Risk factors for advanced sporadic colorectal neoplasia in persons younger than age 50

Abstract

Background-Colorectal cancer (CRC) screening is recommended for average risk adults beginning at age 50. However, 7% of CRC occurs in persons younger than age 50, a group for which risk factors are not well defined. We sought to determine whether a retrospective case-control study could identify risk factors for sporadic CRC and advanced adenomatous polyps (together known as sporadic colorectal neoplasia [CRN]).

Clinical usefulness of glycosylated hemoglobin as a predictor of adenomatous polyps in the colorectum of middle-aged males

“…However, nearly 1 in 15 CRCs develops in adults \50 years [13]. Given the long lead time associated with the adenoma-to-carcinoma progression, the increased number of CRCs diagnosed in this age group may reflect the end result of adenomas present in individuals in their 40 s [12].…”

A Hospital Based Cohort Study of Colorectal Cancer Cases Treated at Braga Hospital, Northern Portugal

“…Advanced age is the most significant risk factor for diagnosis of CRC, which is defined as a disease of elderly people, with the majority of cases arising after 65-70 years of age and with an incidence relatively lower under 40 years of age. Still, 15% of cases will occur in people ≤ 50 years old [1,3,10,11,[21][22][23][24][25][26], although another study suggests a lower value (7%) [27] and a large study identifies it as one of the 10 most commonly diagnosed cancers among men and women aged 20-49 years [26]. Early onset of CRC is assumed to be indicative of genetic susceptibility [22], often associated with a positive family history [28].…”

“…Early onset of CRC is assumed to be indicative of genetic susceptibility [22], often associated with a positive family history [28]. In some studies, such younger patients presented more advanced disease and more aggressive tumour grades at diagnosis and had less favourable prognosis [26][27][28][29]. Prevalence of advanced colorectal neoplasms increases with age and is higher among men than women [18,25,[29][30][31].…”

Editor`s Comments

“…We don't as yet know what impact the newer modalities of screening will have on the importance of limited endoscopic techniques in open access units or whether we will be able to identify population-based subgroups where such a limited endoscopic approach will prove most cost-effective [17][18][19]. The decisions made here will have endoscopic durability where demographic risk factors can be identified, (although there is cohort selection bias), for population-based repeat take-up rates of endoscopy in those who have already undergone prior screening procedures [20]. In this respect, the predictability of colorectal adenomas increases with age (particularly in males) although this effect is lost a little as patients exceed 70 years of age [21].…”