Kidwai study flags high burden of colorectal cancer among Indians below 45

A new study published in the Indian Journal of Surgical Oncology has raised concerns over the rising burden of colorectal cancer among younger Indians. Researchers reported that almost one in three patients at the State-run Kidwai Memorial Institute of Oncology was below 45 years of age at the time of diagnosis.

The study, titled “Colorectal Cancer Trends in Younger Versus Older Adults: An Analysis from a Tertiary Cancer Centre,” analysed data from 964 patients treated at Kidwai between 2019 and 2024.

Speaking to The Hindu, corresponding author of the study, Pavan T. Sugoor, associate professor of Surgical Oncology at Kidwai, said young-onset colorectal cancer is no longer rare. “Young-onset colorectal cancer is often detected late and tends to be biologically more aggressive. This combination makes management challenging,” the doctor said.

Aggressive in young 

Of the 964 patients examined, 279 (28.8%) were under 45 years - an unusually high proportion compared to global averages. While colorectal cancer has traditionally been seen as a disease of older adults, the study noted that this trend is rapidly shifting in India.

The study found that younger patients were significantly more likely to present with aggressive histological subtypes.

“These subtypes are known to have poorer outcomes and lower five-year survival rates,” the doctor explained. He further said that younger adults showed higher rates of advanced disease at diagnosis and greater likelihood of metastatic presentation.

National trend 

According to ICMR, colorectal cancer accounts for 7% - 8% of all cancer cases in India, with over 70,000 new cases annually. Bengaluru, too, has seen a steady uptick. The study showed that the average age of diagnosis is now 50, nearly a decade younger than the Western average of 60.

“Since 2018, 30% of Kidwai’s colorectal cancer cases have been diagnosed in patients 45 years or younger, a majority presenting in Stage 3 or Stage 4. Our findings underline an urgent need to increase clinical awareness and consider earlier screening strategies for younger populations,” he said.

Rectal cancers formed the bulk of cases in both age groups, accounting for two-thirds (66.7%) of all tumours. The study also found no significant gender differences in tumour characteristics.

Why young Indians?

While the exact cause of this rise remains unclear, Dr Sugoor pointed to several possible contributors - changing dietary patterns influenced by western lifestyles, improved diagnostic capabilities, and possible genetic or hereditary predisposition in a subset of young patients.

Previous studies have shown that India has a smaller overall colorectal cancer burden compared with Western countries, but a higher proportion of cases occurring in younger adults, he said.

Globally, several countries have already lowered the recommended age for routine colorectal cancer screening - from 50 to 45 years - following rising incidence among younger adults.

“The study’s findings bolster the case for adopting similar measures in India,” the doctor said.

The study concluded that younger patients in India not only present more often with aggressive tumour biology but also at more advanced stages, impacting treatment options and survival. “Even young and otherwise healthy individuals should not ignore red flags such as a change in bowel habits - whether increased or reduced frequency - bleeding per rectum, persistent abdominal pain, or unintentional weight loss,” Dr Sugoor added.