Last April, after his regular fitness routine, Chris Kowalski felt discomfort in his stomach and rib area. The Hanover father of two contacted his primary care doctor at Mass General Hospital.
A CT scan revealed stage 4 colon cancer that had spread to his liver. He was 36.
Kowalski was in disbelief. He was healthy, young and had minimal symptoms, a two-sport Boston College graduate who still works out daily.
“When you hear something like that … the word ‘cancer,’ you’re like, ‘Am I going to die in the morning?’” he said.
Kowalski is among a growing number of people under the age of 50 being diagnosed with colorectal cancer in the U.S. The American Cancer society estimates there will be 159,000 new cases of such cancers in the U.S. in 2026, a number that’s fallen over the past few decades largely due to better screening.
But cases in people under age 50 are rising 3% annually, and are often being diagnosed at advanced stages. Many of those recently diagnosed had no symptoms beforehand, and no one knows why the incidence of cases in younger people is rising.
Dr. Leon Pappas of Mass General Brigham Cancer Institute, who is Kowalski’s oncologist, said early detection through screening is critical.
“Unfortunately, we’re seeing increasing incidents of colorectal cancer in young people. And because the screening age is 45, often people haven’t had a colonoscopy yet,” he said. “The earlier that you discover any cancer, the more chances you have for a better response and potentially cure, including colon cancer.”
In Kowalski’s case, he said his first thought after being diagnosed was to talk to his wife about it. “She helps keep me in the fairway, as I call it,” he said.
His wife, Erin, was pregnant with their second child at the time.
“The hardest part of this has been watching how it impacts the kiddos, I think. We try our best to not let this impact them. But knowing what we know, it’s going to,” she said.
‘I hadn’t been ill’
In July 2022, Tracy O’Rourke of Worcester was diagnosed with rectal cancer after a routine colonoscopy screen, despite having no symptoms or family history. She was 47.
O’Rourke used an over-the-counter stool DNA test that requires no special prep or diet change. The diagnosis came as a big shock.
“I did not have any symptoms at all. I didn’t have any stomach pains. I hadn’t been ill,” O’Rourke said.
She underwent chemotherapy, radiation treatment and surgery to remove a large tumor in her rectum at UMass Memorial Medical Center.
Dr. Justin Maykel, chief of colon and rectal surgery at UMass Memorial Medical Center, said that recently, “there’s been a lot of attention to the increased incidence of colorectal cancer in patients under age 50.”
The recent deaths of actors James Van Der Beek at age 48, and Chadwick Boseman at age 43, both from colon cancer, have shone a bright light on the disease.
“People are diagnosed in their 40s, in their 30s, and then even in their 20s.” Maykel said.
“Why is that happening? We don’t have a great answer, to be honest with you,” he said.
He said that lifestyle factors like diet and inactivity may play a role. Other risk factors include family history — particularly in a first-degree relative — and there’s a higher risk in certain ethnic groups including African-Americans and Native Americans.
Screening guidelines were lowered to the age of 45, but colon cancer remains one of the most preventable cancers.
O’Rourke later had surgery after the cancer spread to her lung and is now in remission.
“You never know when you’re going through this what’s going to happen, there are no promises, nothing is 100%, ” she said.
O’Rourke stresses staying positive and getting screened.
“I just want to talk about it. If it’s one person that I can talk to, I feel like, okay, my day is complete,” she said.
Likewise, Kowalski says he’s pushed nearly 500 people to get screened. His inspiration in spreading the word about colorectal cancer is none other than Pete Frates of the Peter Frates ALS Foundation and creator of the Ice Bucket Challenge.
While at Boston College, Kowalski said that Frates was the captain of his baseball team. That was long before Frates was diagnosed with ALS.
A year after his diagnosis, Kowalski is in a clinical trial alongside chemotherapy and has responded well. He hopes to spread the word about the prevalence of the disease, and the importance of catching it early.
“If what happened to me happened to me, it can happen to anybody,” Kowalski said.
