Risk for Advanced Colorectal Neoplasia in Young Adults Tied to Age, Tobacco, and More

Illustration of intestinal carcinoma, showing malignant tumor in intestine.
Presenting at DDW 2022, researchers identified the risk factors associated with the development of early-onset advanced colorectal neoplasia in young adults.

Among young adults with advanced neoplasia at baseline and follow-up colonoscopy, increasing age, being exposed to tobacco, and high-risk indications for colonoscopy, such as rectal bleeding or rectal mass, were associated with early-onset colorectal neoplasia, according to study results presented at Digestive Disease Week (DDW), held from May 21 to 24, 2022, in San Diego, California, and virtually.

Early screening and the removal of adenomas can help reduce the incidence of colorectal cancer (CRC). However, the risk factors associated with advanced colorectal neoplasia in young adults has remained unknown. The researchers of the current study sought to identify the factors that influence the development of early-onset neoplasia to better inform targeted screening strategies in this age group.

In their analysis, researchers included patients aged 18 to 49 years (N=3022) who underwent a baseline colonoscopy with polypectomy at the Cleveland Clinic between 2011 and 2021. Exclusion criteria included a history of inflammatory bowel disease and inherited colon cancer syndromes. The researchers defined high-risk indications for colonoscopy as the following: rectal bleeding or rectal mass, iron deficiency anemia, weight loss, family history of CRC (first- and second-degree relative), a family history of polyps, positive stool-based screening test, and abnormal imaging.

Patients were assessed based on these risk factors: age, sex, race, body mass index (BMI), alcohol and tobacco use, history of diabetes or hyperlipidemia, nonsteroidal anti-inflammatory drugs (NSAIDs) and satin use, and a family history of colon cancer. The correlation between risk factors and advanced neoplasia was examined using a multivariate binary logistic regression model. Unadjusted Cox PH regression models were conducted to identify the risk factors for metachronous advanced neoplasia.

The researchers considered tubular adenomas greater than 9 mm, adenoma with low- or high-grade dysplasia, sessile serrated polyp (SSP) greater than 9 mm or SSP with dysplasia, and traditional serrated adenomas detected at baseline colonoscopy as the primary outcome of the study.

The presence of advanced neoplasia at baseline colonoscopy was detected in 23.6% of patients in the study. Compared with patients without advanced neoplasia, individuals with the condition tended to be older (median age 45.5 vs 44.4 years, P =.001), exposed to tobacco (49.8% vs 45.2%, P =.034), and had more high-risk indications for colonoscopy (63% vs 54.6%; P <.001).

Recurrent advanced neoplasia was associated with a history of prior advanced neoplasia (HR, 2.09; 95% CI, 1.05-4.1; P =.034) in a univariate analysis. At baseline colonoscopy, BMI, diabetes, and hyperlipidemia were not associated with advanced neoplasia in young adults.

The researchers concluded, “The results of this study are consistent with current guidelines recommending initiating screening at an earlier age and call for particular attention to young adults exposed to tobacco.”


Torrejon NV, Lyu R, Burke CA, Liska D, Macaron C. Risk factors associated with young onset advanced neoplasia at baseline and on follow up colonoscopy. Presented at: DDW 2022; May 21-24, 2022; San Diego, CA. Abstract Mo1450.

This article originally appeared on Gastroenterology Advisor