America Needs to Talk About Poop

March is Colorectal Cancer Awareness Month, but you probably didn’t know that. Unless you work with cancer patients or actively go looking for it, the message is easy to miss. The conversation is not dominating the airwaves or social media. If I were not a surgery resident who often cares for patients with colorectal disease, I probably would not know either.

This quiet is striking given the scale of the problem. Colorectal cancer is the second leading cause of cancer death in the U.S. At the same time, colorectal cancer remains one of the most preventable and treatable cancers we face.

Even more concerning, colorectal cancer has been rising among younger adults for decades and is now the leading cause of cancer death in adults younger than 50. Because of this shift, screening guidelines now recommend that people at average risk begin screening at age 45. Yet, many people have never heard that “45 is the new 50.”

When colorectal cancer does enter the national conversation, it is often in moments of loss. The tragic deaths of actors Chadwick Boseman, James Van Der Beek, and Catherine O’Hara brought sudden national attention to the disease. These moments honor lives and remind us how devastating colorectal cancer can be. But the conversation should not depend on tragedy. Awareness should be happening more often.

This is not for a lack of effort. Extraordinary work is already happening in this space. Organizations such as the Colorectal Cancer Alliance and Fight Colorectal Cancer have spent years raising awareness and supporting patients. Fight Colorectal Cancer’s “United in Blue” installation on the National Mall displays more than 27,000 blue flags, each representing a young person who could face a colorectal cancer diagnosis in 2030. Other efforts from campaigns like “Box Out Colon Cancer” to partnerships with groups such as the NFL Alumni Association bring the message into sports, communities, and public spaces. The advocates behind these initiatives have poured enormous energy and compassion into raising awareness and supporting patients. This piece is not a criticism of their work.

The problem is that these efforts have not fully broken into the broader public conversation. Awareness works when the message is all over the place — in news coverage, on television, on social media, during sports broadcasts, and in everyday conversation. Mainstream media, public institutions, national leaders, and healthcare professionals all have a role in amplifying this message.

There is also a major societal barrier: discomfort. Talking about colorectal cancer means talking about the colon, the rectum, and poop. For many, that is why they avoid the conversation. But avoiding the conversation carries real consequence. If we want to prevent this disease or find it early, we have to be willing to talk about it directly.

In the hospital, I often meet patients who delayed seeking care because they did not realize their symptoms might be serious. Some assumed the blood they noticed would pass. Others ignored persistent changes in their bowel habits because no one had told them these could be warning signs. Delays in diagnoses are common, with up to 6 months passing between initial symptoms in young people and colorectal cancer diagnosis. By the time they arrive in a doctor’s office, the disease may have already advanced.

For healthcare professionals, this creates both an opportunity and a responsibility. We should be making sure our patients hear three simple messages:

It can be difficult to know where to start. In busy clinical environments, it is often hard to address anything beyond the immediate reason for a patient’s visit. But small actions add up, and clinicians are uniquely positioned to move this conversation forward.

Remind patients that screening saves lives. Colonoscopy is the gold standard, but other screening methods are available. Look for small ways to bring discussions about screening into routine care. When reviewing preventive health opportunities, remind patients that colorectal cancer screening now begins at age 45 and ask whether they have been screened. Place colorectal cancer awareness materials in waiting rooms.

Encourage patients to pay attention to warning signs and to look in the toilet. Blood in the toilet should never be ignored. When discussing prevention, emphasize the basics such as diets rich in whole grains, fruits, vegetables, nuts, seeds, and high in fiber. Mention the importance of avoiding alcohol and tobacco, and in limiting red and processed meats. And of course, highlight the importance of regular physical activity and maintaining a healthy weight.

Outside the clinic, there are opportunities everywhere. Mention Colorectal Cancer Awareness Month in conversations with loved ones and members of your community. I recently mentioned it to a rideshare driver, which led to a long discussion about screening and prevention.

Share information through social media. Encourage your hospitals and clinics to recognize Colorectal Cancer Awareness Month with visible displays. Work with professional societies to amplify public education campaigns year-round. When I proposed the idea of a patient education page on early-onset colorectal cancer, the American College of Surgeons convened a working group that helped develop the resource. Professional organizations can be powerful partners in spreading information.

These actions may not move the needle on their own. But taken together, they help bring colorectal cancer into everyday conversation. Although March offers a moment to focus attention on colorectal cancer, this work should not be confined to a single month. Patients continue to develop colorectal cancer every day, and driving awareness must be ongoing.

People cannot act on information they have never been given. The advocates, survivors, and organizations already working in this space are doing extraordinary work. We as healthcare professionals should see ourselves as part of that effort.

Until that changes, too many people will continue to learn about colorectal cancer after it is already too late.

Diego Schaps, MD, MPH, is a resident physician in general surgery at Duke University Health System and a member of the American College of Surgeons Early Onset Colorectal Cancer Task Force. These opinions are held by the author and do not represent any position held by the U.S. government, the Department of Veterans Affairs, or Duke University.

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