At 32, Azucena Reyes began experiencing months of intense nausea that suddenly progressed to severe abdominal pain. After a hospital visit she learned the cause was a tumor. Doctors told her it was unlikely to be cancer — she was young and Hispanic, they said, and colorectal cancer was more common in older and Black patients. Two months later the tumor returned and she received a diagnosis: stage 3B colon cancer.
Reyes’s story reflects a growing reality: colorectal cancer rates are rising in adults under 50 across all racial and ethnic groups, with the fastest increases seen among Hispanic and Latino people in the United States. That trend has led professional organizations to lower routine screening age recommendations; the American Cancer Society moved its starting age to 45 in 2018 and the U.S. Preventive Services Task Force issued similar guidance in 2021. But most testing for people under 45 still happens only after symptoms appear.
Warning signs of colorectal cancer that should prompt medical evaluation at any age include:
– Blood in the stool or rectal bleeding
– New or persistent changes in bowel habits (diarrhea, constipation, thinner stools, difficulty emptying)
– Ongoing abdominal pain, cramping, or bloating
– Unexplained anemia
– Unintentional weight loss, weakness, or fatigue
Certain people under 45 should also be offered screening even without symptoms: those with known hereditary cancer syndromes (for example, Lynch syndrome or familial adenomatous polyposis), people with a strong family history of colorectal polyps or cancer beginning at a young age, and anyone with long-standing inflammatory bowel disease such as Crohn’s disease or ulcerative colitis. For people who are under the routine screening age and lack symptoms or high-risk factors, noninvasive stool-based tests (FIT, FIT-DNA/Cologuard, and similar options) can be requested; a positive result would then lead to colonoscopy.
Reyes underwent surgery and what she expected to be a short course of chemotherapy turned into 12 rounds. Treatment changed her body and life. She gained a great deal of weight during therapy, experienced numbness in her feet, and needed extensive physical therapy to regain strength. Some digestive side effects have persisted: she still cannot tolerate certain foods and must plan her outings around restroom access. She also developed long-term conditions from treatment, including low thyroid function, low B12 that requires injections, and iron deficiency treated with infusions.
Despite ongoing worries about recurrence, she follows a high-fiber, low red-and-processed-meat diet, stays current with bloodwork and surveillance, and tries to stay hopeful about improvements in cancer care. She notes that chemotherapy regimens have evolved since her treatment a decade ago and hopes research will clarify why colorectal cancer is increasing in younger people.
Experts believe there is unlikely to be a single cause for the rise in early-onset colorectal cancer. Factors under study include shifts in diet toward more ultra-processed foods and red meat, rising overweight and obesity rates, environmental exposures (chemicals, microplastics, pollutants, endocrine disruptors), changes in the gut microbiome (including bacteria that may produce harmful compounds), antibiotic use, and the impact of stress on genetic expression. Public health leaders warn the trend requires careful monitoring and may eventually lead to further changes in screening recommendations.
The lack of information and peer support early in her journey motivated Reyes to become an advocate. After finishing treatment she connected with colorectal cancer support resources and later joined a taskforce focused on young-onset colorectal cancer. She volunteers to speak at events, reaches out to Spanish-speaking communities, and directs people to free screening resources and educational materials. She stresses that many Spanish-speaking people lack equal access to information and few advocates speak Spanish, so reaching those communities is a priority.
Key takeaways from her experience: know the warning signs, insist on evaluation if you have symptoms regardless of age, ask about noninvasive screening options if you are under routine screening age, and seek out support and information in your language and community. Early recognition and timely testing save lives.
