Episode notes
An approach episode on early-onset colorectal cancer, built on part one of the Core IM five pearls series with gastroenterologists Rachel Issaka, Xavier Llor, Samir Gupta and Joseph Feuerstein, and on the 2026 American Cancer Society statistics report and screening guideline update. Its organizing idea is a distinction worth holding onto: rising incidence in young adults changes the threshold at which you investigate a symptom, and does not change the age at which you screen an asymptomatic person. Those are different activities and conflating them is how a thirty-eight-year-old with rectal bleeding gets told to come back at forty-five. It covers the incidence and mortality numbers, the birth cohort analysis showing men born in 1995 carry four to eightfold the risk of those born in 1960, what is and is not known about causes, the red flag symptoms and the specific language that elicits them, the rule that a benign diagnosis does not close the loop, why family history fails as a filter when only a quarter of early-onset cases have one, and the 2026 ACS screening update including where the blood-based test belongs.