Risks of colorectal advanced neoplasia in young adults versus those of screening colonoscopy in patients aged 50 to 54years

Abstract

BACKGROUND AND AIM: The role of screening or diagnostic colonoscopy to detect advanced neoplasia in young cohorts of age <50 is unclear. This study compared the risk of colorectal neoplasia in a young age cohort against that in 50-54s screening cohort. METHODS: A multi-center retrospective study was conducted at 14 university hospitals to compare the detection rates of neoplasia and advanced neoplasia in screening or diagnostic colonoscopy in the young cohort of <50s against those in screening colonoscopy in the 50-54s cohort. RESULTS: Among 10477 eligible subjects, 9765 subjects were enrolled after excluding 712 subjects. Advanced neoplasia detection rates in the young screening cohort was significantly lower than that in the 50-54s screening cohort (5.9% vs 9.3%, P<0.001). Compared with 50-54s screening cohort, the risk of advanced neoplasia was significantly reduced by 23%, 53%, and 54% in the 45-49s, 40-44s, and 20-39s screening cohorts, respectively. The detection rates of advanced neoplasia in the young diagnostic cohort was 5.0%, which was much lower than 11.8% in 50-54s screening cohort (P<0.001). Compared with the 50-54s screening cohort, the risk of advanced neoplasia was significantly reduced by 50%, 66%, and 71% in the 45-49s, 40-44s, and 20-39s diagnostic cohorts, respectively. CONCLUSIONS: Colonoscopy to detect advanced neoplasia in young adults aged <50years should be reconsidered as their risk of advanced neoplasia on screening or diagnostic colonoscopy was much lower than those of 50-54s screening cohort; however, colonoscopy screening may be justified for high-risk 45-49s cohorts.