Advertisement

Young adults and metachronous neoplasia: risks for future advanced adenomas and large serrated polyps compared with older adults

Published:November 21, 2019DOI:https://doi.org/10.1016/j.gie.2019.11.023

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cha J.M.
        • La Selva D.
        • Kozarek R.A.
        • et al.
        Young patients with sporadic colorectal adenomas: current endoscopic surveillance practices and outcomes.
        Gastrointest Endosc. 2018; 88: 818-825
        • Cameron K.
        • Moss A.
        Is 35 the new 50? Challenges in determining colonoscopy surveillance recommendations for young patients with incidentally detected adenomas.
        Gastrointest Endosc. 2018; 88: 826-829
        • Ahnen D.J.
        • Wade S.W.
        • Jones W.F.
        • et al.
        The increasing incidence of young-onset colorectal cancer: a call to action.
        Mayo Clin Proc. 2014; 89: 216-224
        • Patel S.G.
        • Ahnen D.J.
        Colorectal cancer in the young.
        Curr Gastroenterol Rep. 2018; 20: 15
        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Colorectal cancer mortality rates in adults aged 20 to 54 years in the United States, 1970-2014.
        JAMA. 2017; 318: 572-574
        • Wolf A.M.D.
        • Fontham E.T.H.
        • Church T.R.
        • et al.
        Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society.
        CA Cancer J Clin. 2018; 68: 250-281
        • Fedewa S.A.
        • Siegel R.L.
        • Jemal A.
        Are temporal trends in colonoscopy among young adults concordant with colorectal cancer incidence?.
        J Med Screen. 2019; 26: 179-185
        • Lieberman D.A.
        • Rex D.K.
        • Winawer S.J.
        • et al.
        Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer.
        Gastroenterology. 2012; 143: 844-857
        • Anderson J.C.
        • Butterly L.F.
        • Robinson C.M.
        • et al.
        Risk of metachronous high-risk adenomas and large serrated polyps in individuals with serrated polyps on index colonoscopy: data from the New Hampshire Colonoscopy Registry.
        Gastroenterology. 2018; 154: 117-127
        • Kim N.H.
        • Jung Y.S.
        • Park J.H.
        • et al.
        Risk of developing metachronous advanced colorectal neoplasia after colonoscopic polypectomy in patients aged 30 to 39 and 40 to 49 years.
        Gastrointest Endosc. 2018; 88: 715-723
        • Nagpal S.J.S.
        • Mukhija D.
        • Sanaka M.
        • et al.
        Metachronous colon polyps in younger versus older adults: a case-control study.
        Gastrointest Endosc. 2018; 87: 657-665
        • Park S.K.
        • Kim N.H.
        • Jung Y.S.
        • et al.
        Risk of developing advanced colorectal neoplasia after removing high-risk adenoma detected at index colonoscopy in young patients: a KASID study.
        J Gastroenterol Hepatol. 2016; 31: 138-144
        • Weaver D.L.
        • Rosenberg R.D.
        • Barlow W.E.
        • et al.
        Pathologic findings from the Breast Cancer Surveillance Consortium: population-based outcomes in women undergoing biopsy after screening mammography.
        Cancer. 2006; 106: 732-742
        • Butterly L.F.
        • Goodrich M.
        • Onega T.
        • et al.
        Improving the quality of colorectal cancer screening: assessment of familial risk.
        Dig Dis Sci. 2010; 55: 754-760
        • Greene M.A.
        • Butterly L.F.
        • Goodrich M.
        • et al.
        Matching colonoscopy and pathology data in population-based registries: development of a novel algorithm and the initial experience of the New Hampshire Colonoscopy Registry.
        Gastrointest Endosc. 2011; 74: 334-340
        • Cha J.M.
        • Kozarek R.A.
        • La Selva D.
        • et al.
        Findings of diagnostic colonoscopy in young adults versus findings of screening colonoscopy in patients aged 50 to 54 years: a comparative study stratified by symptom category.
        Gastrointest Endosc. 2015; 82: 138-145
        • Kim S.B.
        • Lee H.J.
        • Park S.J.
        • et al.
        Comparison of colonoscopy surveillance outcomes between young and older colorectal cancer patients.
        J Cancer Prevent. 2017; 22: 159-165
        • Kim H.G.
        • Cho Y.S.
        • Cha J.M.
        • et al.
        Risk of metachronous neoplasia on surveillance colonoscopy in young patients with colorectal neoplasia.
        Gastrointest Endosc. 2018; 87: 666-673
        • Tjaden J.
        • Muller C.
        • Wideroff G.
        • et al.
        Metachronous advanced neoplasia on surveillance colonoscopy in young versus older onset colorectal cancer patients.
        Clin Gastroenterol Hepatol. Epub 2019 Jul 24;
        • Anderson J.C.
        • Attam R.
        • Alpern Z.
        • et al.
        Prevalence of colorectal neoplasia in smokers.
        Am J Gastroenterol. 2003; 98: 2777-2783
        • Anderson J.C.
        • Latreille M.
        • Messina C.
        • et al.
        Smokers as a high-risk group: data from a screening population.
        J Clin Gastroenterol. 2009; 43: 747-752
        • Anderson J.C.
        • Messina C.R.
        • Dakhllalah F.
        • et al.
        Body mass index: a marker for significant colorectal neoplasia in a screening population.
        J Clin Gastroenterol. 2007; 41: 285-290
        • Anderson J.C.
        • Moezardalan K.
        • Messina C.R.
        • et al.
        Smoking and the association of advanced colorectal neoplasia in an asymptomatic average risk population: analysis of exposure and anatomical location in men and women.
        Dig Dis Sci. 2011; 56: 3616-3623
        • Anderson J.C.
        • Pleau D.C.
        • Rajan T.V.
        • et al.
        Increased frequency of serrated aberrant crypt foci among smokers.
        Am J Gastroenterol. 2010; 105: 1648-1654
        • Anderson J.C.
        • Stein B.
        • Kahi C.J.
        • et al.
        Association of smoking and flat adenomas: results from an asymptomatic population screened with a high-definition colonoscope.
        Gastrointest Endosc. 2010; 71: 1234-1240
        • Anderson J.C.
        • Weiss J.E.
        • Robinson C.M.
        • et al.
        Adenoma detection rates for screening colonoscopies in smokers and obese adults: data from the New Hampshire Colonoscopy Registry.
        J Clin Gastroenterol. 2017; 51: e95-e100
        • Holme O.
        • Bretthauer M.
        • Eide T.J.
        • et al.
        Long-term risk of colorectal cancer in individuals with serrated polyps.
        Gut. 2015; 64: 929-936
        • Rice K.
        • Sharma K.
        • Li C.
        • et al.
        Cost-effectiveness of a patient navigation intervention to increase colonoscopy screening among low-income adults in New Hampshire.
        Cancer. 2019; 125: 601-609