Aim In recent decades the incidence of early onset colorectal cancer (EOCRC) occurring in those aged under 50 years has been sharply increasing. The largest predictor of survival is stage at diagnosis, therefore finding ways to diagnosis EOCRC at an early stage should be a focus of clinicians and policy makers. For over 30% of EOCRC cases, by the time symptoms develop, they already have metastatic disease. While Improving diagnostic pathways in symptomatic patients is clearly beneficial, this only leads to improved outcomes in a minority of patients. Methods The aim of this study was to assess the impact of international screening trends on EOCRC incidence and review the literature to assess the role of screening in those under 50 years of age. Results Screening with FIT and colonoscopy, has been proved to be effective in those under 50 years of age. Modelling suggests that this method to be cost effective from as low as 40 years of age, and there is evidence that some countries screening below 50 have prevented the rise in EOCRC incidence. The use of new and novel non-invasive biomarkers may also be able to improve the accuracy of screening asymptomatic patients. Conclusion In the patient population under 50 years of age, focusing on symptomatic patients is missing an opportunity for better outcomes. Reducing the age to start FIT screening in younger patients is the best way to improve outcomes in EOCRC.