From the time she woke up with abdominal pain in 2020, it took Williamson County resident Paula Rojas nearly two years to be diagnosed with colon cancer.

After she visited an emergency room to see about her pain, it took roughly four months to receive a colonoscopy. Previously, doctors told her the discomfort could be a result of pancreatitis or irritable bowel syndrome.

“They expressed to me that I was too young; I was too active,” Rojas said. “I knew it was more than that.”

In April 2022, she was officially diagnosed with Stage 3 colon cancer at age 43.

More people under 50 are experiencing Rojas’ situation, as doctors have noticed a rise in colorectal cancer diagnoses in this age demographic.

The big picture

Due to changes in lifestyle and a greater emphasis on screenings, the overall rate of people in the U.S. being diagnosed with colon or rectal cancer has dropped each year since the 1980s, according to the American Cancer Society.

Despite the overall decrease, colorectal cancer is now the leading cause of cancer deaths in men under age 50 and the second-leading cause of cancer deaths in women under age 50, according to a 2024 report by the ACS.

The incidence rate of new colorectal cancer cases among people younger than 55 years old almost doubled from 11% to 20% from 1995 to 2019, according to the ACS. In light of recent trends, the U.S. Preventive Services Task Force lowered the recommended screening age for colorectal cancer from 50 to 45 years old in 2021.

Dr. Junaid Siddiqui, a gastroenterologist at St. David’s Georgetown, said medical experts are witnessing a rise in colorectal cancer in patients under age 50 and are exploring what might be causing the trend.

“This is a problem for us, and the trend is increasing, so we have to see what’s going on,” Siddiqui said.

Meanwhile, Texas has one of the lowest rates for colon screenings in the U.S., according to data from the National Cancer Institute—another trend local health experts are hoping to reverse.

Put in perspective

Rojas celebrated one year of being cancer free on March 6. However, it did not come without undergoing multiple surgeries and 12 rounds of chemotherapy.

“I’m thankful I was able to do all the rounds; it’s too strong for some people,” she said. “I have some permanent side effects, but I’m still here.”

During her chemotherapy, Rojas had a temporary ileostomy, which requires an ostomy bag to collect waste. She said some people liken an ostomy bag to a “death sentence,” but she says it’s nothing to be ashamed of.

Rojas now advocates for more screenings and refutes associated stigmas that may cause hesitancy. That is an uneasiness fellow Williamson County resident Donavon Jacobs said he had to overcome.

His journey began when his regular physician noticed his white blood cell count was high. However, Jacobs said he was nervous about getting a colonoscopy, so it was recommended he take a Cologuard test, which is a stool DNA test.

After the results came back, he was told he needed to get a colonoscopy, which gave him pause.

“Whenever we were growing up, there were a lot of things that people didn’t talk about,” he said. “[A colonoscopy] was almost a taboo kind of topic, but like anything else, the more you learn about it, the less fearful it is.”

In late 2020, Jacobs was told his colonoscopy revealed cancerous polyps. A surgery to remove half of his colon followed.

Because the cancer didn’t spread through the wall of his large intestine, Jacobs did not have to undergo chemotherapy. His last two colonoscopies since then have come back cancer free.

Jacobs said he now recognizes the importance of screenings, such as colonoscopies. He and his wife, Sabra, said they would also like to see greater access to affordable screenings.

Prior to the screening age being lowered, Georgetown resident Scott Butler began undergoing colonoscopies at the age of 45 as both his father and grandmother were survivors of colorectal cancer.

Butler now receives colonoscopies every five years, which he said has been a relatively quick and easy process.

“It’s not a big deal,” Butler said. “Just like the fear of any medical procedure, people kind of freak out on that, but the alternative is way, way worse.”

Did you know?

Colorectal cancer warning signs include:
  • A change in bowel habits
  • Blood in or on your stool
  • Diarrhea, constipation or feeling that the bowel does not empty all the way
  • Abdominal pain, aches or cramps that don’t go away
  • Unexplained weight loss
  • Fatigue
  • Vomiting
Zooming in

Texas ranks 45th for the rate of people between the ages of 45-75 who have received a recommended colon screening, according to recent NCI data.

The Affordable Care Act requires private insurers and Medicare to cover the cost of colorectal screenings because the tests are recommended by the U.S. Preventive Services Task Force. However, patients can still incur costs related to the procedure.

A diagnostic procedure for a person younger than age 45 who has symptoms of colorectal cancer may not be fully covered by insurance, which can be a barrier in doctors catching advanced polyps in younger patients, Siddiqui said.

“A lot of times that becomes a hurdle because patients who are younger may not have resources to pay for [a colonoscopy],” he said. “A lot of times we have to push and try to find reasons and find them a way to get their colonoscopy done.”

Dr. Navkiran Shokar, chair of the Department of Population Health at Dell Medical School also said personal factors and “system complexity” may prevent people from getting screened.

Shokar said people may be embarrassed to discuss colon care or fear what a screening may discover. She said it can also be difficult for people to find a physician, make an appointment, receive test results and book a colonoscopy.

Shokar is leading an initiative called the Coordinating Center for Colorectal Cancer Screening across Texas, which is creating a statewide network of health organizations to help develop and implement a strategic plan for expanding screening resources.

Screening rates

In 2022, the percentage of people between ages 45-75 who received a recommended colorectal screening in the U.S. was 66.9%, according to NCI data. Texas, ranked 45th among states, had a rate of 61.4%. Connecticut had the highest rate at 75.3%.

Types of colon screenings
  • Fecal immunochemical test (FIT): A test to check for hidden blood in stool
  • Blood test: Requires a blood draw to detect the presence of cancer
  • Sigmoidoscopy: Used less often to examine the lower part of the colon
  • Colonoscopy: Checks the entire colon and can remove polyps
  • Virtual colonoscopy: Uses X-rays and a computer to create images of the colon
Moving forward

Dr. Judith Amaning, section chief for gastroenterology for Baylor Scott & White Health in Round Rock and Pflugerville, said colonoscopies are the “gold standard.” During the procedure, doctors can locate and remove potentially cancerous polyps.

“You don’t want to wait 10-plus years to get screened and then instead of something small that can be removed within 20-30 minutes, now you have to have surgery,” Amaning said.

According to a 2021 report by the U.S. Preventive Services Task Force, the number of colorectal cancer cases averted per 1,000 individuals who begin screening at age 45 ranges from 42-61 cases, depending on the method.

Noninvasive screening options also exist, including fecal immunochemical tests, or FITs, that test blood in the stool as well as virtual colonoscopies through X-rays and computer imaging. Additionally, new blood tests and a minimally invasive robotics system are allowing doctors to screen and treat patients in new, innovative ways.

The da Vinci 5 allows surgeons to operate on patients through smaller incisions without directly touching them, said Dr. Thiru Lakshman, medical director of the rectal cancer program at St. David’s North Austin Medical Center.

“Educating the population about [colorectal cancer] and trying to find it as early as possible allows us to either catch it early or to use these minimally invasive techniques to do the surgery, so we can get people back to a more normal lifestyle,” said Lakshman, who is also a colon and rectal surgeon at Texas Colon & Rectal Specialists.