More than one quarter of colonoscopies carried out in Americans aged 30 to 49 years reveal some type of neoplasm, and slightly over 6% of these patients have advanced cancer, results of a nationally representative endoscopic registry show.

“This is the largest study to date that has looked at the prevalence of what you find at colonoscopy in people younger than the age of 50,” Steven Itzkowitz, MD, professor of medicine, oncological sciences, and medical education, Icahn School of Medicine at Mount Sinai, in New York City, told Medscape Medical News.

“And the point is that our data do justify lowering the new screening age to 45— we like to say 45 is the new 50 — and physicians need to start talking to patients before they reach the age of 45, because people procrastinate before they actually come in for screening,” he added.

The study was jointly carried out by the Icahn School of Medicine at Mount Sinai and AMSURG, a division of Envision Healthcare, and was presented during the Digestive Disease Week (DDW) 2021 virtual scientific meeting.

Quality Improvement Consortium

For this study, Itzkowitz and colleagues analyzed a subset of the GI Quality Improvement Consortium registry of outpatient colonoscopies, focusing on individuals who had undergone a screening or a diagnostic colonoscopy between 2014 and 2021.

In total, the dataset contained 3 million colonoscopies, from which investigators selected the first recorded colonoscopy for patients aged 18 to 54 years. Patients were excluded if they had previously undergone a colonoscopy or they had a personal history of colorectal polyps, cancer, inflammatory bowel disease, or an inherited colorectal cancer (CRC) syndrome. Patients whose colonoscopy was of low quality as well as those who underwent surveillance or therapeutic procedures were also excluded.

“This left 563,000 procedures in the analyzable dataset — 146,000 of which were performed on patients aged 18 to 44, and 80,000 of which were performed on patients aged 45 to 49,” the investigators observe.

Among patients between 45 and 49 years of age, the most frequent indication for the colonoscopy was for routine screening, at over 41%, they note.