Colorectal Cancer Surveillance for Young Patients with Low Risk Adenomas: Five-Year Interval Is Adequate

Abstract

Introduction: Colorectal cancer (CRC) is increasing in patients younger than 50. The recommended follow-up for low risk adenomas (LRA) is 5 years for patients over 50. It is likely that surveillance is performed at shorter intervals in younger patients with adenomas, as this is an understudied group with no guidelines. Our aim was to report our center's experience with this patient population. Methods: Retrospective review of all patients with colon adenomas from a single academic center from 1/1999-12/2008. Patients with LRA and age less than 40 at diagnosis were identified. LRA were defined according to widely accepted criteria (1-2 tubular adenomas, size < 10 mm, without villous histology or high grade dysplasia). Patients with high-risk adenoma(s), hereditary colorectal cancer syndrome, or IBD were excluded. Medical records were reviewed for any follow-up colonoscopies. The primary outcome was adenoma recurrence displayed as Kaplan Meier curves with exploratory analysis by Cox proportional hazards regression. Results: Seventy-five patients with LRA and at least one surveillance examination were identified. Patient demographics (table 1) were 53% male and 83% Caucasian, 11% were 18-29 years old, 32% were 30-34, and 57% were 35-39. Adenomas were found on follow-up examination in 33.3% of all patients. There were 24 LRA and 1 advanced adenoma, with median time to LRA detection of 5.3 years. No cancer was detected. In this sample, age, race, BMI, smoking status, family history or location of index adenoma were not significantly associated with development of future adenomas. Mean time to follow-up was 3.0 years, with 21% of patients having follow-up at the 4-6 year interval, while 71% of the patients had premature follow-up occurring at only 1-3 years.Table 1Figure 1Conclusion: Given our findings, surveillance colonoscopy interval of 5 years is adequate for young patients with LRA. This is in line with guidelines for older adults. A majority of the young patients had premature surveillance. This has substantial implications for reducing procedure burden and improving health-care utilization in this group. Adenomas in the young deserve further study and confirmation of our findings.