Colorado’s population growth doesn’t fully explain the rise, because no other cancer saw a comparable increase in deaths between 2000 and 2023. Delayed detection during the pandemic could be a factor in some cases, but until 2021, the guidelines recommended that most people not start screening until they turned 50, meaning a significant number of those who died wouldn’t have been eligible even without disruptions to health care.

The odds of being diagnosed with colorectal or dying from it increase with age, and the majority of deaths still are in older people. Even so, the death rate is trending in the right direction for people over 55, with an older person having about half the risk of dying of colorectal cancer in 2023 that they did in 2000.

“It really shows the power and the impact of colonoscopies,” said Dr. Christopher Lieu, co-lead of the gastrointestinal oncology program at UCHealth. Colonoscopies allow doctors to detect colorectal cancer at an earlier stage, and to snip out polyps before they have a chance to turn cancerous.

People who are below the screening age are more likely to be diagnosed only after they develop symptoms, such as blood in their stool; significant changes in bowel habits; abdominal pain; or unexplained weight loss. Most of the time, people with those symptoms don’t have colorectal cancer, but they should see a doctor to be sure, even if they’re relatively young, Lieu said.

“We don’t want people to ignore them,” he said.

Other states have seen the same pattern, with colorectal cancer deaths decreasing among older people and increasing in younger ones. That pushed the U.S. Preventive Services Task Force to change its guidelines for average-risk people, meaning insurance covers colonoscopies or stool-based tests without out-of-pocket costs at 45. People can also purchase a new blood test for colon cancer, but the U.S. Food and Drug Administration hasn’t reviewed how well it works, and most insurance plans won’t cover it.

“In the past 10 years, I have seen an increasing number of younger patients with advanced lesions and cancers,” Dr. Lawrence Miller, a gastroenterologist at Denver Digestive Health Specialists who specializes in colorectal cancer prevention, said in a statement. “Patients undergoing regular screening and surveillance colonoscopies substantially reduce their lifetime risk of colon cancer.”

People with a family history of cancer or genetic variants that put them at higher risk should talk to their doctors about whether to start screening earlier, Lieu said.

No one knows exactly why colorectal cancer is increasing in younger people, but the cancer has some clear risk factors regardless of age, Lieu said. People who eat a great deal of red meat, grilled meat or highly processed foods are at higher risk. So are those who drink large amounts of alcohol, smoke or have obesity, he said. Eating fruits, vegetables and other high-fiber foods offers some protection.

“If your plate has a lot of color on it, that’s probably healthy for your gut,” he said.

Researchers are still working out how diet influences risk, but the leading theory is that disruptions to the bacteria and other microbes in the intestines increase inflammation, Lieu said. When tissue has high inflammation, cells divide faster, creating more chances for mutations and cancers.

“Whenever we talk about inflammation, we talk about an environment where cancer has more of a chance to develop,” he said.

Koehler, who now volunteers with the American Cancer Society, including lobbying lawmakers to require insurance coverage for testing to determine the best cancer treatment, said he was lucky in some ways. The tumor hadn’t metastasized throughout his body, and after surgery and chemotherapy, he’s been cancer-free for 10 years.

He encouraged others with unexplained symptoms to push their doctors for testing, and people without symptoms to get screened regularly.

“I was blessed, because that pain was acute enough that I went in and they found it,” he said.

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