Project GRACCE: A community-led, peer-driven education program to address rising early-onset colorectal cancer through awareness, prevention, and screening among young adults

Background: Colorectal cancer (CRC) incidence is rising at alarming rates among adults under 50. Despite updates to national guidelines lowering the starting age for screening from 50 to 45, awareness of CRC risk, early symptoms, and screening remains limited, especially among young adults and underserved communities. This knowledge gap contributes to diagnostic delays, advanced disease at presentation, and widening disparities in outcomes. Methods: In partnership with the Angelic Warrior Foundation, a patient-led advocacy group, we adapted Against Colorectal Cancer in Our Neighborhoods (ACCION)-an evidence-based intervention into PROJECT GRACCE (Getting Real About Colorectal Cancer Education). GRACCE trained student ambassadors from five North Carolina universities using a three-session workshop series. Ambassadors then prepared and delivered peer-led campus education sessions. We conducted pre-post knowledge assessments with ambassadors and post-session surveys with attendees to assess feasibility, acceptability, and CRC knowledge improvement. Results: Nine trained student ambassadors hosted education sessions across five campuses and one community organization, reaching 126 attendees. Ambassadors demonstrated meaningful gains in knowledge about CRC biology, risk factors, and screening. Among attendees, 95 (77%) completed surveys. Attendees reported high satisfaction with the education sessions (M = 4.7/5 across domains), significant perceived knowledge gains (CRC: M = 4.8; screening: M = 4.8; risk factors: M = 4.8), and strong intentions to engage in preventive behaviors, including exercising more (M = 4.7), learning family history (M = 4.7), and talking to loved ones about CRC screening (M = 4.6). Qualitative feedback highlighted new awareness of early-onset CRC risk, screening guidelines, and disparities, as well as strong resonance with personal storytelling. Conclusions: PROJECT GRACCE demonstrates that a community-led, peer-driven education model is feasible, culturally resonant, and effective in improving CRC knowledge and motivating preventive intentions among young adults. By bridging epidemiological evidence with community engagement, GRACCE addresses critical gaps in awareness contributing to the rise in early-onset cancers. This model holds promise for scalable interventions that can mitigate disparities and reverse current trends in CRC incidence.