Modifying Risk Factors

There are multiple well-known risk factors for CRC,  although not all have been studied specifically among young people.5 In addition, approximately 44% of racial disparities are attributable to risk factors, whereas the remaining are likely due to socioeconomic status and access to screening and treatment.2 This trend is also present among young people with CRC.

The established risk factors for CRC — regardless of a person’s age — include obesity, smoking, diet (eg, alcohol, red or processed meats, micronutrients), exercise, a sedentary lifestyle, and certain chronic conditions.5 Patients can reduce their risk by:

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  • Losing excess body weight
  • Quitting smoking
  • Improving dietary choices, such as reducing consumption of alcohol and red and processed meats and increasing fruit and vegetable intake
  • Engaging in exercise and reducing sedentary time by enjoying activities that include movement
  • Seeking care and adhering to therapies to control chronic conditions such as diabetes and inflammatory bowel disease.

Screening for CRC is also critical for decreasing incidence and stage at diagnosis.2 The American Cancer Society now recommends that individuals of average risk (ie, no family history of CRC) undergo screening for CRC at age 45 years by colonoscopy or a high-sensitivity stool-based test.6 However, any patient, regardless of age, who notices the following changes should see their health care provider, as it could be a sign of CRC:7

  • Rectal bleeding or blood in the stool
  • Changes in bowel habits, such as change in color or shape
  • Abdominal pain, cramping, bloating, or feeling of fullness
  • Unexplained weight loss
  • Fatigue


The incidence and rate of deaths associated with CRC are rising among people younger than 50 years, and racial disparities for incidence and CRC outcomes persist in this population. Patients can lower their risk of CRC by changing their lifestyle and habits, but also being aware of potential symptoms of CRC. Patients should begin CRC screening by age 45, but should also report any potential symptoms to their health care provider at any age.


  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30. doi:10.3322/caac.21590
  2. Siegel RL, Miller KD, Sauer AG, et al. Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145-164. doi:10.3322/caac.21601
  3. Araghi M, Soerjomataram I, Bardot A, et al. Changes in colorectal cancer incidence in seven high-income countries: a population-based study. Lancet Gastroenterol Hepatol. 2019;4:511-518. doi:10.1016/S2468-1253(19)30147-5
  4. Al-Husseini MJ, Saad AM, Jazieh KA, et al. Outcome disparities in colorectal cancer: a SEER-based comparative analysis of racial subgroups. Int J Colorectal Dis. 2019;34(2):285-292. doi:10.1007/s00384-018-3195-3
  5. Stoffel EM, Murphy CC. Epidemiology and mechanisms of the increasing incidence of colon and rectal cancers in young adults. Gastroenterol. 2019;158:341-353. doi:10.1053/j.gastro.2019.07.055
  6. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68:250-281.
  7. Symptoms. Fight Colorectal Cancer. Accessed September 7, 2020.