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

Bowel Cancer Australia 3 mins read
  • 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 Openi, nearly 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.”

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.


- ENDS -

June is Bowel Cancer Awareness Month – Bowel Cancer Australia’s signature event to raise awareness of Australia’s second deadliest cancer and funds for the leading community-funded charity dedicated to championing what matters most to people impacted by bowel cancer and empowering everyone affected to live their best life.


Bowel Cancer Australia’s latest awareness campaign, Australia’s Deadliest, features five early-onset patients, Nina, Jake, Rachel, Kin, and Anthony to highlight the impact of this disease on younger Australians. The 60 second film can be viewed here:


Bowel Cancer Australia’s Never2Young Advocacy Agenda seeks to improve care experiences and health outcomes for younger people by championing:

  • Greater awareness: among the community and health professionals of early-onset bowel cancer.
  • Lower screening age: in response to the increasing rates of bowel cancer in younger people.
  • Prompt GP referral: to a colonoscopy for all younger people who present with symptoms that may be consistent with bowel cancer.
  • Improved pathways: that ensure timely triage, diagnosis, and treatment for younger people.
  • Better understanding: the challenges of early-onset bowel cancer to improve and tailor treatment, support, and care for younger patients.
  • Further research: into the causes of early-onset bowel cancer, that has the potential to improve survival and/or help build a path toward a cure.

[i] Demb J, Kolb JM, Dounel J, et al. Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024;7(5):e2413157. doi:10.1001/jamanetworkopen.2024.13157

[ii] AIHW 2023, Cancer data in Australia (Note: Estimates for 2023 are based on incidence and mortality projections)

[iii] Lamprell K, Fajardo-Pulido D, Arnolda G, et alThings I need you to know: a qualitative analysis of advice-giving statements in early-onset colorectal cancer patients’ personal accounts published onlineBMJ Open 2023;13:e068073. doi: 10.1136/bmjopen-2022-068073

[iv] Lamprell, K., Pulido, D.F., Arnolda, G. et al. People with early-onset colorectal cancer describe primary care barriers to timely diagnosis: a mixed-methods study of web-based patient reports in the United Kingdom, Australia, and New Zealand. BMC Prim. Care 24, 12 (2023).

Contact details:

For an interview with a medical expert or patient contact:
Stephanie Bansemer-Brown – Bowel Cancer Australia   |   0412 915 797


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