To Secretary Kennedy:

On behalf of the colorectal cancer community including patients, families, researchers, and healthcare providers across the nation, we write to emphasize the concerns you raised in your recent appearances before both the House Appropriations Committee and the Senate Health, Education, Labor and Pension (HELP) Committee, about the sharp rise in early onset colorectal cancer (EOCRC). Once considered a disease primarily affecting older adults, colorectal cancer is now increasingly diagnosed in individuals under the age of 50. This trend is alarming and demands immediate federal attention and investment.

As you continue to spotlight rising cancer rates in younger Americans, we urge a clear distinction between pediatric and early-onset colorectal cancer, both concerning, but biologically and clinically distinct.

Pediatric colorectal cancer, diagnosed in individuals under 18, is rare, estimated at 150 to 200 cases per year in the U.S. These cases often present at advanced stages and require pediatric-specific research and care protocols.

EOCRC affects adults under 50 and is increasing at an alarming rate, growing 1–2% annually since the mid-1990s. In 2023, colorectal cancer became the leading cause of cancer death in men under 50 and the second in women. More than 19,500 Americans under 50 were expected to be diagnosed last year alone.

Both trends underscore the urgent need to invest in understanding why this is happening. Sustained federal investment in research is critical. We need to identify the drivers of EOCRC to develop effective prevention and treatment strategies. We share your goal of addressing our nation’s food supply and addressing chronic diseases as obesity and certain dietary habits have been among the variety of potential factors linked to the rise in EOCRC. Proposed cuts to research funding and staffing threaten to halt progress and undermine years of advancement.

In the HELP Committee hearing, Senator Patty Murray shared about a young stage IV colorectal cancer patient named Natalie attempting to access an NIH clinical trial. Natalie’s journey illustrates not only the systemic challenges patients already face when accessing clinical trials, but also the devastating impact that cuts to federal research funding and staff have on patient care. We cannot afford to go backward. We hope to work with you to expand trial access so patients like Natalie can benefit from the best available science.

It is also important to note that the rising trends in EOCRC are occurring even as overall incidence in older populations has declined due to screening efforts. Colorectal cancer is one of the few cancers that can be prevented with timely screening. Screening for colorectal cancer can prevent cancer by removing polyps before they develop into cancer and prevent death by finding cancer earlier when it is more responsive to treatment. In 2021, in response to the increase in EOCRC, the U.S. Preventive Services Task Force lowered the recommended screening age for average risk patients from 50 to 45. This change helped millions more people have access to life-saving colorectal cancer screening.

Additionally, programs like the CDC’s Colorectal Cancer Control Program (CRCCP) are critical to help increase colorectal cancer screening rates in communities most in need. The CRCCP works with local clinics and health systems that serve populations with low colorectal cancer screening rates. From 2015-2024, clinics that participated in CRCCP for at least two years saw improvements in their screening outcomes. When looking at their most recent year of participation, clinics reported a 20% increase in the proportion of patients up to date with CRC screening rates. From 2009-2020, the CRCCP was associated with 806 less CRC diagnoses (primarily late-stage cancers) and averted 392 CRC deaths.

We have made important progress in colorectal cancer research and screening, but there is still much more work to be done. We urge you to lead efforts at HHS to:

Thank you for your attention to this critical challenge. We stand ready to serve as a resource to you and your staff and look forward to working together to change the course of this disease.

Sincerely,

• AliveandKick’n
• American Cancer Society Cancer Action Network
• American College of Gastroenterology
• American Gastroenterological Association
• American Society for Gastrointestinal Endoscopy
• American Society of Colon & Rectal Surgeons
• Association of Black Gastroenterologists and Hepatologists (ABGH)
• Big Mike’s Bottom Line
• California Colorectal Cancer Coalition
• CancerCare
• Cancer Support Community
• Cheeky Charity
• Collaborative Group of the Americas on Inherited Gastrointestinal Cancer (CGA-IGC)
• Colon Cancer Coalition | Get Your Rear in Gear
• Colon Cancer Prevention Project
• Colon Cancer Stars
• Colorectal Cancer Alliance
• Colorectal Cancer Equity Foundation
• CoxHealth Foundation
• Digestive Disease National Coalition
• Fight Colorectal Cancer
• Georgia Center for Oncology Research and Education
• GH Foundation
• GI Cancers Alliance
• Global Colon Cancer Association
• Hitting Cancer Below the Belt
• Missouri Colorectal Cancer Roundtable (MCCRT)
• Nevada Cancer Coalition
• PALTOWN Development Foundation/COLONTOWN
• Prevent Cancer Foundation
• Raymond Foundation
• Tell 5 Friends Foundation
• The Blue Hat Foundation
• The Gloria Borges WunderGlo Foundation
• United Ostomy Associations of America