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Colorectal cancer mortality rates have increased for white patients ages 30-54 years over the last few decades, as reported this week in JAMA. Granted, this is largely driven by a surge in incidence in younger populations which outweighs modest contemporaneous gains in survival outcomes. Nonetheless this is surprising (and disheartening) for a number of reasons, not least of which is that this time frame coincides with the emergence in the 1970s of colonoscopy screenings starting at age 50. There is no clear reason behind the growing incidence in younger decades of life, though some postulate obesity prevalence may contribute--especially to clusters seen in the South and along the Mississippi River. Ultimately we really don’t know how to explain this, other than sooner or later it comes down to fate.