Colorectal cancer, once considered a disease of the elderly, is increasingly affecting young people in India. Firstpost presents expert views, discussing the causes, early warning signs and the urgent need to lower the screening age and raise awareness to combat this growing health problem.
Colorectal cancer (CRC) in India, once considered a disease of the elderly, is increasingly being diagnosed in younger people, a trend highlighted by recent studies and reports by the Indian Council of Medical Research (ICMR) and other national cancer registries. While India still has a lower incidence compared to Western countries, several regional studies indicate a dramatic increase in younger age groups, often presenting at advanced stages and with aggressive tumor biology.
The growing tide has prompted calls among oncologists to lower the screening age, increase public awareness, and change diagnostic strategies. Firstpost spoke to Doctor Dinesh Singh, Director of Radiation Oncology, Action Cancer Hospital, Delhi, to discuss key drivers of change, practical screening guidelines and the way forward for young Indians.
What factors are responsible for the rise in colorectal cancer among young people, especially in India?
Dr. Singh: India’s ongoing surge in colorectal cancer among young adults is multifactorial. Changing dietary habits – especially increased consumption of processed foods and red meat combined with low fiber intake – is a major factor. At the same time, a sedentary lifestyle, obesity and increased consumption of tobacco and alcohol further increase the risk. Environmental pollution, changes in the gut microbiome, and genetic predisposition also play a very important role. Equally important is late diagnosis: low levels of awareness among young people and health professionals often lead to late detection. It is noteworthy that the urban population, which is exposed to a westernized lifestyle and increased stress, may see a sharper increase.
Should the screening age for colorectal cancer be lowered, given the increasing incidence in people under 50?
Dr. Singh: Undoubtedly. Historically, screening for rectal cancer began at age 50, but with the rise in incidence in younger people, a review is needed. Ideally, we should start screening at age 40 and even 35 for people at high risk. Those with a family history of colon cancer, inflammatory bowel disease, or genetic syndromes such as Lynch syndrome require early follow-up. Early detection through colonoscopy or non-invasive tests can remove precancerous polyps and prevent progression. In India, national guidelines, targeted awareness campaigns and greater access to screening should now be a priority.
How important are lifestyle factors such as diet, alcohol and lack of physical activity in early-onset colorectal cancer?
Dr. Singh: Lifestyle factors are among the strongest contributors to early-onset colorectal cancer. According to the World Health Organization (WHO), there is no safe minimum level of alcohol consumption: the risk increases with the amount. Diets high in red and processed meat but low in fiber promote gut inflammation and DNA damage, and heavy alcohol consumption increases oxidative stress. A sedentary lifestyle, obesity, and chronic stress disrupt metabolic balance and hormone levels, further promoting tumor growth. Meanwhile, modern lifestyles characterized by a lot of screen time, fast food consumption and limited physical activity also affect the gut microbiota, which may play a key role. Prevention should focus on a balanced diet, daily activity and moderation.
What are the main barriers to timely screening and diagnosis in India and how can awareness be raised?
Dr. Singh: A major obstacle is misattribution: many young people dismiss symptoms of hemorrhoids (piles) or minor bowel problems and delay intervention. The biggest obstacles are lack of awareness, stigma and unequal access to diagnostic infrastructure. Many gastrointestinal symptoms go unnoticed by both patients and physicians, believing them to be benign. High out-of-pocket costs and limited access to colonoscopy outside metropolitan centers further delay diagnosis. To raise awareness, public health campaigns should focus on early warning signs and regular check-ups. Corporate wellness programs, digital health platforms, and influencer-led social media dialogue can help normalize discussions around gut health. Government-backed screenings and better insurance coverage for colon health assessments are also critical to closing the gap.
Are tumor symptoms or behavior different in younger patients than in older patients?
Dr. Singh: yes. Younger patients often have more aggressive tumor biology and advanced disease. Symptoms such as rectal bleeding, altered bowel patterns, or unexplained fatigue are often dismissed as stress-related, leading to a delay in intervention. Studies show that early-onset rectal cancer tends to be left-sided and have high microsatellite instability (MSI), indicating molecular differences from later-onset disease. Younger patients also have higher recurrence rates and more rapid progression. Therefore, any persistent bowel-related symptom in young adults deserves prompt and thorough evaluation rather than simple symptomatic treatment.
Dr. Singh: New technologies are promising for early detection of colorectal cancer. Stool-based assays such as the Fecal Immunochemical Test (FIT) or DNA-based assays (eg Cologuard) offer cost-effective, non-invasive options. Liquid biopsies that detect circulating tumor DNA (ctDNA) represent another limit. AI-driven algorithms that analyze genetic, lifestyle and imaging data are potentially game-changing, especially in resource-constrained settings like India, where access to colonoscopy is patchy. However, large-scale validation and cost reduction are essential for widespread adoption.
What are the key warning signs young people should never ignore and when they should see a doctor?
Dr. Singh: Young people should not ignore the following: persistent rectal bleeding, unexplained anemia, abdominal pain, chronic constipation or diarrhea, and sudden weight loss. Blood in the stool, changes in bowel habits lasting more than two weeks, or persistent fatigue require immediate medical attention. Even mild but recurring symptoms should not be treated independently or attributed only to diet. A complete workup, including a stool test and colonoscopy, is essential if there is a family history of rectal or gastrointestinal cancer. Early detection greatly increases the chances of survival.
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