Twelve years into this job, I still remember the first time I told a 29-year-old man he had stage three colon cancer. I remember it because back then, it felt like a fluke, a one-in-a-million case. It isn't a fluke anymore. I now see patients in their late twenties and thirties on a fairly regular basis, and if you'd told me during my training this would be routine, I wouldn't have believed you.
Studies from Indian cancer centers have found that roughly a third of colorectal cancer patients walking through the door are under 40. In the West, that figure is a fraction of that. One retrospective study out of Eastern India put the median age of these 'young' patients at just 30, with some as young as their early teens. This isn't a rare exception showing up once a year. It's a third of my operating list.
And here's a detail that should worry you more than the raw numbers: Indian patients under 40 are more likely to have the disease show up in the rectum rather than higher up in the colon, and more likely to have an aggressive cell type called signet-ring histology, the kind that doesn't respond as predictably to treatment.
On top of that, Lynch syndrome, a hereditary condition that sharply raises colorectal cancer risk, shows up in an estimated 10 to 15 per cent of Indian patients, compared to under 5 per cent in Western populations. If cancer runs in your family, that's not a footnote. That's a reason to get screened years, sometimes decades, earlier than the standard guidelines suggest.
Zoom out to the national picture and it gets no less unsettling. India's own cancer registry data shows colorectal cancer incidence rose by over 20 per cent between 2004 and 2014, with the increase concentrated specifically in people under 50. It's already the sixth leading cause of disability-adjusted life years lost to cancer in the country and yet, unlike breast or cervical cancer, it still isn't part of any national government screening program. The Northeast and southern states currently carry the highest burden, but that's a regional detail, not a reason for anyone elsewhere to relax.
Why is this happening here specifically? Nobody has one clean answer, but the ordinary consequences of a country changing fast. India's diet has shifted hard toward processed food, refined carbs, red meat, and sugary drinks in a single generation. Physical activity has dropped as jobs move indoors and commutes move into cars. Add India's young population pyramid: simply put, we have far more people in their twenties and thirties than most Western countries do and you get more raw cases in that age bracket even before you account for lifestyle.
What worries me most, though, isn't the biology. It's the delay. Indian studies consistently show young patients are diagnosed at a more advanced stage than older ones, not because the disease behaves differently, but because nobody suspects cancer in a 32-year-old with stomach pain. Rectal bleeding gets called piles. Fatigue gets called stress. And this is a cancer where stage matters enormously: caught early, survival runs above 90 per cent. Caught late, it's an entirely different conversation.
So yes, be concerned, not panicked, but attentive. Persistent bleeding, bowel habits that won't settle, unexplained weight loss, or pain that lingers for weeks deserves a real appointment, not a guess. And if a parent or sibling has had this cancer, say so out loud to your doctor; it changes everything about when you should start looking.
I've operated on people who spent a year being told they were too young for this. Age was never the diagnosis. It was just the excuse. Don't let it be yours.
(The author is a senior consultant, surgical gastroenterology, bariatric and GI oncology at Manipal Hospital, Sarjapur)
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
