Background and Aims
Recent increases in colorectal cancer (CRC) incidence in adults younger than 50 years
of age have led to more colonoscopies in this age group. As a result, there may be
an increasing number of adults <50 years old with polyps detected. There is concern
that younger adults may require closer follow-up. Our goal was to use data from the
New Hampshire Colonoscopy Registry (NHCR) to examine the risk for metachronous advanced
adenomas (AAs) and large (>1 cm) serrated polyps in younger versus older adults who
return for a follow-up colonoscopy.
Methods
Our cohort consisted of NHCR participants with at least 1 polyp on index examination
and a follow-up colonoscopy at least 1 year after the index examination. Outcomes
were the risks for metachronous AAs (adenomas ≥1 cm, with villous elements or high-grade
dysplasia, or CRC) and large (≥1 cm) serrated polyps. We present absolute risk and
adjusted risks from a logistic regression model stratified by age at index colonoscopy
(<40, 40-49, 50-59, and 60+ [reference]). Covariates included index findings, endoscopist
adenoma detection rates, sex, smoking, body mass index, follow-up time (months), bowel
preparation quality, and family history of CRC.
Results
In our sample of 12,380 adults, absolute risk for metachronous AA was lower for younger
patients than for patients aged ≥60. After adjusting for covariates, when comparing
with the 60+ group (reference), the lowest risk was observed in those younger than
40 years (odds ratio, .19; 95% confidence interval, .05-.80). Of note, similar risks
were observed in the 40 to 49 age group (odds ratio, .61; 95% confidence interval,
.41-.92) and 50 to 59 age group (odds ratio, .71; 95% confidence interval, .58-.86).
The risk for large metachronous serrated polyps was not associated with age.
Conclusions
Younger adults aged <40 with index adenomas had a lower risk for metachronous AAs
than those aged ≥60. The 40- to 49-year age group was found to have metachronous risk
similar to the 50- to 59-year age group, with both less than the ≥60 age group. These
data suggest that current surveillance interval guidelines for patients aged ≥50 years
may appropriately be used with younger adults.
Abbreviations:
AA (advanced adenoma), ADR (adenoma detection rate), BMI (body mass index), CRC (colorectal cancer), CSSP (clinically significant serrated polyp), NHCR (New Hampshire Colonoscopy Registry)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 21, 2019
Accepted:
November 10,
2019
Received:
September 4,
2019
Footnotes
DISCLOSURE: All authors disclosed no financial relationships. Research support for this study was provided by the National Cancer Institute (grant no. R01CA131141 and contract no. HHSN261201400595P) and the Norris Cotton Cancer Center. Additional funding: R21CA191651-02 and The Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. The contents of this work do not represent the views of the Department of Veterans Affairs or the United States Government.
If you would like to chat with an author of this article, you may contact Dr Anderson at [email protected]
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