Medical
  • Research and White Papers
  • February 2026

Early-Onset Colorectal Cancer and Implications for the Life Insurance Industry

By
  • Dr. Russell Hide
Doctor pointing to a model of the colon
In Brief

Early-onset colorectal cancer is reshaping how insurers assess and manage risk, prompting shifts in underwriting, product design, and wellness strategy. This article, from RGA's ReFlections newsletter, examines how its growing prevalence underscores the need for models that better account for earlier detection, individualized risk factors, and evolving screening practices.

Key takeaways

  • Colorectal cancer incidence is rising in individuals under age 50, with rates rising about 30% over two decades, creating significant underwriting and risk assessment implications for the life insurance industry.
  • Some guidelines now recommend routine screening starting at age 45, and advances in screening and diagnostic tests are improving early detection in younger populations.
  • Insurers should consider underwriting models that incorporate lifestyle, genetic, and screening adherence data, as well as developing products that incentivize early detection and wellness, to mitigate risk and enhance product value.

 

Historically considered a disease of older adults, colorectal cancer is now increasingly diagnosed in individuals under the age of 50. This rise in early-onset colorectal cancer (EOCRC) has direct implications for the life insurance industry, impacting underwriting, risk assessment, product design, and wellness strategies.

EOCRC refers to colorectal cancer diagnosed in people younger than 50. Understanding the factors driving young-onset cases – including rising incidence in younger groups, lifestyle influences such as obesity and diet, and advances in genetic screening and early detection – enable insurers to refine risk assessment and improve product design.

Strategies include evidence-based underwriting rules, pricing that reflects emerging risks, and screening incentives and wellness-linked benefits to promote early detection and reduce claims exposure.

Epidemiology of young-onset colorectal cancer

Colorectal cancer rates in people under 50 have risen steadily over the past two decades, with increases of 30% in the age group.1 Studies indicate a year-on-year increase of approximately 2% in incidence among adults ages 20 to 50.2 11 Although absolute case numbers remain lower than in older populations, the growth trend is significant and unlikely to reverse without intervention.3

Young-onset cases often present at a more advanced stage. Symptoms can often be mistaken for benign conditions like hemorrhoids or irritable bowel syndrome, delaying diagnosis. For life insurers, these delays increase morbidity and mortality risks not captured by traditional age-based underwriting models.

Risk factors for early-onset disease

Multiple factors contribute to increased incidence of colorectal cancer in younger adults:

  • Diet and lifestyle influences, societal trends
    • High consumption of red and processed meats
    • Low fiber intake and decreased fruit and vegetable consumption
    • Sedentary behavior and obesity
  • Genetic predispositions
    • Familial adenomatous polyposis and Lynch syndrome, and genetic mutations in e.g., NTHL1, POLD1, POLE and RNF434
    • Family history of colorectal or endometrial cancer
  • Environmental exposures and co-morbidities
    • Antibiotic use influencing gut microbiome balance
    • Chronic inflammation from conditions like inflammatory bowel disease

Recognizing these risk factors can help insurers update underwriting practices and adjust predictive models to more accurately identify high-risk applicants, regardless of age.

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Revision of screening guidelines

In response to rising early-onset cases, several health organizations have lowered screening age thresholds:

  1. The United States Preventive Services Task Force (USPST) now recommends routine screening starting at age 45.6
  2. The American Cancer Society advises average-risk adults to start screening at 45 and to consider earlier screening when additional risk factors are present.7
  3. Some European nations and healthcare networks are testing guidelines for screening adults at 40, particularly if they have family history or metabolic syndrome.8

Advances in screening methods

Traditional colonoscopy remains the gold standard, but recent technological advances have expanded options for early detection:

  • Fecal immunochemical test (FIT) – A non-invasive stool test that detects occult blood. Frequent testing tends to increase acceptance and compliance by younger adults who are reluctant to undergo more invasive colonoscopy. Multi-target stool (mt-sDNA) testing combines DNA markers with FIT to improve detection rates for precancerous lesions and early-stage cancers.5
  • CT colonography (virtual colonoscopy) – Radiologic imaging that visualizes the colon. It offers a safer, non-invasive alternative to colonoscopy but requires bowel preparation similar to colonoscopy and specialized equipment.
  • Capsule endoscopy – Swallowed camera capsule that captures internal images of the gastrointestinal tract. Currently used mainly for small-bowel diseases, its role in colorectal screening is being considered.
  • Blood-based biomarkers (liquid biopsy) – Tests that detect circulating tumor DNA or methylated DNA fragments. Germline multigene panel testing (MGPT) identified a clinically actionable pathogenic germline variant in 14% of CRC patients in one study and is now recommended universally for all EOCRC patients’ cases.9 Machine-learning-enabled liquid biopsy platforms combine DNA methylation sequencing with fragment analysis to detect tumor indicators at very low titers.10 Together, these advances promise to shift detection toward preclinical phases in younger populations.
Table 1: A comparison of various colorectal carcinoma screening tools11

Tracking and understanding the sensitivity, specificity, cost, and frequency requirements of each screening method enables insurers to review underwriting requirements and guide applicants and policyholders toward the most effective, accessible options.

Underwriting implications

Earlier screening and rising young-onset incidence may impact underwriting practices in several ways:

  • Improved risk stratification – Combining family history, lifestyle factors, and screening protocol adherence provides a more accurate risk profile than age alone.
  • Adjusted premium models – Younger applicants with increased risk factors may require modified pricing or adjusted benefits. Those who follow recommended screening protocols and maintain healthy lifestyle practices could be offered more favorable assessments.
  • New data sources – Digital health records, wearable device data, and off-the-shelf genetic tests (used in underwriting only when regulations permit) can offer real-time risk indicators, enabling more precise selection and pricing decisions.

Adopting underwriting models that evolve with medical guidelines ensures insurers remain competitive and avoid adverse selection. Underwriters should be encouraged to apply enhanced risk stratification practices while remaining aware of the risks of anti-selection and information asymmetry.

Product innovation and strategic opportunity

Beyond pricing, life insurers can develop products and services that support early detection and healthier outcomes:

These value-added options can increase customer satisfaction, improve retention, and position insurers as proactive risk managers. Implementing new technologies and applying them can turn a risk trend into a strategic competitive advantage for insurers willing to adapt.

Challenges

Implementing early-onset screening programs presents several challenges:

  • Privacy and data security – Using genetic and other personal data for underwriting purposes must comply with local and general privacy regulations and laws.
  • Anti-selection – Applicants, aware of an increased risk, may selectively seek specific insurers or policies, skewing the risk pool.
  • Medical uncertainty – Recently developed screening technologies and changes in underwriting guidelines may result in rating and pricing inaccuracies.
  • Operational complexity – Incorporating new data sources, updating underwriting systems, and retraining underwriters and support staff require additional resources.

Conclusion

The rise of early-onset colorectal cancer necessitates a reassessment of underwriting practices. Insurers must apply the latest epidemiologic data and screening innovations to refine risk assessment, product design, and wellness strategies. This will not only mitigate risk exposure, but it also can help a younger demographic detect and manage disease earlier, improving survival rates and quality of life.

Now is the time to revisit underwriting guidelines, expand screening incentives, and build partnerships that advance early detection. Insurers who adopt such practices will strengthen market position and positively contribute to reversing the trend of early-onset colorectal cancer.

RGA experts are eager to engage with clients to better understand and tackle the industry’s most pressing challenges together. Contact us to learn more about RGA's capabilities, resources, and solutions.

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Meet the Authors & Experts

Russell Hide
Author
Dr. Russell Hide
Medical Officer, RGA South Africa

References

  1. Siegel RL, Torre LA, Soerjomataram I, et al. Global patterns and trends in colorectal cancer incidence in young adults. Gut. 2019; 68:2179–85. doi: 10.1136/gutjnl-2019-319511
  2. Siegel RL, Miller KD, Goding Sauer A, et al. Colorectal cancer statistics, 2023. CA Cancer J Clin.2023;73(3):233–289. doi:10.3322/caac.21715
  3. Chambers AC, Dixon SW, White P, et al. Demographic trends in the incidence of young-onset colorectal cancer: a population-based study. Br J Surg. 2020;107(5):595–605. doi:10.1002/bjs.11486
  4. Turk A, Mondaca S, Nervi B, et al. Early-onset colorectal cancer: from genetic discovery to clinical innovation. ASCO Educ Book. 2025;45: e473618. doi:10.1200/EDBK-25-473618
  5. de Klaver W, Wisse PHA, van Wifferen F, Bosch LJW, Jimenez CR, van der Hulst RWM, Fijneman RJA, Kuipers EJ, Greuter MJE, Carvalho B, Spaander MCW, Dekker E, Coupé VMH, de Wit M, Meijer GA. Clinical Validation of a Multitarget Fecal Immunochemical Test for Colorectal Cancer Screening: A Diagnostic Test Accuracy Study. Ann Intern Med. 2021 Sep;174(9):1224-1231. doi: 10.7326/M20-8270; epub 2021 Jul 20. PMID: 34280333.
  6. US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(19):1965–1977. doi:10.1001/jama.2021.6238
  7. American Cancer Society. Colorectal Cancer Screening Guidelines. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening- tests-used.html Accessed July 2025.
  8. Rex DK, Boland CR, Dominitz JA, et al. Colorectal Cancer Screening: Recommendations for Physicians and Patients from the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2017;153(1):307–323. doi: 10.1053/j.gastro.2017.04.001
  9. Sarah E. Coughlin et al. Multigene Panel Testing Yields High Rates of Clinically Actionable Variants Among Patients With Colorectal Cancer. JCO Precis Oncol 6, e2200517(2022). DOI:10.1200/PO.22.00517
  10. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget stool DNA testing for colorectal- cancer screening. N Engl J Med. 2014;370(14):1287–1297. doi:10.1056/NEJMoa1311194
  11. PDQ® Screening and Prevention Editorial Board. PDQ Colorectal Cancer Screening. Bethesda, MD: National Cancer Institute. Updated 04/10/2025. Available at: https://www.cancer.gov/types/colorectal/hp/colorectal-screening-pdq Accessed 11/21/2025. [PMID: 26389266]