A Review of the Management of Sporadic Colorectal Adenomas in Young People: Is Surveillance Wasted on the Young?

  • Daniel Bushyhead
  • Otto S. T. Lin
  • Richard A. KozarekEmail author


The national incidence of colorectal cancer is increasing in people younger than 50 years old. Although diagnostic colonoscopy is detecting more sporadic adenomas in young adults, there are no guidelines for post-polypectomy surveillance. The aim of this review was to survey the medical literature on the prevalence of sporadic adenomas in young adults, subsequent risk of metachronous neoplasia, and lastly to provide several concluding recommendations for clinical practice. We found that the prevalence of sporadic adenomas in young adults is greater than initially estimated and dependent upon factors such as colonoscopy indication and age. The incidence of metachronous colorectal neoplasia following polypectomy is unclear but does not appear to be greater than that of older adults. Risk factors for metachronous neoplasia include findings on index colonoscopy, male gender, smoking status, and certain medical comorbidities. Upon finding a colorectal adenoma in a young person, we suggest that a detailed family history be obtained to confirm that it is truly sporadic. Testing adenomas for evidence of Lynch syndrome is low yield. Strategies to inform surveillance intervals may include an assessment of risk factors for metachronous neoplasia, although surveillance intervals shorter than those recommended in current guidelines are not warranted. Future research should focus on obtaining long-term, prospective data on the incidence of metachronous neoplasia in diverse patient populations.


Colorectal cancer Colorectal cancer screening Adenomas Colorectal neoplasia Young patients 


Compliance with ethical standards

Conflict of interest

The authors disclose no conflicts.


  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.CrossRefGoogle Scholar
  2. 2.
    Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell. 1990;61:759–767.CrossRefGoogle Scholar
  3. 3.
    Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977.CrossRefGoogle Scholar
  4. 4.
    US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2016;315:2564–2575.CrossRefGoogle Scholar
  5. 5.
    Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on colorectal cancer. Am J Gastroenterol. 2017;112:1016.CrossRefGoogle Scholar
  6. 6.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.CrossRefGoogle Scholar
  7. 7.
    Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–573.CrossRefGoogle Scholar
  8. 8.
    Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974–2013. J Natl Cancer Inst. 2017;109:djw322.Google Scholar
  9. 9.
    Gado A, Ebeid B, Abdelmohsen A, Axon A. Colorectal cancer in Egypt is commoner in young people: Is this cause for alarm? Alex J Med. 2014;50:197–201.CrossRefGoogle Scholar
  10. 10.
    Abou-Zeid AA, Jumuah WA, Ebied EF, et al. Hereditary factors are unlikely behind unusual pattern of early—onset colorectal cancer in Egyptians: a study of family history and pathology features in Egyptians with large bowel cancer (cross-sectional study). Int J Surg. 2017;44:71–75.CrossRefGoogle Scholar
  11. 11.
    Wolf AMD, Fontham ETH, Church TR, 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.CrossRefGoogle Scholar
  12. 12.
    Lieberman DA, Weiss DG, Harford WV, et al. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007;133:1077–1085.CrossRefGoogle Scholar
  13. 13.
    Lieberman DA, Rex DK, Winawer SJ, 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.CrossRefGoogle Scholar
  14. 14.
    Farraye FA, Odze RD, Eaden J, et al. AGA medical position statement on the diagnosis and management of neoplasia in inflammatory bowel disease. Gastroenterology. 2010;138:738–745.CrossRefGoogle Scholar
  15. 15.
    Giardiello FM, Allen JI, Axilbund JE, et al. Guidelines on genetic evaluation and management of lynch syndrome: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol. 2014;109:1159–1179.CrossRefGoogle Scholar
  16. 16.
    Syngal S, Brand RE, Church JM, et al. ACG clinical guideline: genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015;110:223.CrossRefGoogle Scholar
  17. 17.
    Pearlman R, Frankel WL, Swanson B, et al. Prevalence and spectrum of germline cancer susceptibility gene mutations among patients with early-onset colorectal cancer. JAMA Oncol. 2017;3:464–471.CrossRefGoogle Scholar
  18. 18.
    Mendelsohn RB, Herzog K, Shia J, Rahaman N, Stadler ZK, Shike M. Molecular screening for Lynch syndrome in young patients with colorectal adenomas. Clin Colorectal Cancer. 2017;16:173–177.CrossRefGoogle Scholar
  19. 19.
    Velayos FS, Allen BA, Conrad PG, et al. Low rate of microsatellite instability in young patients with adenomas: reassessing the Bethesda guidelines. Am J Gastroenterol. 2005;100:1143–1149.CrossRefGoogle Scholar
  20. 20.
    Kang KJ, Min BH, Ryu K, et al. Clinical usefulness of microsatellite instability test in Korean young patients with high-risk features associated with adenoma. Clin Res Hepatol Gastroenterol. 2012;36:378–383.CrossRefGoogle Scholar
  21. 21.
    Kastrinos F, Allen JI, Stockwell DH, et al. Development and validation of a colon cancer risk assessment tool for patients undergoing colonoscopy. Am J Gastroenterol. 2009;104:1508–1518.CrossRefGoogle Scholar
  22. 22.
    Lieberman DA, Williams JL, Holub JL, et al. Colonoscopy utilization and outcomes 2000 to 2011. Gastrointest Endosc. 2014;80:133–143.CrossRefGoogle Scholar
  23. 23.
    Heitman S, Ronksley P, Hilsden R, Manns B, Rostom A, Hemmelgarn B. Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2009;7:1272–1278.CrossRefGoogle Scholar
  24. 24.
    Cha JM, Kozarek RA, 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.CrossRefGoogle Scholar
  25. 25.
    Vu H, Ufere N, Yan Y, Wang S, Early D, Elwing J. Diabetes mellitus increases risk for colorectal adenomas in younger patients. World J Gastroenterol. 2014;20:6946–6952.CrossRefGoogle Scholar
  26. 26.
    Thiruvengadam R, Thiruvengadam S. Pre-cancerous colon polyps in the young—incidental adenoma detection in average-risk persons forty and younger. Scand J of Gastroenterol. 2018;53:1–3.CrossRefGoogle Scholar
  27. 27.
    Kim O, Yang H, Cha J, et al. Risks of colorectal advanced neoplasia in young adults versus those of screening colonoscopy in patients aged 50 to 54 years. J Gastroenterol Hepatol. 2017;32:1825–1831.CrossRefGoogle Scholar
  28. 28.
    Chung S, Kim Y, Yang S, et al. Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40–49 years undergoing screening colonoscopy. J Gastroenterol Hepatol. 2010;25:519–525.CrossRefGoogle Scholar
  29. 29.
    Wong JC, Lau JY, Suen BY, et al. Prevalence, distribution, and risk factor for colonic neoplasia in 1133 subjects aged 40–49 undergoing screening colonoscopy. J Gastroenterol Hepatol. 2017;32:92–97.CrossRefGoogle Scholar
  30. 30.
    Jung YS, Ryu S, Chang Y, et al. Risk factors for colorectal neoplasia in persons aged 30–39 years and 40 to 49 years. Gastrointest Endosc. 2015;81:637–645.CrossRefGoogle Scholar
  31. 31.
    Chung SJ, Kim YS, Yang SY. Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40–49 years undergoing screening colonoscopy. Gastrointest Endosc. 2015;81:637–645.CrossRefGoogle Scholar
  32. 32.
    Lee SE, Jo HB, Kwack WG, Jeong YJ, Yoon YJ, Kang HW. Characteristics of and risk factors for colorectal neoplasms in young adults in a screening population. World J Gastroenterol. 2016;22:2981–2992.CrossRefGoogle Scholar
  33. 33.
    Au S, Marquez V, Donnellan F, et al. Colorectal polyps in childhood cancer survivors treated with radiation therapy. Dig Dis Sci. 2018;63:2451–2455.CrossRefGoogle Scholar
  34. 34.
    Rigter SL, Kallenberg FG, Bastiaansen B, et al. A case series of intestinal adenomatous polyposis of unidentified etiology; a late effect of irradiation? BMC Cancer. 2016;16:862.CrossRefGoogle Scholar
  35. 35.
    Daly PE, Samiee S, Cino M, et al. High prevalence of adenomatous colorectal polyps in young cancer survivors treated with abdominal radiation therapy: results of a prospective trial. Gut. 2017;66:1797–1801.CrossRefGoogle Scholar
  36. 36.
    Imperiale TF, Wagner DR, Lin CY, et al. Results of screening colonoscopy among persons 40–49 years of age. N Engl J Med. 2002;346:1781–1785.CrossRefGoogle Scholar
  37. 37.
    De John AE, Morreau H, Nagengast FM, et al. Prevalence of adenomas among young individuals at average risk for colorectal cancer. Am J Gastroenterol. 2005;100:139–143.CrossRefGoogle Scholar
  38. 38.
    Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Am J Gastroenterol. 2015;110:72–90.CrossRefGoogle Scholar
  39. 39.
    Yamaji Y, Mitsushima T, Yoshida H, et al. The malignant potential of freshly developed colorectal polyps according to age. Cancer Epidemiol Biomark Prev. 2006;15:2418–2421.CrossRefGoogle Scholar
  40. 40.
    Kim NH, Jung YS, Park JH, Park DI, Sohn CI. 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.CrossRefGoogle Scholar
  41. 41.
    Park SK, Kim NH, Yung YS, et al. Intestinal cancer study group of Korean Association for Study of Intestinal Disease (KASID). 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.CrossRefGoogle Scholar
  42. 42.
    Kim HG, Cho YS, Cha JM, et al. Risk of metachronous neoplasia on surveillance colonoscopy in young patients with colorectal neoplasia. Gastrointest Endosc. 2018;87:666–673.CrossRefGoogle Scholar
  43. 43.
    Nagpal SJS, Mukhija D, Sanaka M, Lopez R, Burke CA. Metachronous colon polyps in younger versus older adults: a case-control study. Gastrointest Endosc. 2018;87:657–665.CrossRefGoogle Scholar
  44. 44.
    Cha JM, La Selva D, Kozarek RA, Gluck M, Ross A, Lin OS. Young patients with sporadic colorectal adenomas: current endoscopic surveillance practices and outcomes. Gastrointest Endosc. 2018;88:e1.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Daniel Bushyhead
    • 1
  • Otto S. T. Lin
    • 2
  • Richard A. Kozarek
    • 2
    Email author
  1. 1.Division of GastroenterologyUniversity of Washington School of MedicineSeattleUSA
  2. 2.Department of Gastroenterology, Digestive Disease InstituteVirginia Mason Medical CenterSeattleUSA

Personalised recommendations