From the time she woke up with abdominal pain in 2020, it took Round Rock 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 the demographic.

The big picture

Due to changes in lifestyle and a greater emphasis on screenings, the overall rate of people in the U.S. who are 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 50, and the second-leading cause of cancer deaths in women under 50, according to a 2024 report by the ACS.

Dr. Andrew Miller, a surgeon for Texas Colon & Rectal Specialists’ Austin North and Round Rock locations, who also serves as chief of surgery at St. David’s Round Rock Medical Center, said this is a trend that is still being explored. However, it is something medical experts across the board are seeing.

“We are catching younger and younger people,” Miller said. “At this point in my practice, probably a third of my patients with colorectal cancer are under the age of 50. We’re not exactly sure why that is ... but it is a trend that is startling.”

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 first 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 Round Rock 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 he said 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 like colonoscopies. He and his wife, Sabra, said they would also like to see greater access to affordable screenings.

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
Quote of note

“Make [colonoscopies] affordable so people don’t spend years paying it off. A lot of people will never do it and wait until they have cancer before they ever get any kind of treatment,” said Sabra Jacobs, Round Rock resident.

Zooming in

Texas ranks 45th for the rate of people between 45-75 who have received a recommended colon screening, according to the most 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, the task force recommends people at average risk begin screening at 45, and patients are still likely to incur costs for services related to the procedure.

“I think we would all be really happy to hear that screening number moved to 40, but that’s a big foundational shift amongst a lot of bureaucracies, but hopefully over time the data will support that,” Miller said.

Access to health insurance is just one factor impacting Texas’ low rate, said Dr. Navkiran Shokar, chair of the Department of Population Health at Dell Medical School.

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

Shokar said it can be difficult for people to find a physician, arrange a timely screening, receive test results and book a follow-up colonoscopy.

“We want to help facilitate the clinical systems to support screenings, testing and treatment,” Shokar said. “We also have to work on education for patients, so they understand the need for screening and know where the resources are.”

A closer look

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%.

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,” said Amaning.

According to a 2021 report by the UPSTF, the estimated number of colorectal cancer cases averted per 1,000 individuals who begin screening at age 45 ranges from 42-61 cases.

In addition to colonoscopies, there are a variety of other noninvasive screenings helpful for early detection. Virtual colonoscopies can be done using x-rays and computer imaging to detect cancer.

At facilities such as Quest Diagnostics and LabCorp in Round Rock, fecal immunochemical tests, or FITs, can be ordered to test blood in the stool. At Any Lab Test Now in Round Rock, the facility now offers a new test that only requires a simple blood draw.

“We know colorectal cancer is preventable and can be detected early, leading to better outcomes,” Shokar said. “The way to prevent colorectal cancer is called screening, and you do it when you don’t have symptoms.”

Something to know

There are a variety of steps people can take to mitigate the risk of colorectal cancer, including:
  • Getting screened
  • Maintaining a health weight
  • Stopping smoking
  • Limiting alcohol
  • Limiting red meat to two meals a week
  • Eating more whole grains and fiber