According to Cancer Research UK, in the UK, incidents of early onset colorectal cancer have risen by more than 50 per cent since the early 90s. Although young adults still account for only about one in twenty of those with bowel cancer, the upward trend is hard to ignore.
Here, we’ll look at why rates may be rising, how a research programme called PROSPECT hopes to provide answers, and what practical steps younger adults can take to protect themselves.
Why are more under-50s being diagnosed with Colorectal Cancer?
Colorectal tumours develop when genetic changes allow cells lining the bowel to grow out of control. In older adults, that genetic damage accumulates gradually with age. In younger people, however, something seems to be accelerating the process.
Researchers have linked several modern exposures to early onset colorectal cancer (EOCRC). Obesity, diets high in processed food, sedentary work patterns and even shifts in our gut microbiome have been linked, yet none fully explains the magnitude of the rise.
One theory is the Birth-Cohort Effect. Each generation born since around 1970 has encountered a unique mix of lifestyle and environmental factors (for instance, greater antibiotic use in childhood, higher fructose intake and micro-plastics in the food chain) that may play a part in EOCRC.
The PROSPECT Project
To tackle these unknown factors head-on, Cancer Grand Challenges launched the PROSPECT team in 2024, uniting epidemiologists, molecular biologists, nutritionists and patient advocates. Their three-step plan is both ambitious and practical:
Step 1: Pinpoint the culprits
By pooling data from more than 15 large population studies – nearly 10 million volunteers and over 2,700 EOCRC cases – they will analyse lifelong exposures using advanced ‘exposomics’, microbiome and epigenetic profiling. The aim is to spot patterns that distinguish people who develop cancer in their thirties or forties from those who remain cancer-free.
Step 2: Unpack the biology
Suspected risk factors will then be tested in organoids (mini-gut cultures) and animal models to reveal how, at a cellular level, they drive cancerous change.
Machine-learning tools will integrate these multi-omics datasets to map the pathways most amenable to intervention.
Step 3: Test precision-prevention
Finally, the team plans clinical and community trials in the UK, US and India, exploring whether targeted dietary tweaks, medications or risk-feedback tools can curb tumour-promoting pathways before cancer develops.
Colorectal Cancer screening
In England, anyone aged between 50 and 74 is eligible to receive an at-home FIT test as part of NHS England’s bowel cancer screening programme. Given the EOCRC surge, vigilance is key.
Get to know the red flags of colorectal cancer. Persistent rectal bleeding, a sustained change in bowel habit or abdominal pain, warrant prompt assessment. A strong family history, inflammatory bowel disease or certain hereditary syndromes (e.g., Lynch) justify earlier colonoscopy. Discuss timing with your GP or specialist.
Maintaining a healthy weight, limiting ultra-processed foods and alcohol, staying active and not smoking, remain the best-evidenced steps for bowel-cancer prevention at any age.
If you are concerned you may have early onset colorectal cancer, schedule an appointment with Mr Micheal Stellakis today.
