navigators who help arrange screening.
Common barriers include bowel preparation, time off work, and the need for a driver after sedation, and a home stool test can avoid all three.
Symptoms That Should Not Wait for a Birthday
Screening is for people without symptoms. Anyone with warning signs should see a clinician regardless of age, since a 35-year-old with rectal bleeding does not need to wait until 45.
Symptoms that warrant medical attention include blood in or on the stool, a lasting change in bowel habits such as diarrhea or constipation, ongoing abdominal pain or cramping, unexplained weight loss, and fatigue linked to iron-deficiency anemia. Many of these have harmless causes, but younger patients are often diagnosed at an advanced stage. According to the ACS, about three in four colorectal cancers in adults younger than 50 are found at an advanced stage.
People most likely to benefit from acting now include adults 45 to 49 who have never been screened, people with a parent or sibling diagnosed with colorectal cancer, and anyone with ongoing bowel symptoms. Asking relatives about their cancer history can change when screening should start.
Practical next steps are simple. Check whether you are 45 or older and have never been screened, ask your primary care clinician about colonoscopy or a home stool test, and confirm coverage with your insurer before booking. Heavy rectal bleeding, severe abdominal pain, or dizziness requires urgent evaluation.
The ACS publishes its full colorectal cancer statistics report every three years, so the next national snapshot is expected in 2029.
The core message is steady and actionable: colon cancer is rising among younger adults for reasons no one fully understands, but screening at 45 can find and remove polyps before they turn into cancer.
Key Questions Answered
What did Delaware announce? The Division of Public Health launched a campaign on Sept. 21 urging adults at average risk to begin colon cancer screening at age 45.
Why start at 45? Colorectal cancer is rising in younger adults. Incidence among ages 20 to 49 rose about 3% per year from 2013 to 2022.
What screening options exist? Colonoscopy every 10 years if normal, home stool tests such as FIT that are repeated more often, and other tests your clinician can explain.
Who should screen earlier? People with past polyps, a family history of colon cancer, type 2 diabetes, or inflammatory bowel disease should ask a clinician about earlier screening.
Is screening covered by insurance? Most private plans must cover recommended screening at 45 and older without cost-sharing. Delaware's Screening for Life program helps uninsured residents.
Why is colon cancer rising in young people? The reasons remain largely unknown. Researchers are studying possible factors, but none has been shown to drive the increase.
What symptoms need attention? Rectal bleeding, lasting bowel changes, abdominal pain, unexplained weight loss, or anemia should be checked by a clinician at any age.
Published by Medicaldaily.com
