Colorectal cancer is already one of the Philippines’ most significant cancer burdens, yet the country still has no national screening program for it.
According to the International Agency for Research on Cancer’s GLOBOCAN 2022 Philippines fact sheet, colorectal cancer was the third most common cancer in the country in 2022, with 20,736 new cases and 10,692 deaths. The same fact sheet shows that it was the second most common cancer among Filipino men and also the second most common among Filipino women. In other words, the burden is not marginal or emerging — it is already deeply established.
Meanwhile, a 2025 Lancet Oncology analysis of colorectal cancer incidence trends in 50 countries and territories found that early-onset colorectal cancer, or disease diagnosed before age 50, increased in 27 of the 50 locations studied during the most recent decade examined. In 20 of those 27, the increase was either limited to younger adults or was rising faster in younger adults than in older age groups.
This suggests that the age profile of colorectal cancer is shifting internationally, not only in isolated settings.
That global trend has already changed screening policy abroad. According to the U.S. Preventive Services Task Force (USPSTF), colorectal cancer screening now applies to adults aged 45 years and older who are at average risk and who do not have symptoms of the disease.
Likewise, the American Cancer Society recommends that people at average risk begin regular screening at age 45.
Hence, the conversation in many countries is no longer whether colorectal cancer belongs only to old age, but whether health systems have adjusted quickly enough to a disease that is appearing earlier than many patients expect.
The Philippine Screening Gap
In the Philippines, however, the problem is not only the age at which screening begins.
According to the Department of Science and Technology–Health Technology Assessment Council (HTAC) February 2025 evidence review on fecal immunochemical testing (FIT), the country currently has no national colorectal cancer screening program. The same review states that, for equity, the Philippines needs a national screening system to improve access to early detection and prevention.
The HTAC review also notes that before organized screening programs were introduced elsewhere, most colorectal cancer cases worldwide were diagnosed at stages II and III. This distinction is critical because earlier-stage detection is linked to better outcomes, less extensive treatment, and lower mortality.
Policy movement is beginning but remains incomplete.
According to PhilHealth Circular No. 2025-0025, FIT is now the preferred first-line screening test for colorectal cancer because it is more accurate than guaiac-based fecal occult blood testing. FIT is a non-invasive stool test designed to detect hidden blood.
In parallel, the HTAC’s preliminary 2025 recommendation supports annual qualitative FIT screening for apparently healthy adults aged 50 years and above for financing by the Department of Health and/or PhilHealth.
Nevertheless, a preferred screening test is not the same as a functioning population-wide screening system.
In practice, many Filipinos still enter medical care only when symptoms push them into the clinic, not because a public screening program reached them early.
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Symptoms Do Not Wait for Screening Age
This reality is especially important for adults under 45. Screening guidelines for average-risk adults were never meant to reassure symptomatic people that they are “too young” to worry.
The USPSTF recommendation explicitly applies to individuals without signs or symptoms of colorectal cancer.
Once symptoms appear, the issue is no longer routine screening but diagnostic evaluation.
Age under 45 may matter for screening policy, but it should not cancel concern over warning signs such as rectal bleeding, persistent abdominal pain, or lasting changes in bowel habits.
The most comprehensive recent evidence on these warning signs comes from “Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer,” a 2024 JAMA Network Open systematic review and meta-analysis.
Based on 81 studies involving more than 24.9 million patients, the analysis found that:
- Nearly half of early-onset colorectal cancer patients had hematochezia (blood in the stool)
- Nearly half also reported abdominal pain
- About one-quarter experienced altered bowel habits
The study also found that diagnostic delays of four to six months from initial presentation were common.
Importantly, hematochezia was associated with at least a fivefold increased risk of early-onset colorectal cancer.
Consequently, the danger for younger adults is often not the absence of symptoms but the tendency to normalize them, postpone consultation, or assume that youth rules out serious disease.
What Filipinos Know — and Do Not Know — About Screening
The best recent Philippine evidence suggests that awareness remains limited even when willingness is high.
According to a 2024 Acta Medica Philippina study, Knowledge, Attitudes, and Practices in Colorectal Cancer Screening in the Philippines, researchers surveyed 288 household heads from urban and rural communities between January and March 2023.
The study found that:
- Only 12.2% correctly identified colorectal cancer as a tumor of the large intestine or rectum
- Only 15.6% initially knew about colonoscopy as a screening tool
These findings point to a public-health gap in which many people are expected to act early against a disease they do not fully recognize.
Nevertheless, the same study revealed a more nuanced picture.
86.1% of respondents said they would be willing to participate in a government screening program. However, willingness dropped significantly when cost became personal: only 46.9% agreed to undergo screening if they had to pay out of pocket.
The authors concluded that knowledge levels were modest and that directed educational campaigns and awareness programs could help improve public understanding.
Thus, the problem is not simply indifference. Many Filipinos are navigating a system where awareness is limited, organized screening is absent, and cost remains a barrier.
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Diet, Fiber, and the Urban Routine
The under-45 question is not only about symptoms and screening. It is also about the environment in which risk accumulates.
A 2020 Nutrients study examining 1,264 Filipino working adults found that the top sources of dietary energy were:
- Rice (35.6%)
- Pork (15.1%)
- Fats and oils (4.7%)
- Chicken (4.4%)
- Bread (3.8%)
Average dietary fiber intake was only 7.97 grams per day, roughly 30–40% of recommended intake.
In addition:
- 59.1% of participants were physically inactive
- 46.7% had a BMI above 25, indicating overweight or obesity
These findings do not prove that one urban meal pattern causes cancer. However, they describe a lifestyle combination of low fiber intake, physical inactivity, and excess weight, all factors associated with colorectal cancer risk.
Government nutrition data show the pattern persists.
According to a DOST-FNRI release on the 2023 National Nutrition Survey (published July 2025), the average Filipino household’s daily intake still relies heavily on rice, vegetables, and fish. Consumption of fruits, legumes, nuts, root crops, and whole plant foods remains low.
Rice alone contributes about 58% of total energy intake for many Filipinos.
Meanwhile, the World Health Organization recommends that adults and children older than 10 consume at least 400 grams of fruits and vegetables daily.
These figures suggest a food environment where protective plant foods remain insufficient while starchy staples dominate the plate.
International evidence reinforces this concern.
According to the World Cancer Research Fund (WCRF), there is strong evidence that foods containing dietary fibre reduce colorectal cancer risk, while red and processed meat consumption, excess body fat, and physical inactivity increase risk.
Physical activity, the report adds, reduces the risk of colon cancer.
Thus, concerns about colorectal cancer in younger Filipinos intersect with urban lifestyles shaped by sedentary work, long commutes, processed foods, and fiber-poor diets.
Men, Women, and Different Screening Barriers
Gender may also influence screening behavior.
A 2025 review titled “Gender and Sex Differences in Colorectal Cancer Screening, Diagnosis and Treatment” found clear international evidence of differences in screening participation.
Women tend to participate in colorectal cancer screening more frequently than men, although patterns vary across countries.
Men, the review noted, are more likely to exhibit “avoidant procrastination with underlying fatalism,” including beliefs such as “what you don’t know can’t hurt you.”
At the same time, screening itself may perform differently by sex.
Women may have lower stool hemoglobin levels, increasing the risk of false-negative FIT results. They are also more likely to develop right-sided colorectal cancers, which are harder to detect with stool-based tests.
Thus, the Philippine challenge is not simply one of compliance.
Men may delay screening because of avoidance, while women may face detection limitations even when they participate.
Screening behavior also depends on cost, access, and healthcare support, not merely personal discipline.
In a country that still lacks a national screening program, these differences may quietly widen, especially among adults who do not yet see themselves as part of a cancer-risk population.
The Real Risk May Be Delay
The evidence does not support panic, but it does support urgency.
According to GLOBOCAN 2022, colorectal cancer is already a major cancer burden in the Philippines.
According to the 2025 Lancet Oncology analysis, early-onset colorectal cancer is rising in many parts of the world.
Still, according to JAMA Network Open (2024), warning signs among younger adults are well documented, and delays in diagnosis remain common.
Meanwhile, the Acta Medica Philippina study shows awareness of screening remains limited, even though willingness is high.
And according to the DOST-HTAC review, the Philippines still lacks a national colorectal cancer screening program.
Thus, the issue may not be that young Filipinos are ignoring early colon cancer signs out of indifference.
Rather, many are navigating a health system and daily environment where delay is easy.
When colorectal cancer is culturally viewed as a disease of older adults, when screening is not yet widely organized, when awareness remains low, and when daily routines drift toward low-fiber diets and sedentary work, it becomes easier to dismiss symptoms such as blood in the stool, persistent abdominal pain, or prolonged changes in bowel habits.
For Filipinos under 45, the greatest risk may not be youth itself.
It may be the quiet assumption that youth is protection enough.
DISCLAIMER
This article provides general information and does not constitute medical advice. Consult your healthcare provider for personalized recommendations. If symptoms persist, consult your doctor.
Photo by Amie Bell on Unsplash
References:
Centers for Disease Control and Prevention. (2025, February 26). Screening for colorectal cancer. https://www.cdc.gov/colorectal-cancer/screening/index.html
Demb, J., Earles, A., Martínez, M. E., Murphy, C. C., Liu, L., Gupta, S., … Umar, A. (2024). Red flag signs and symptoms for patients with early-onset colorectal cancer: A systematic review and meta-analysis. JAMA Network Open, 7(5), e2413157. https://doi.org/10.1001/jamanetworkopen.2024.13157
Department of Health Technology Assessment Council. (2025, February 26). Evidence considered in the health technology assessment of fecal immunochemical test (FIT) for colorectal cancer screening. Department of Science and Technology. https://hta.dost.gov.ph/wp-content/uploads/2025/02/Evidence-considered-HTA-of-FIT-for-CRC-Screening-26-February-2025.pdf
Department of Science and Technology–Food and Nutrition Research Institute. (2025, July 3). DOST-FNRI unveils 2023 Filipinos’ state of health and nutrition. https://www.dost.gov.ph/knowledge-resources/news/86-2025-news/4067-dost-fnri-unveils-2023-filipinos-state-of-health-and-nutrition.html
Fernandez, J. K. U., Ang, V. Y. D., Lee, J. A. A., Encarnacion, R. D. C. G., Dacillo, J. J. M., Roxas, K. B. E., Bragais, M. A., Salo, M. L. J. V., Chua, C. T. A., & Domingo, M. E.
