Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death worldwide.^[1] In the United States, overall CRC incidence and mortality continue to decline. That decline comes from adults 65 years and older. Incidence and mortality are rising in adults younger than 65 years, driven mainly by distal colon and rectal tumors.^[2] Early-onset CRC (diagnosis before age 50 years) is increasing in the US and in many high-income countries.^[3] Marked racial and ethnic disparities persist. American Indian/Alaska Native and Black populations carry the highest burden.^[4]

• GLOBOCAN 2022 estimated 1,926,425 new CRC cases and about 904,000 CRC deaths worldwide in 2022, or nearly 1 in 10 cancer cases and deaths. CRC ranks third in incidence and second in cancer mortality.^[1][5]
• Incidence varies about 10-fold by region:^[1]
  • Highest rates are in Europe, Australia/New Zealand, and Northern America. Denmark has the highest rate in men and Norway the highest in women.
  • Lowest rates are in most of Africa and South/Central Asia.
• Incidence is rising in transitioning economies (Eastern Europe, South-Eastern and South-Central Asia, South America). This is attributed to Westernized diets, obesity, and sedentary behavior.^[1]
• Age-standardized incidence and mortality are higher in males than in females in every world region.^[5][6]
• Projections put annual new cases at roughly 2.4–3.2 million by 2040–2050, driven mainly by population aging and growth.^[5][6]

• The American Cancer Society (ACS) estimates 158,850 new CRC diagnoses and 55,230 CRC deaths in the US in 2026.^[2]
• CRC is the third most commonly diagnosed cancer and the second leading cause of cancer death in the US.^[2]
• In adults younger than 50 years, CRC is the leading cause of cancer death in men and the second leading cause in women.^[2][3]

Overall US CRC incidence fell about 0.9% per year from 2013 to 2022. Trends differ sharply by age.^[2]

• Nearly 45% of new US CRC cases now occur in adults younger than 65 years, up from 27% in 1995.^[2][7]
• Birth-cohort effect: each generation born since about 1950 has had higher CRC risk at younger ages than the one before.^[2][4]

• Rising incidence in younger adults is concentrated in distal colon and rectal tumors.^[2]
• After decades of decline, rectal cancer incidence has risen about 1% per year since 2018. Rectal cancer now makes up about 32% of CRC diagnoses, up from 27% in the mid-2000s.^[2][4]

• Alaska Native individuals have the highest CRC incidence and mortality of any US population. American Indian individuals have the second-highest burden.^[2]
• From 1999 to 2024, age-adjusted CRC mortality declined in every sex and racial group. Males stayed higher than females throughout. Black individuals had the highest mortality and Asian/Pacific Islander individuals the lowest.^[8]
• Screening uptake:^[4]
  • Up-to-date screening rose from about 38% in 2000 to 72% in 2023.
  • Uptake remains lower among Hispanic (56%), Asian (58%), and American Indian/Alaska Native (59%) adults.
  • Uptake is especially low at ages 45–49 years (37%) and 50–54 years (55%).

Early-onset CRC (EOCRC) is CRC diagnosed before age 50 years.

Burden

• EOCRC accounts for about 14% of US CRC cases, with about 20,805 US diagnoses in 2022.^[3]
• Worldwide there were 184,709 new EOCRC cases in 2022. CRC is the most common early-onset gastrointestinal cancer.^[3]

US incidence trends

• US EOCRC incidence has risen about 2–3% per year.^[3]
• The steepest rise is in adults younger than 40 years, from 4.1 to 5.5 per 100,000 between 2013 and 2022.^[3]
• A 50-state analysis found the rate of increase sped up from 1.27% per year (2001–2012) to 3.00% per year (2012–2017).^[9]
  • The fastest rise was at ages 20–24 years and in non-Hispanic White individuals.

Age, stage, sex, and race/ethnicity

• About half of US CRC diagnoses before age 50 occur at ages 45–49 years. This group is already eligible for screening.^[2][7]
• About three-quarters of CRC in younger adults is diagnosed at an advanced stage.^[7]
• EOCRC is more common in males (male-to-female incidence rate ratio about 1.20).^[3]
• EOCRC incidence is rising in every US racial and ethnic group. Relative increases have been especially rapid among non-Hispanic Black and Hispanic individuals.^[3]
• Compared with later-onset disease, EOCRC patients are more often Black (15% vs 11%) or Hispanic (9% vs 5%).^[3]

Global trends

• EOCRC incidence is rising worldwide, especially in high-income countries, including:^[3][10]
  • Australia, New Zealand, South Korea, Canada, and the UK
  • Several European countries
• A few countries, including Italy, Austria, and Lithuania, have seen EOCRC rates fall.^[3]
• From 1990 to 2021, global age-standardized EOCRC death and disability rates declined even as incidence rose.^[11]

Areas of uncertainty

• The cause of rising EOCRC incidence is unknown.^[4] Proposed contributors are covered in risk factors.
• Detection or reporting artifact may contribute to the rise. However, distant-stage disease is also increasing, which points to a true rise in incidence.^[12][10]
• The steepest increases are in adults younger than 40 years, who fall below current screening thresholds. Whether screening younger adults would improve outcomes is unresolved.^[3][4]

• Rising incidence in younger adults led the ACS to lower the average-risk screening start age from 50 to 45 years in 2018. The ACS reaffirmed age 45 in 2026.^[2][4]
• General-population statistics do not capture hereditary risk. For hereditary syndromes, see Lynch syndrome and Familial adenomatous polyposis.