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Detection of Colorectal Neoplasia by Colonoscopy in Average-Risk Patients Age 40–49 Versus 50–59 Years

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Abstract

Background

The USPSTF recommends beginning colorectal cancer screening at age 50. A recent study showed prevalence of colorectal adenomas among individuals aged 40–49 was similar to that among those aged 50–59.

Aim

To assess the prevalence of colorectal neoplasia, detected during colonoscopy, by age among average-risk patients.

Methods

Nine-hundred and ninety-four colonoscopies were analyzed (247 ages 40–49, 747 ages 50–59). We included consecutive patients of ages 40–59 undergoing their first colonoscopy. Colonoscopies that did not reach the cecum and patients at increased risk of colorectal cancer were excluded. The primary endpoint was the prevalence of colorectal neoplasia by age. Secondary endpoints included the prevalence of colorectal neoplasia by gender, ethnicity, and BMI.

Results

The prevalence of colorectal neoplasia was 12.1% in patients aged 40–49 and 22.6% in those aged 50–59. Compared with individuals aged 40–49 there was a significantly greater prevalence of adenomas (chi-squared = 12.72, P = 0.0004) and of advanced adenomas or cancer (chi-squared = 5.73, P = 0.01) in individuals aged 50–59. After adjusting for gender, race, and BMI the effect of age remained significant (OR 0.5, 95% CI 0.33–0.76). Higher BMI was associated with increased risk of colorectal neoplasia (OR 1.03, 95% CI 1.00–1.06). The number that had to be screened to detect one advanced lesion in the 40–49 age group was 49 compared with 20 in those aged 50–59.

Conclusion

Individuals aged 40–49 have a lower but measurable risk of colorectal neoplasia compared with those aged 50–59. Although there may be population subgroups for which screening below the age of 50 may be indicated, our results do not support lowering the age threshold for colonoscopy in the general population.

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Acknowledgments

There was no financial support for this study. The authors have no financial disclosures to report.

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Authors and Affiliations

  1. Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA

    Matthew N. Thoma & Fernando Castro

  2. Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, USA

    Mushfeka Golawala

  3. College of Medicine, University of South Florida, Tampa, FL, USA

    Ren Chen

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  1. Matthew N. Thoma
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  2. Fernando Castro
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  3. Mushfeka Golawala
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Correspondence to Matthew N. Thoma.

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Thoma, M.N., Castro, F., Golawala, M. et al. Detection of Colorectal Neoplasia by Colonoscopy in Average-Risk Patients Age 40–49 Versus 50–59 Years. Dig Dis Sci 56, 1503–1508 (2011). https://doi.org/10.1007/s10620-011-1565-6

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  • DOI: https://doi.org/10.1007/s10620-011-1565-6

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