Rick Rivers didn’t learn that his grandfather had died of colorectal cancer until Rivers himself was diagnosed at 31. In his family, cancer was hush-hush, especially cancers involving intimate body parts. That silence, he says, delayed conversations that might have helped catch disease earlier.
The quiet matters. Colorectal cancer is rising, is more deadly among Black people, and has become the cancer most likely to kill people under 50. That trend puzzles clinicians because much colorectal cancer is preventable: tumors usually take years to form, and routine screening — colonoscopy or at-home stool tests such as FIT or Cologuard — can find precancerous polyps or early cancers when treatment is simpler and more effective.
Dr. Neil Parikh, a gastroenterologist, puts it plainly: remove a tiny polyp and you can prevent cancer. Yet screening remains underused. Insurance coverage rules, limited awareness and, crucially, stigma about talking about bowel habits all suppress testing and delay diagnosis. Parikh says cultural shifts play a role: children joke about bathroom topics, many middle-aged adults avoid such talk, and older relatives often complain openly about constipation. People in their 30s and 40s are particularly unlikely to mention warning signs like blood in the stool or changes in bowel regularity, so symptoms can be missed.
When young patients’ complaints are ignored, the consequences can be severe. A survey from the Colorectal Cancer Alliance found that symptoms reported by younger people are often dismissed, causing delays in diagnosis. Michael Sapienza, the Alliance’s CEO, urges people under 45 who notice symptoms or who have a family history to push for testing. Under current U.S. Preventive Services Task Force guidance, routine screening generally begins at age 45, so anyone younger often has to request diagnostic testing — a path that can trigger out-of-pocket costs or require special insurer authorization. Many avoid that hassle because of time constraints, child care or simply the discomfort of bringing it up.
Rivers, now cancer-free after multiple surgeries, works to normalize screening conversations among his peers. He says persuasion often requires trust and framing the message around what someone values — for example, the desire to be there for their children. That practical, personalized approach has helped him convince friends and parents at his judo club to get screened.
Advocates say the solution is straightforward: normalize open, stigma-free conversations about bowel health and encourage symptomatic younger adults to ask for diagnostic testing. More frank talk could mean earlier diagnoses, fewer advanced cancers and lives saved.