Marathon runners have been held up as models of peak fitness. With their lean builds, strong hearts, and seemingly endless endurance, they embody the idea that extreme physical activity equals extreme health. But new research is challenging that perception. A recent study led by oncologists at the Inova Schar Cancer Institute in Virginia has revealed a surprising trend: marathon and ultramarathon runners may face a higher risk of developing colon cancer than the general population.This finding is not only counterintuitive but also potentially life-saving, raising important questions about how extreme exercise affects the body in ways that go beyond muscle strength and cardiovascular fitness.Dr. Timothy Cannon, an oncologist at Inova Schar, first noticed the potential link in his own clinic. He treated three patients, all under the age of 40, who were accomplished endurance athletes. These men and women didn’t smoke, didn’t drink, and had no family history of colon cancer. One was vegan. Yet each of them had advanced colon cancer. Despite aggressive treatment, all three later passed away.“It didn’t make sense,” Cannon explained when he presented his findings at the American Society of Clinical Oncology (ASCO) conference. “They were the kind of people we’d expect to be the least likely to develop colon cancer.”That anomaly drove Cannon and his team to explore whether there was a hidden link between extreme endurance running and colorectal cancer risk.The research focused on 100 athletes aged 35 to 50 who had completed either at least two ultramarathons (50 km or longer) or five marathons. None had family histories of colorectal cancer or traditional risk factors such as smoking, obesity, or heavy alcohol consumption. When the participants underwent colonoscopies, the results were striking:39% had at least one polyp15% had advanced adenomas, a type of pre-cancerous polypBy comparison, only about 1.2% of people in their 40s in the general population are expected to have advanced adenomas. The difference was significant and unexpected.“These were athletes who, on paper, should have been the least likely to show these warning signs,” Cannon said.Why Would Marathon Running Increase Risk of Colon Cancer?The study stopped short of proving causation, but experts have floated several theories.One explanation is that intense endurance exercise diverts blood away from the gastrointestinal tract to fuel muscles during long races. Over time, this may cause recurring oxygen deprivation in colon tissues, sparking cycles of inflammation and repair. Eventually, these repeated injuries could create an environment where abnormal cells thrive.Another possibility is that endurance athletes may ignore early symptoms of colon cancer, attributing digestive changes or abdominal pain to normal “runner’s gut.” This delay in seeking medical help could allow cancer or pre-cancerous lesions to progress unnoticed.In other words, the danger may not just lie in running itself but in the culture of endurance sports, where toughness and tolerance for discomfort are celebrated.Early-Onset Colon Cancer on the RiseThe findings come at a time when early-onset colorectal cancer is already increasing worldwide. In the United States, colon cancer is now the second deadliest cancer among young women and the deadliest among young men. Cases among Americans aged 30 to 34 have risen by more than 70% in recent decades.Globally, nearly 10% of new colorectal cancer cases are diagnosed in people under the age of 50. Researchers are still piecing together the reasons, with diet, lifestyle, environmental exposures, and genetics all under scrutiny. Cannon’s study adds another layer to the puzzle: could extreme physical activity play a role for a subset of young adults?Does this research mean you should hang up your running shoes? Absolutely not, experts say. The health benefits of regular physical activity—including reduced risk of obesity, diabetes, and at least eight types of cancer—still far outweigh the risks. The concern lies specifically with extreme endurance athletes who log hundreds of miles per year and push their bodies to their physiological limits. For these individuals, it may be wise to:Stay alert to unusual gastrointestinal symptomsSeek medical attention for persistent abdominal pain, unexplained weight loss, or blood in the stoolTalk to a doctor about earlier or more frequent colon cancer screenings, even without traditional risk factorsSo Is Exercise A Friend Or Foe?The irony is that exercise itself has been shown to reduce colon cancer recurrence in patients who have already been diagnosed. A separate three-year exercise coaching study found that participants had 28% fewer recurrences and were 37% less likely to die from any cause.This dual role of exercise protective at moderate levels, potentially harmful at extremes—underscores how complex the relationship is between physical activity and cancer risk.Cannon’s study is still preliminary. It lacked a control group, and the sample size was small. Future research will need to confirm these findings and explore mechanisms in more detail. Until then, oncologists are urging caution without alarm.“We don’t want to discourage people from exercising,” Cannon emphasized. “But we also want runners to understand that being fit doesn’t make you invincible. If something feels off, don’t dismiss it.”Marathon runners may look like the picture of health, but new research suggests that their extreme training regimens could carry hidden risks. With colon cancer already rising among younger adults, the possibility that endurance athletes face added vulnerability is too significant to ignore.