For adults who develop adenomas before age 50, the risk of developing colorectal cancer (CRC) and dying from it is low, especially for nonadvanced adenomas, but even for advanced adenomas, new data show.
“The findings support the concept that young individuals with adenoma diagnosis do not need more aggressive colonoscopy follow-up than recommended by current guidelines for older adults,” Samir Gupta, MD, professor, Division of Gastroenterology, and coleader, Cancer Control Program, Moores Cancer Center, University of California San Diego, told Medscape Medical News.
However, “young individuals with multiple adenomas (more than 5-10) or a family history of colorectal cancer may require special evaluation,” he added.
The study was published online April 13 in the American Journal of Gastroenterology.
Evaluating Cancer Risk
Many people younger than 50 years are exposed to colonoscopy for diagnostic workup of gastrointestinal signs and symptoms, Gupta said.
It’s not uncommon for these patients to have incidentally detected adenomas, “raising questions about whether having the diagnosis at a young age implies increased risk for colorectal cancer that would warrant closer follow-up than would be recommended by current guidelines for repeat colonoscopy in older individuals,” Gupta said.
The study is one of the largest to evaluate CRC risk in adults diagnosed with adenoma before age 50, or young-onset adenoma (YOA), Gupta and colleagues note.
Using Veterans Health Administration electronic health record data, the study team identified 54,284 veterans ages 18-49 who underwent colonoscopy from 2005 to 2016. Among them, 7233 (13%) had YOA at baseline and 47,051 (87%) had normal colonoscopy findings.
Overall, the cumulative 10-year incidence of CRC was low:
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Normal colonoscopy: 0.06%
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Any adenoma: 0.11%
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Nonadvanced adenoma: 0.10%
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Advanced adenoma: 0.18%
Veterans with advanced YOA had an 8-fold greater incident CRC risk than peers with normal colonoscopy (hazard ratio, 8; 95% confidence interval, 1.8 – 35.6), but the absolute number of cases was low (two cases).
Notably, YOA was not associated with fatal CRC, although there is potential for insufficient power related to the low number of fatal CRC events in this age group (eight patients with normal colonoscopy and one patient with advanced YOA), Gupta and colleagues write.
“The findings illustrate that while veterans under age 50 with advanced adenoma might be at increased risk for CRC, the low absolute incidence might not necessitate more intense surveillance than recommended for older individuals,” they conclude.
Am J Gastroenterol. Published online April 13, 2023. Absract
This research was supported by grants from the National Cancer Institute, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, and the VA Health Services Research and Development. The authors have declared no relevant financial relationships.
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