Young adults with colorectal cancer face delays, unequal access to care

Colorectal cancer was once considered a disease of older adults. That assumption no longer holds. Diagnoses among people younger than 50 continue to rise across the United States — and for many of these younger patients, the challenge is not only confronting cancer at an unexpected stage of life, but navigating a health care system that does not treat all patients equally or promptly.

Research led by Meng‑Han Tsai, PhD, an assistant professor at the Georgia Prevention Institute at Augusta University, shows that young adults with colorectal cancer frequently experience treatment delays, uneven access to care and significant differences in survival. Together, her studies reveal how race, sex, geography and long‑standing socioeconomic factors can shape outcomes — sometimes before treatment even begins.

“Early‑onset colorectal cancer is no longer rare,” Tsai said. “What we’re seeing is that social and structural factors play a major role in determining who is diagnosed early, who receives timely treatment and who ultimately survives.”

In one national study examining patients under 50, Tsai and her colleagues found that many young adults waited more than 90 days to begin treatment after diagnosis — a delay long enough for cancer to progress. These extended waits were more common among young men and among Hispanic, Asian/Pacific Islander and Black patients. Notably, delays often occur in urban areas, challenging the assumption that proximity to health care facilities ensures timely care.

“Access isn’t just about distance,” Tsai said. “Insurance coverage, referrals, care coordination and system‑level barriers can significantly slow treatment, even in cities with major medical centers.”

Delays were only part of the picture. Additional research showed that young men and Black patients had poorer survival overall, regardless of when treatment began. For Hispanic, American Indian/Alaska Native and Asian/Pacific Islander patients, delays further increased the risk of death, pointing to layered inequities that compound over time.

“These patterns suggest that the same delay doesn’t affect every patient the same way,” Tsai said. “Existing disparities magnify its impact.”

Geography also played a critical role. In an analysis focused on Georgia, Tsai’s team found that young adults living in rural areas or communities affected by persistent poverty had significantly worse outcomes. Patients ages 30 to 39 living in rural, impoverished regions faced some of the highest risks of death from colorectal cancer.

“When communities have been under‑resourced for decades, it shows up in survival,” Tsai said. “Cancer exposes those gaps very quickly.”

Another study added an important dimension: when and how colorectal cancer develops in younger patients. Using national cancer registry data, Tsai and her colleagues found that racial and ethnic minority patients were more likely to be diagnosed at much younger ages — particularly between 20 and 29 — and at later stages of disease compared to non‑Hispanic White patients.

These younger patients were also more likely to have aggressive tumor subtypes, including mucinous and signet ring cell cancers, which are harder to treat and associated with poorer outcomes.

“Many young adults don’t meet current screening guidelines, and their symptoms are often dismissed or misattributed,” Tsai said. “By the time cancer is identified, it can be more advanced and more aggressive.”

Across all age groups studied, Black patients consistently faced a higher risk of death from colorectal cancer, reinforcing that disparities persist even after accounting for clinical factors.

Tsai’s research also revealed differences in the treatments patients ultimately received. Young men were less likely to undergo surgery. Black and Hispanic patients living in urban settings were less likely to start treatment at all. Meanwhile, American Indian/Alaska Native and Asian/Pacific Islander patients in rural areas were less likely to receive radiation therapy — a key component of care for many colorectal cancer patients.

“These are not small differences,” Tsai said. “Receiving the right treatment at the right time can be the difference between survival and poor outcomes.”

Tsai’s work paints a clear picture: young adults with colorectal cancer do not experience the disease — or the health system — in the same way. Disparities can emerge at diagnosis, intensify during treatment and persist through survivorship.

“As early‑onset colorectal cancer continues to rise, we need systems that recognize symptoms sooner, reduce delays and ensure that care is delivered equitably,” Tsai said. “Improving survival means addressing both the cancer and the conditions surrounding it.”

The research was supported in part by a pilot grant from the Career Enhancement Core of the Augusta ROAR SCORE grant program.

As the number of young adults diagnosed with colorectal cancer continues to rise, Tsai’s work highlights an urgent reality: progress will depend not only on medical advances, but on ensuring that every patient can access timely, high‑quality care when it matters most.