A new national study is pointing to education level as a growing divide in colorectal cancer deaths among younger Americans. It found that rising death rates are becoming more and more concentrated among people with less education.
The study, published online this week in JAMA Oncology, examined nearly three decades of U.S. data and found that colorectal cancer death rates among adults ages 25 to 49 rose sharply for those with a high school education or less.
Researchers analyzed mortality records from 1994 through 2023 and found that more than 101,000 people in that age group died from colorectal cancer during the period. The increase in deaths over time was “largely confined” to individuals with 15 or fewer years of education.
Death rates rise fastest among least educated
Among men with 12 years of education or less, colorectal cancer death rates increased steadily throughout the study period, accelerating after 2017. Death rates among men with 16 or more years of education declined in earlier years and showed only slight increases more recently.
A similar pattern was seen among women. Significant increases in death rates occurred primarily among women with 15 years of education or less, while rates among women with higher education levels remained low.
By 2023, men with a high school education or less were nearly twice as likely to die from colorectal cancer as men with a college degree or more. The mortality gap between those groups nearly doubled over the three‑decade study period, researchers found.
Possible links to screening and awareness
Researchers said the reasons for the widening education gap are not fully understood but may reflect differences in exposure to risk factors such as obesity, diet and physical inactivity, which tend to be more common among people with lower socioeconomic status.
They also pointed to inequities in access to colorectal cancer screening and treatment, as well as delayed detection. The study did not examine screening rates directly but noted that earlier screening and treatment are key.
“We tend to see two extremes,” said Dr. Dean Tsarwhas, a gastroenterologist with Northwestern Medicine, in an interview with Straight Arrow News. “You have people who are getting screened and catching things early, and then others who don’t get checked at all and present very late.”
Screening guidelines lowered, but gaps remain
In response to rising early‑onset cases nationwide, U.S. screening guidelines were lowered in recent years from age 50 to 45 for average‑risk adults. Tsarwhas said lack of awareness and barriers such as fear of the procedure or taking time off work still prevent many younger adults from being screened.
“A lot of patients put it off. They think it’s not going to happen to them,” he said. “And then unfortunately, it’s cancer by the time we catch it.”
Colonoscopy remains the most effective screening method, he said, because it can prevent cancer by allowing doctors to remove precancerous polyps before they turn malignant.
Study highlights role of social factors
The authors cautioned that their analysis could not account for all social determinants of health, including race, ethnicity and insurance status, due to limited data. Education levels were also self‑reported or provided by family members.
Still, researchers concluded that the findings point to a growing role for social determinants of health in shaping who is most affected by colorectal cancer at younger ages.
“The increase in young‑onset colorectal cancer mortality over the past decades in the U.S. was confined largely to persons with lower educational attainment,” the authors wrote.