304 Increasing Incidence of Polyps Greater Than 9 mm in Young Adults Undergoing Colonoscopy: A Prospective Multi-Center Study

Abstract

INTRODUCTION: Colorectal cancer (CRC) is the fourth leading newly diagnosed cancer and second most common cause of cancer mortality in the United States. Young adults 40-49 years old have an increasing incidence of CRC. Recent guidelines from the American Cancer Society suggest lowering the age of CRC screening to 45 years of age based on modeling analyses. We hypothesize that rates of polyps > 9 mm would also increase before the age of 50. The aim of this study is to determine the incidence of polyps > 9 mm from 2002 to 2014 in patients under 50 years old. METHODS: We reviewed colonoscopy data that was prospectively collected from the Clinical Outcomes Research Initiative (CORI) from 2002 through 2014. CORI uses a computerized endoscopic procedure report generator to collect data in a national endoscopy database from a consortium of 70 adult gastrointestinal practices. We identified all patients who were 40 to 59 years old and reviewed their endoscopic data. We used a robust surrogate marker for advanced adenoma defined as polyps > 9 mm as our end point. Patient outcomes were compared using age groups 40-49, 50-54, 55-59. RESULTS: We identified 398672 patients who were 40 to 59 years of age who underwent colonoscopy from 2002 to 2014. Twenty two percent were less than 50 years old. There was a progressive increase in polyps greater than 9 mm for all age groups over the course of this twelve year period (Figure 1). Patients who were under 50 years of age had a rise in advanced adenoma from 4.5% to 6.3% from 2005 to 2014 (Table 1). CONCLUSION: From 2002 to 2014 there was an increased rate of polyps > 9 mm in all subjects undergoing colonoscopy aged 40 to 59. By 2014, rates of polyps greater than 9 mm in the 40-49 year old group were similar to the 2005 rates in the 55-59 year old group. Screening before age 50 years should be considered and further studies are needed to validate this recommendation and determine the most optimal form of screening before age 50 years.