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New study reinforces message not to ignore red flag signs and symptoms of bowel cancer

Bowel cancer screening


  • New international analysis of nearly 25 million people under age 50 shows blood in the stool associated with a 5 to 54-fold increased likelihood of early-onset bowel cancer.

  • 1-in-9 new bowel cancer cases occur in Australians under age 50.

  • Bowel cancer deadliest cancer for Australians aged 25-44.

New international analysis of nearly 25 million patients younger than 50, across 81 studies, found the most common presenting signs and symptoms of early-onset bowel cancer were blood in the stool (hematochezia), abdominal pain, altered bowel habits, and unexplained weight loss.


Published in JAMA Network Openinearly half of individuals (45%) presented with blood in the stool, 40% presented with abdominal pain, and more than one-quarter (27%) presented with altered bowel habits, which included constipation, diarrhoea, or alternating bowel habits. The study reviewed 81 articles from 1985 to May 2023.


Blood in the stool and abdominal pain were associated with a 5 to 54-fold and 1.3 to 6-fold increased likelihood of early-onset bowel cancer, respectively.


Bowel Cancer Australia Medical Director, A/Prof Graham Newstead AM said, “In Australia, the risk of diagnosis with bowel cancer before age 40 has more than doubled since 2000ii and knowing the symptoms is only part of the solution.”


“This latest study sends a clear message to GPs and younger people of the need to have a high suspicion of red flag signs and symptoms and to work together to ensure prompt access to colonoscopy to rule out early-onset bowel cancer as an underlying cause or to improve outcomes.”

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The research authors suggest GPs put in place a 30-to-60-day follow-up visit for younger individuals to confirm whether the original diagnosis was correct, the red flag sign or symptom has resolved, or to refer for colonoscopy to exclude early-onset bowel cancer.


“Regardless of age, blood in the stool, must be investigated for possible underlying bowel cancer,” A/Prof Newstead added.


The analysis also found that delays in diagnosis were common, with the time from symptom onset to bowel cancer diagnosis ranging from 1.8 to 13.7 months, with an average of 6.4 months.


Delays were up to 40% longer for younger individuals compared to older individuals with bowel cancer, which may contribute to a greater proportion of late-stage diagnosis and increasing mortality rates.


The analysis further supports Australian research published in BMJ Openiii and BMC Primary Careiv which found younger people may spend between three months and five years seeing multiple doctors before diagnosis; make ten or more visits to GPs; with time to diagnosis up to 60% longer for younger people who are more likely to be diagnosed in later stages of the disease.


Early-onset bowel cancer is on the rise both in Australia and globally and is the deadliest cancer for people aged 25-44.

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