‘We need to talk more about poop’: The stigma driving colorectal cancer deaths in young adults

Key facts

• Colorectal cancer is now the leading cause of cancer deaths in adults under 50 in the United States.
• Rectal cancer deaths are rising among millennials; by 2035 it could be the top cancer killer in people under 50.
• Actor Chadwick Boseman died of colorectal cancer at 43 in 2020; James Van Der Beek died at 48 in February 2025.
• The recommended screening age has dropped from 50 to 45, and to 20 for those with family history or symptoms.
• Rick Rivers was diagnosed at 31; he was never told his grandfather died of the same disease.
• A 38-millimeter sessile serrated adenoma — a precancerous polyp — was found in Kathleen Whilden’s colon during her first colonoscopy at age 23.
• Black Americans have higher incidence and mortality rates from colorectal cancer.

A preventable cancer is killing the young

Colorectal cancer, once considered a disease of the elderly, has become the leading cause of cancer deaths in Americans under 50. The paradox, doctors say, is that it is almost entirely preventable when caught early. “This is a cancer that if you find a polyp — a little pimple on the inside — and you remove it, you can prevent it,” said Dr. Neil Parikh, a gastroenterologist at Hartford Hospital in Connecticut. “Yet we’re seeing this rise.” New research from the American Cancer Society shows that while colorectal cancer rates are declining in people 65 and older, they are increasing steadily in younger adults. Rectal cancer deaths, in particular, are rising among millennials, and if the trend continues, rectal cancer will be the top cause of cancer death in people under 50 by 2035.

The shame factor that silences symptoms

For Rick Rivers, a father of three in Williamstown, New Jersey, the diagnosis came at age 31 — but the family history had never been discussed. “No one ever mentioned to me that my grandfather died of colorectal cancer,” he said. “There’s a shame factor to talk about certain areas of your body and them not functioning the way that they’re supposed to.” That stigma is especially acute among younger adults, who are less likely to report warning signs such as rectal bleeding, changes in bowel habits, or abdominal pain. Dr. Parikh noted that people in their 30s and 40s rarely discuss bowel movements with peers, creating a dangerous silence. “The last time another 40-year-old told me they had a good bowel movement … that’s a rare conversation,” Parikh said. His prescription: “We need to talk more about poop.”

Warning signs often mistaken for hemorrhoids

The most common symptom of rectal cancer is rectal bleeding, which can appear as blood in the stool, on toilet paper, or as maroon-colored stools. This is “much more common” in younger patients, said Dr. Michael Foote, a gastrointestinal medical oncologist at Memorial Sloan Kettering Cancer Center in New York. Many people mistake the bleeding for hemorrhoids or menstruation, delaying diagnosis. Other symptoms include abdominal pain, changes in bowel habits, constipation, thinner stools, fatigue, weight loss, and anemia. Dr. Jatin Roper, a gastroenterologist with Duke Health, emphasized that any change in gastrointestinal function should be investigated. “The most concerning signs that should prompt an investigation include any sign of blood in the stool,” he said. However, some people with rectal cancer have no symptoms at all, making regular screenings even more critical.

A young patient’s story: fear, then a precancerous polyp

Kathleen Whilden, a literature and psychology student at UC Santa Cruz, was 23 when she told her doctor about abdominal pain and constipation. Her doctor recommended a colonoscopy to test for celiac disease, inflammatory bowel disease, and other conditions. “I was not ready to face the idea that I could be sick,” Whilden wrote. During the procedure, doctors found a 38-millimeter sessile serrated adenoma — a precancerous polyp — in her colon. She needed two more colonoscopies that year to remove it. “The hardest part was coming face to face with my own mortality,” she recalled. Whilden now urges her peers to overcome embarrassment and get tested. “Yes, getting a colonoscopy is uncomfortable, but it’s far less frightening than a late diagnosis,” she said.

Screening guidelines have shifted, but awareness lags

The recommended age for colorectal cancer screening has dropped from 50 to 45 for average-risk individuals, and to 20 for those with a family history of colon polyps, symptoms, or other risk factors. Despite this, many young people remain unaware or avoid screening due to fear or embarrassment. Insurance limitations and lack of awareness also prevent people from getting screened, but Dr. Parikh said the biggest challenge is the persistent stigma. “If you mentioned farting to my 8-year-old, they love it — but yet then we can’t fart in public for the next 40 years of our life,” he observed. The deaths of actors Chadwick Boseman in 2020 at age 43 and James Van Der Beek in February 2025 at age 48 have brought some public attention to the disease, but doctors say much more needs to be done to normalize conversations about colorectal health.

A rising toll that demands action

The trend lines are clear: colorectal cancer is striking younger adults with increasing frequency, and the stigma surrounding the disease is costing lives. Unlike many cancers, colorectal cancer can be caught at a precancerous stage through colonoscopy or fecal tests like FIT and Cologuard, making early detection a powerful tool. “This is a cancer that if you find a polyp and you remove it, you can prevent it,” Parikh repeated. Yet the rise continues. For Black Americans like Rick Rivers, the burden is even heavier: colorectal cancer occurs more often and is more lethal in that population. As Whilden put it, the discomfort of a colonoscopy is a small price to pay. “I fell asleep afraid of what my doctor would tell me. I was scared of dying.” Her polyp was benign, but the message for her generation is urgent: talk about it, get screened, and break the silence.

The bottom line

• Colorectal cancer is the leading cause of cancer death in adults under 50, yet it is largely preventable with early screening.
• Rectal cancer deaths are rising in millennials; by 2035 it may become the top cancer killer in that age group.
• Stigma and embarrassment prevent many young people from discussing symptoms or getting screened, delaying diagnosis.
• Common warning signs include rectal bleeding, abdominal pain, changes in bowel habits, and anemia; these are often mistaken for less serious conditions.
• Screening guidelines now recommend starting at age 45, or at 20 for those with family history or symptoms.
• Personal stories from patients like Rick Rivers and Kathleen Whilden highlight the need to overcome taboo and talk openly about colorectal health.