More young adults are getting bowel cancer. Is Switzerland screening too late?

Microscope screen of a colon cancer cell. Keystone / Laif Jens Gyarmaty

As colorectal cancer rises globally among adults under 50, a few countries are responding by lowering the minimum age for screening. Calls are growing for Switzerland to follow suit, but experts warn it might not be enough to tackle the real problem: low participation rates.

Almost a million people around the world die every year from bowel cancer. In 2020External link it became the second-leading cause of cancer deaths worldwide, according to the World Health OrganizationExternal link. It is the third most commonExternal link cancer in men and women in Switzerland, with around 4,500 diagnoses and 1,600 deaths each year.

The disease, also known as colorectal cancer (CRC), predominantly affects older adults. In Switzerland, for example, people aged 55 and over accounted for 86% of CRC diagnosesExternal link in the five years through 2021. But while cases among this age group have stabilised or declined in recent years, many countries, including Switzerland, have witnessed a significant rise in early-onset cases, typically defined as a diagnosis before the age of 50.

In the USExternal link, incidence rates among people under 50 increasedExternal link by 2.4% per year from 2012 to 2021. In CanadaExternal link, AustraliaExternal link and New ZealandExternal link, they have risen External linksignificantly over the last 20 years, while they have generally declined or remained stable for older adults.

In Switzerland, the incidence rate among men aged 25-29 quadrupledExternal link from 0.9 per 100,000 people in the 1992-1996 period to 3.7 in 2017-2021. For males aged 30-34, it surged from 1.6 to 6.4. A similar trend has been observed among women, although the jump has been less dramatic.

Incidence among the 20-39 age group increased significantlyExternal link in several European countries, including France, Belgium, Germany and the UK, from 1990 to the mid-2010s, a trend that has continuedExternal link.

Screening can halve bowel cancer deaths

The reasons for the increase are not yet fully understood. Some risk factors – including alcohol consumption, smoking, lack of physical activity, and diets high in red or processed meat and low in fibre – have become more common in recent decades, but studies suggest they cannot fully account for the rise.

With causes unclear, a targeted prevention strategy is also lacking. This prompted experts to focus on early detection: the aim is to catch the disease when it is easier to treat and chances of survival are the highest. Some countries, including the US and Austria, have already lowered the minimum age for screening.

In Switzerland, screening starts at 50, and it has been shown to significantly reduce the number of deaths from CRC, according to Swiss Cancer ScreeningExternal link, which monitors and promotes testing programmes. Without screening, roughly two in every 100 people in the country die from bowel cancer before the age of 80, but with screening (either via a doctor’s referral or an invitation to a programme), this drops to one in 100.

Switzerland already has one of Europe’s highest survival rates for bowel cancer, but early detection is crucial: over 90% of people diagnosed at stage I surviveExternal link five years or more, compared with under 13% at stage IV, the most advanced phase.

Read more on the challenges of getting cancer at a young age:

Bowel cancer screening and treatment

CRC develops when cells in the colon or rectum grow uncontrollably, often starting as small, non-cancerous polyps that can take years to become malignant.

Two main screening tests exist. The faecal blood test (FBT) detects hidden blood in the stool. It is a cheap and non-invasive first step that requires minimal preparation by the patient. However, it can miss non-bleeding polyps and should be repeated every two years. If blood is detected, a colonoscopy follows.

Colonoscopy is more thorough but invasive. A doctor uses a thin, flexible camera to examine the entire colon and can remove precancerous polyps immediately during the procedure. It is more costly and requires preparation (such as fasting and taking a laxative), but it is considered the gold standard. Colonoscopies are typically repeated every ten years.

If cancer is present, treatment depends on how advanced it is. Early-stage cases are typically managed with surgery alone or surgery followed by chemotherapy, while advanced cancers that have spread to other organs may require a combination of surgery, chemotherapy and radiation therapy.

Low screening participation rates

CRC symptoms – such as changes in bowel movements, abdominal pain, or blood in stools – are often subtle or absent in the early stages, making testing critical.

But “screening programmes are useless if people don’t get tested,” says Michael Scharl, chief physician at the Department of Gastroenterology and Hepatology at the University Hospital Zurich.

In Switzerland, the participation rate remains well below the 65% recommended by European guidelinesExternal link. In 2012, it was around 40%External link, and even after 2013, when basic, compulsory, health insurance began reimbursing CRC screeningExternal link for people aged 50-69, uptake barely changed. By 2017, the last figure available, it had increased to only 48%External link.

Cost inequalities

Cost is a significant barrier to testing. The price of a colonoscopy in Switzerland ranges from CHF800 ($1,000) to CHF2,500, while a faecal blood test is around CHF50.

What patients actually pay, however, varies widely, depending on insurance coverage and whether their canton runs an organised screening programme. StudiesExternal link have confirmed that higher deductibles and lack of private insurance correlate with lower screening rates.

In cantons with organised programmes, colonoscopies and faecal blood tests are nearly fully covered, with only a 10% co-payment. In others, the test counts towards the annual deductible, meaning that patients pay the full cost out of pocket, unless they have reached their annual deductible threshold, when insurance coverage kicks in.

These cost differences create uneven incentives across the country, as participation tends to be higherExternal link in cantons with organised programmes. To increase uptake, “making the test completely free for the recommended age group would be a significant incentive”, Scharl says.

Screening policies and costs in Switzerland

The Health Care Benefits Ordinance is the Swiss federal law that defines which healthcare services are covered by basic health insurance. It includes some cancer screening tests: mammography every two years for women aged 50 and over, cervical cancer screening every three years, and CRC screening between 50 and 74, either by a faecal test every two years or colonoscopy every ten years. The upper age limit for CRC screening was increased from 69 to 74 in 2025.

Each canton then decides whether to run its own organised screening programme, which usually involves sending written invitations to eligible residents to participate. In Switzerland, 15 out of 26 cantons offer organised CRC screening, and three more plan to introduce it, according to Swiss Cancer ScreeningExternal link. In the remaining cantons, screening is opportunistic: individuals are tested based on a doctor’s referral rather than through systematic invitations.

Experts call for more awareness

Beyond cost barriers, risk perception is also a factor. Screening uptake is lower among the under 60s, suggesting that adults aged 50-59 may perceive their risk as sufficiently low to forgo screening. Yet while risk does increase with age, evidence showsExternal link that screening in this age group substantially increases the chances of detecting precancerous polyps and early-stage cancers.

Philippe Groux, vice-president of Swiss Cancer Screening, calls for stronger public information campaigns. He points to the cantons of Jura and Neuchâtel as an example of their impact. “Their joint programmeExternal link is very active and informative and has one of the best participation rates,” he says.

Scharl agrees. “We need more targeted communication, perhaps via public health campaigns, to help people understand that screening matters, even at a younger age,” he says.

Policy momentum is building, but slowly

In addition to increasing participation in screening, Switzerland needs to start offering the service to people at 45 rather than the current age of 50, some experts say.

A studyExternal link led by Scharl at the University Hospital Zurich analysed around 2,800 colonoscopies and found that detection rates of CRC and precancerous polyps among the 45-49 age group were similar to those aged 50 and over, in both men and women. The results suggest that screening at an earlier age could catch as many cases as the programmes targeted at older age groups.

But Groux notes that “politicians in Switzerland are not very interested in implementing activities to promote prevention and screening programmes”. Knowledge of screening opportunities remains limited, he adds, and not just for cancer.

Swissinfo has reached out to members of the federal Social Security and Health Committee for comment, but as of publication time has received no response.

Cantons can decide whether to run an organised screening programme, but the age groups covered by basic health insurance are defined at the federal level.

There are signs that changes to the basic health insurance law to lower the screening age are being considered, Groux says. “Some discussions have begun at the political level, but no decision has been made yet.”

At the cantonal level, more regions are examining whether to introduce organised screening programmes. In 2024, Zurich’s parliament asked the cantonal government to consider launching a screening programme. The executive respondedExternal link that it was “reviewing feasibility and legal requirements”.

Some countries have taken action

The US Preventive Services Task ForceExternal link updated its guidelines in 2021 to recommend starting screening at 45 rather than 50. By 2023, uptake among 45- to 49-year-olds had increased External linkfrom 21% to 34% in 2019.
 
Most European countries still only begin screening at 50. In Austria, the starting age was loweredExternal link to 45 in 2023, but testing is only based on a doctor’s referral and access remains uneven across regions and facilities.

In contrast, Japan raised its recommended starting age from 40 to a range of 45-50 in late 2024.

In China, CRC screening guidelines recommend people aged 40 and over undergo a risk assessment. Those deemed high-risk are recommended for screening from age 40, while others are advised to test between the ages of 50 and 75.

In Russia and Central Asia, younger cancer diagnoses are increasingly common, but access to screening remains patchy. In Kazakhstan, for example, CRC mortality is among the highest in the region. New screening programmes have been introduced, but many patients are not diagnosed until it’s too late for effective treatment.

Read more on why treating cancer is so expensive in Switzerland:

Is more screening always better?

Cancer screening saves lives, but it comes with trade-offs, such as the risk of false positives, unnecessary procedures and higher costs for patients and healthcare systems. Overdiagnosis – the detection of slow-growing tumours that may never develop into full blown cancer – has led to hesitancy in many countries to offer breast screeningExternal link in women under 50, for example.

But CRC screening is different, especially when it involves a colonoscopy, Scharl says. “It’s the gold standard. Colonoscopies are safe and provide a clear, definitive answer,” he says.

“30% of CRC is only found at stage IV. At that point, chances of survival have dropped dramatically – the five-year survival rate is just 10-15%. This is why screening should be done when you do not have symptoms. It’s when it matters most – before the cancer even shows up.”

Edited by Nerys Avery/vm/ts