In U.S. Veterans, Advanced Adenomas, Not Nonadvanced Adenomas, Before Age 50 Associated With Higher CRC Risk
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In U.S. Veterans, Advanced Adenomas, Not Nonadvanced Adenomas, Before Age 50 Associated With Higher CRC Risk

Douglas K. Rex, MD, MASGE, reviewing Casey Y, et al. Am J Gastroenterol 2023 Apr 13.

Adenomas are commonly diagnosed in patients younger than age 50 undergoing colonoscopy. Adenomas in young people often initiate surveillance at shorter than the recommended intervals, perhaps out of fear the adenoma represents genetic predisposition to colorectal cancer (CRC).

In a national study of 54,284 U.S. veterans younger than 50 who underwent colonoscopy, 13% had at least one adenoma. With a median follow-up of nearly 5 years in both the adenoma and nonadenoma groups, only 3 patients (0.08%) developed CRC in the adenoma group and only 13 (0.03%) in the nonadenoma group.

Among those with an advanced adenoma at baseline, the hazard ratio for CRC was increased 8-fold. However, those with nonadenomas had no increase in CRC risk (hazard ratio, 0.8).

Douglas K. Rex, MD, FASGE

COMMENT

In the postpolypectomy surveillance literature, including the National Polyp Study, younger age generally predicts a lower risk of advanced adenoma at surveillance. The low absolute rates of CRC in this veterans’ study favor using the current postpolypectomy surveillance intervals regardless of patient age.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Casey Y, Demb J, Enwerem N, et al. Risk of incident and fatal colorectal cancer after young-onset adenoma diagnosis: a national cohort study. Am J Gastroenterol 2023 Apr 13. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000002296)

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