Last year, an American Cancer Society (ACS) statistical report found that cancer rates for people under 50 were increasing—with an uptick in colorectal cancer diagnoses, in particular, causing concern. Colorectal cancer, 30 years ago, was the fourth leading cause of cancer death for women under 50; now, it’s the second leading cause of cancer death for women in the same age bracket.
“The percentage of colon cancer cases among young people under the age of 55 has doubled,” Katie Couric, founder of Katie Couric Media and Stand Up To Cancer, shared at the SHE Media Co-Lab at SXSW. She quoted a statistic from a TIME magazine report: “today’s young adults are about twice as likely to be diagnosed with colon cancer and four times as likely to be diagnosed with rectal cancer as those born around 1950.”
Couric headed to Austin, Texas to find out why—and identify steps women can take across their lifespan to prevent colorectal cancers and catch them earlier. She was joined by Dr. Nancy You, a surgeon and director of the Young-Onset Colorectal Cancer Program at the University of Texas MD Anderson; Dr. Susan Bullman, an associate professor of gastrointestinal medical oncology at Anderson; and Julie Smolyansky, CEO of Lifeway Foods.
“We’re definitely, unfortunately, seeing more and more young people—who are in the middle of building a career, forming relationships, raising children—who get diagnosed with colorectal cancer,” explained You. “Sadly, most of these patients are already stage three or four at diagnosis.”
The ACS report in 2024 observed that only one in three people diagnosed had a family history or genetic predisposition to colorectal cancers. You said up to 80% of her patients don’t have a predisposition. Couric revealed last year that she is genetically predisposed to colon cancer—but her husband, Jay, whom she lost to colon cancer when he was just 42, was part of the majority of patients with no predisposition.
“Cancer is a complex disease,” You asserted. “It’s really hard to pinpoint one smoking gun, and often it’s not one single thing. It’s going to be several things that probably work together.”
The ACS predicted that the rise in colorectal cancers “likely reflects changes in lifestyle exposures that begin with generations born around 1950.” You ceded that unknown factors that haven’t yet been discovered, including environmental factors like microplastics, could, alongside factors like sedentary lifestyle, drinking and smoking, increase colorectal cancer risk.
Dietary choices that impact our microbiomes can also play a major part in our gut health.
“When we refer to our microbiome, we’re talking about the community or collection of microorganisms that reside on and within our bodies,” Bullman explained. “Most of these are bacteria—but also include fungi, viruses, archaea—and they begin colonizing our body from the moment we’re born and remain with us throughout life, but their composition changes.”
And 99% of our microbiome is within the gut, specifically the colon, where microbes “set the stage for dynamic interactions in human health, including digestion, production of vitamins and priming our immune system and also disease.” While it isn’t possible to eliminate all “bad bacteria” from the gut, we can assist the body in maintaining a balance of microbes by eating probiotics, which diversify microbiomes and prevent bacterial infections that would otherwise damage the gut barrier.
“When you’re eating food, you’re not just eating food for your body, but you’re also feeding your microbiome,” Bullman said. “These microbes within our gut, they are relying on you to supply them with nutrients—and most of the beneficial microbes, like certain types of carbohydrates, so that they can produce short chain fatty acids that help the gut.”
Unfortunately, grocery stores today are stocked with ultra-processed foods that do just the opposite, leading to inflammation and even hyperpermeability, or leaks, in the gut.
You can find out if a food is ultra-processed by glancing at its nutrition label. The first red flag is a lengthy ingredients list, full of things you probably can’t pronounce or define. “They’ll have things listed like chemical modifiers, additives,” Bullman pointed out. “You’ll see things like emulsifiers, stabilizers, artificial flavors, sweeteners and they have very little nutritional value.”
Those ingredients add convenience. “They’re ready to eat,” Bullman added. “You can eat them on the go, and they’re usually hyper palatable, they’re very tasty, because they’re packed full of sugars and salt.” She listed “snack foods, cookies, candies, crackers,” and even meats like sausages and chicken nuggets as examples of shelf-stable, ultra-processed foods. (The protein bars, powders and drinks we’ve been encouraged to incorporate into our diets, she said, also come at great cost to our gut health.)
Ultra-processed foods are modern inventions. Smolyansky’s family, however, has been cultivating gut health for centuries through much more natural means. ”Kefir was something that was passed down, generation to generation, for over 2,000 years,” she shared. “Our ancestors consumed it in the Caucus Mountains. It was passed down from babushka to babushka, grandmother to grandmother, and it survived by the word of mouth.”
Kefir is a fermented dairy drink that Smolyansky’s family, who came to the U.S. from Ukraine, has been selling since 1986 under the Lifeway brand. After inoculating the milk with 12 unique cultures for 18 to 24 hours at room temperature, the drink, which is pasteurized after fermentation, gets a “bubbly, tangy taste”—complete with 50 billion live microbes. (Typical yogurt, Smolyansky noted, contains four cultures.)
“My ancestors, intuitively, in their gut, experienced a sense of well being,” Smolyansky enthused. “They lived past 100 years of age, and they attributed their longevity to the consumption of kefir.”
Smolyansky’s family was inspired by the work of Dr. Élie Metchnikoff, a Nobel-winning gerontologist who who championed the health benefits of consuming fermented milk kefir. The CEO is also celebrating a more recent study by Mass General Brigham, which followed patients who consumed fermented dairy regularly, and found that they were less likely to be diagnosed with colon cancer over a 30-year span.
Bullman added that numerous other studies demonstrated that a diverse gut microbiome had positive impacts on chronic disease and even cancer treatment.
“Kefir helps you grow a good gut garden,” Smolyansky raved. “It keeps those bacteria replenished every day. Our modern lifestyle… the processed foods, stress, social media, travel—all of that disrupts your gut biome.”
Although probiotic supplements are crowding the aisles these days, Bullman emphasized that “food is always best” when you’re looking to incorporate a diversity of microbes into your diet. That isn’t limited to fermented dairy products, although they are excellent sources of probiotics; you can also drink kombucha or add some kimchi to your plate to give your gut a good boost.
“We have become afraid of all sorts of bacteria,” Smolyansky said, encouraging folks instead to “live dirty, eat clean” and noting that antibacterial products, like soaps and hand sanitizers, impact our microbiome. “Every time you take an antibiotic, it takes six months to two years to restore your gut,” she explained. “Imagine a bathtub filled with water, and then you unplug it, and all of the water comes out—and then some people take a probiotic pill. That’s like putting a cup back into the bathtub. You really need to replenish your gut flora and rebalance that microbiome.”
“The beauty of the microbiome is that it’s modifiable,” Bullman remarked. “We can take control by eating healthily, avoiding the ultra-processed foods, incorporating whole foods and fermented foods into our diet.” (Fiber, she added, is also “huge,” as is exercise.)
Colorectal cancer screening, no matter your diet and lifestyle, also remains critical. Although the recommended screening age was lowered to 45, Couric learned that only 20% of people aged 45 to 49 are actually getting screened. Experts are also debating whether the age needs to come down more to better mitigate risk.
“When we talk about screening, we’re talking about subjecting a whole population of patients who are asymptomatic to a particular test, and that’s why the age to start screening is such a hard thing to move, because it impacts the whole society and whole population,” You explained—but she observed that women can still remain vigilant and advocate for their colorectal health. “I always distinguish diagnosis from screening. You can have a symptom at any age. The key there is, if you have a symptom, we’re not talking about screening. We’re talking about diagnosis, at whatever age that comes. Don’t delay, don’t wait… Be your self-advocate and really push for the diagnostic test.”
You added that we also need to have more conversations about gut health—and get comfortable confronting the dirty details of colorectal health. “As a culture, we need to be less shy about talking about our poop,” she asserted. “We’re probably more likely to go to a coffee with a friend than call a physician to look into the blood that’s in our stool.”