Dr Marshall on Challenging Misconceptions About Early-Onset CRC

"It was healthy, fit, young people, [with] no family history, [who were] careful what they ate... there was a culture change that was… required."

John L. Marshall, MD, the chief of the Division of Hematology and Oncology, director of the Otto J. Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown Lombardi Comprehensive Cancer Center and a professor of medicine and oncology at Georgetown University, discussed how misconceptions about the primary drivers of early-onset CRC (EO-CRC) can hinder efforts to improve its diagnosis and ensuing disease management by reinforcing social stigma and delays in seeking medical attention.

In honor of CRC Awareness Month, Marshall joined his colleague, Christopher Lieu, MD, to examine the potential drivers behind the rising incidence of CRC in younger populations.

During the conversation, Marshall noted a significant disconnect between early institutional positions and the reality seen in clinical practice. Historically, official positions from organizations such as The American Cancer Society suggested that the rise in CRC among younger adults was primarily driven by obesity, poor diet, or family history. However, Marshall noted that his clinic was instead seeing "healthy, fit, young people"—including runners and only children—with no family history of the disease and no identifiable "bad behaviors" to explain their risk. The clinical management of these patients faces several systemic and cultural barriers.

Although efforts successfully shifted the recommended screening age down to 45, Marshall pointed out that this does not address the needs of patients in their 20s or 30s. He asserted that a "culture change" is therefore required among primary care physicians and gynecologists to ensure that symptoms like rectal bleeding in young adults are not dismissed as hemorrhoids. Insurance barriers have also complicated this process, as escalating care for a 35-year-old often faces more scrutiny than for a 65-year-old presenting with identical symptoms. Ultimately, Marshall concluded that moving past these misconceptions and barriers is vital for improving broader awareness and intervention.

To hear more exclusive insights on this alarming trend from Drs Marshall and Lieu, be sure to check out our accompanying feature.