Dr explains: Why colorectal cancer is rising among young Indians and why diagnoses are delayed

Colorectal cancer, traditionally considered a disease of older adults, is alarmingly on the rise among younger populations around the world and India is no exception. Recent data and expert observations point to a shifting disease burden with more cases being diagnosed in individuals well under 50. This trend has sparked urgent conversations in medical and public-health circles about early detection, changing lifestyle risks and the need to revisit existing screening guidelines.

Globally, research suggests that this early-onset colorectal cancer often presents differently with more aggressive features and a lower five-year survival rate compared to cases in older adults. In India, oncologists are increasingly seeing young patients with advanced-stage disease, raising concerns about delayed diagnosis, limited awareness, and potential environmental and genetic contributors.

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Firstpost spoke to Dr. Dinesh Singh, Director of Radiation Oncology at Action Cancer Hospital in Delhi to shed light on the worrying rise of colorectal cancer among young Indians, what’s driving it and how both the public and medical community can respond.

What factors are driving the rise of colorectal cancer among young adults, particularly in India?

Dr Singh: The continuous rise of colorectal cancer among the young adults is multifactorial in India. Variety of factors have significantly contributed to the same such as Changing dietary habits, especially high intake of processed foods, red meat, and low-fibre diets. Sedentary lifestyle, obesity and increasing consumption of tobacco and alcohol further increases the risk. At the same time environmental pollution, gut microbiome changes and genetic predisposition also play a very significant role. Additionally delay in diagnosis due to low level of awareness among the young population and providers of healthcare leads to late-stage detection. The urban population is also expecting a continuous rise specially those who are exposed to Westernized lifestyles and stress, making prevention and early screening critically significant.

Should the screening age for colorectal cancer be lowered, given the growing incidence in people under 50?

Dr Singh: Definitely, reducing the screening age is becoming a global public health consideration. On ordinary bases screening of colorectal cancer began at the age of 50, but since cases are increasing, experts recommend that it should be started earlier, ideally at the age of 40 or even 35 for the high-risk individuals. Those who have the family history of colon cancer, inflammatory bowel disease, or genetic mutations such as Lynch syndrome requires earlier surveillance. Early medical detection with the help of colonoscopy or non-invasive tool-based test can prevent the development of cancer by identifying and removing the pre-cancerous polyps. In India awareness campaigns and national guidelines should be promoted on a good level and more widespread access of screening.

How significant are lifestyle factors such as diet, alcohol and physical inactivity in triggering early-onset colorectal cancer?

Dr Singh: As per WHO there is no minimum safe limit of alcohol. Risk keeps increasing with the amount consumed. Factors related to lifestyle are the strongest contributors to early onset colorectal cancer. A diet which is rich in processed and red meats but low in fibre disrupt gut health and promotes inflammation as well. Increase in oxidative stress and damage to DNA increase cancer risk when excessive amount of alcohol is consumed by an individual. Some sedentary habits, obesity and chronic stress further worsen the metabolic imbalance and level of hormones, increasing the growth of tumour. Modern lifestyles which are mainly dominated by the screen time, fast food, and low physical activity also alters gut microbiota, which may play a good role. Preventive strategies of the same should be well focussed on balanced diets, regular exercise and moderation of lifestyle.

What are the main barriers to timely screening and diagnosis in India and how can awareness be improved?

Dr Singh: A big factor in delayed diagnosis is thinking it to be piles and taking alternative or home remedies for a long time. Timely intervention and early diagnosis is highly important. The biggest challenges are the lack of awareness, stigma and inadequate access to diagnostic facilities. Gastrointestinal symptoms are usually ignored by the young people or even the physicians as well by the assumption that they are benign or stress related. Detection is also delayed by the High out-of-pocket healthcare costs and limited colonoscopy availability outside of the urban areas. With the help of public campaigns which more emphasis on early warning signs and significance of health check-ups awareness can be improved. Corporate wellness programs, digital health platforms and influencers present on social media also helps to normalize the conversation around the bowel health. Screening initiatives mainly supported by government and insurance coverage for colon health assessments are also significant to reduce this gap.

Do younger patients show different symptoms or tumour behaviour compared to older individuals?

Dr Singh: Younger patients are often present with the more aggressive tumour of biology and advanced stage disease at the diagnosis. The symptoms of the same such as such as rectal bleeding, altered bowel habits, or unexplained fatigue are frequently dismissed as issues related to stress, delay in interventions. Study shows that early onset of colorectal cancers tens to be life sided and microsatellite-instability (MSI) high, which suggest a genetic and molecular differences from the late onset of cancers. Faster progression and recurrence risk is observed in the younger individuals. Hence persistent symptoms in young adults even if mild, should prompt thorough the correct evaluation rather than just a symptomatic treatment. Early diagnosis also helps to improve outcomes of survival.

How promising are new screening tools like stool-based tests, liquid biopsies or AI-assisted risk prediction in early detection?

Dr Singh: Early colorectal cancer detection is advanced by emerging and advanced technologies. Stool-based tests such as FIT and Cologuard detect occult blood and DNA changes, offers cost effective and non-invasive options as well. Cancer can be identified before symptoms appear by Liquid biopsies—detecting circulating tumour DNA (ctDNA) in blood. AI driven algorithms also help to analyse genetic, lifestyle and imaging data especially in low resource setting countries like India by reducing dependence on colonoscopies. In national screening programs large scale validation, reduction in cost continue to remain very essential for the widespread adoption and real impact as well.

What key warning signs should young adults never ignore, and when should they seek medical evaluation?

Dr Singh: Persistent rectal bleeding, unexplained anaemia, abdominal pain, chronic constipation or diarrhoea, and sudden weight loss should never be ignored by the young adults. Immediate medical attention is required for certain conditions such as Blood in stool, changes in bowel habits lasting more than two weeks, or fatigue. Even mild symptoms, even if they are recurrent should not be self-treated or attributed to changes in diet. A complete evaluation including stool test and colonoscopy is also very crucial if there is family history of colorectal or gastrointestinal cancers. Definitely outcomes can be changed by early recognition and timely diagnosis as colorectal cancer is highly curable when it is detected at early stage.