Increased Prevalence of Advanced Adenomas in Younger Individuals Undergoing Early Screening Colonoscopy Due to a...

Current guidelines recommend patients with a first-degree relative with advanced adenomas (AAs) identified <60 years old should initiate screening colonoscopy at age 40 or 10 years prior to their relative. Data on the prevalence of AAs and colorectal cancer in these patients, especially younger individuals, are lacking. This study determined the prevalence of AAs and colorectal cancer in younger individuals undergoing early screening colonoscopy due to a family history of advanced polyps.

A retrospective case-control study performed at a large community practice identified 409 patients who underwent screening colonoscopy due to a first-degree relative with advanced polyps <60 years old ("FH" [family history]) and 11,441 patients without a family history ("control") who underwent a colonoscopy for abdominal pain or bowel changes between 2015 and 2023. Patients were divided into 3 age groups of 20-39, 40-45, and 45-49 years old for statistical analysis. The primary outcome was the detection of AAs.

The prevalence of AAs was greater in the FH group (n = 40) compared to the control group (n = 682) (9.8% vs 6.0%; P < .001). There was nearly a 3-fold increased risk of AAs in 20- to 39-year-old patients in the FH group compared to the control in the same age group (odds ratio 2.66 [95% confidence interval, 1.17-5.29]).

A family history of AA was associated with an increased prevalence of advanced polyps in younger adults compared to a control population. Prospective research is needed to further evaluate the prevalence of AA in this population.