No one ever told Rick Rivers that his grandfather died of colorectal cancer — not until Rivers was diagnosed himself at 31. In his family, cancer was a taboo topic, especially cancers involving intimate parts of the body. “There’s a shame factor to talk about certain areas of your body and them not functioning the way that they’re supposed to,” says Rivers, a father of three in Williamstown, N.J.
That silence matters: colorectal cancer occurs more often and is more lethal among Black people, and its incidence is rising, making it the cancer most likely to kill people under 50. Dr. Neil Parikh, a gastroenterologist at Hartford Hospital, finds the trend baffling because colorectal cancer is largely preventable. Tumors typically take years to develop, and routine screening — colonoscopies or at-home fecal tests like FIT or Cologuard — can detect precancerous polyps or early cancers when treatment is relatively straightforward.
“This is a cancer that if you find a polyp — a little pimple on the inside — and you remove it, you can prevent it,” Parikh says. Yet screenings are underused. Insurance limits, lack of awareness and, importantly, stigma around discussing bowel habits all reduce screening and delay diagnosis. Parikh bluntly sums up one solution: “We need to talk more about poop.”
That reluctance to discuss symptoms is strongest among younger adults. Parikh notes the odd cultural pattern: kids find bathroom talk hilarious, then many adults avoid discussing bowel function for decades, while older relatives often freely complain about constipation. Clinically, people in their 30s and 40s are less likely to report warning signs such as bloody stools or changes in bowel regularity. “The last time another 40-year-old told me they had a good bowel movement … that’s a rare conversation,” he says.
The consequences can be severe. A Colorectal Cancer Alliance survey shows young patients’ symptoms are often ignored, delaying diagnosis. Michael Sapienza, the Alliance’s CEO, stresses self-advocacy: people under 45 who have symptoms or a family history should press for testing. Under current U.S. Preventive Services Task Force guidance, routine preventive screenings typically start at age 45, so younger patients often must ask that an exam be ordered as diagnostic care — which can lead to out-of-pocket costs or extra insurer authorization. Many don’t pursue that route because of time pressures, family responsibilities and the discomfort of raising the topic.
Rivers, 13 years and many major surgeries after his diagnosis, is now cancer-free and works to normalize conversations about screening among peers. He finds persuading someone to get tested often requires building trust and framing the message around what a person values — for example, emphasizing the desire to live for one’s children. “Speak to that thing that they value most and that they want to keep in their lives,” he says. That tailored approach has helped him convince several friends and parents at his judo dojo to get screened.
Advocates say increasing open, stigma-free conversation about bowel health — and encouraging symptomatic younger adults to request diagnostic testing — could catch cancers earlier and save lives.