A Review of the Management of Sporadic Colorectal Adenomas in Young People: Is Surveillance Wasted on the Young?
- 130 Downloads
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.
KeywordsColorectal cancer Colorectal cancer screening Adenomas Colorectal neoplasia Young patients
Compliance with ethical standards
Conflict of interest
The authors disclose no conflicts.
- 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
- 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
- 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