Researchers have developed and validated a novel prediction model that may be capable of estimating the risk of colorectal cancer and advanced precancerous polyps in patients younger than 45 years, according to a recent study published by Wehbe et al in Digestive Diseases and Sciences.
Background
Colorectal cancer develops from polyps, clumps of abnormal cells that form on the inside lining of the colon or rectum. Several factors can increase the risk of developing the disease.
A diagnosis of colorectal cancer prior the age of 50 years is considered early-onset. Colorectal cancer is the leading and second-leading cause of cancer-related mortality in male and female patients younger than 50 years, respectively, according to data from the American Cancer Society.
“Currently, for individuals at average risk of developing colorectal cancer, the recommended age to start screening is 45 years old,” explained senior study author Carole Macaron, MD, a gastroenterologist at the Cleveland Clinic. “However, data show that about half of the patients diagnosed with early-onset colorectal cancer are younger than 45,” she added.
Study Methods and Results
In the study, the researchers used selected risk factors and the novel prediction score to estimate the likelihood of early-onset colorectal cancer and advanced precancerous polyps among 9,446 adult patients aged 18 to 44 years who underwent colonoscopy between January 2011 and December 2021. With a score equal to or greater than 9 out of 12, the likelihood of developing cancer or an advanced precancerous lesion was greater than 14%.
Among the patients, 39% (n = 3,681) of them were male and 61% (n = 5,765) of them were female. The average body mass index (BMI) was 28.7, which is generally classified as overweight. Further, 80.3% of the patients had no family history of colorectal cancer. Among the study participants, 39.7% (n = 3,468) reported current or former tobacco use and 70.9% (n = 6,489) reported current or former alcohol use.
Following the colonoscopy, early-onset colorectal cancer and/or advanced precancerous polyps were detected in 346 of the patients and a control group of 9,100 patients was formed. Among those in the control group, 88.4% (n = 8,040) had no lesions and 11.6% (n = 1,060) had nonadvanced precancerous lesions found during the screening exam.
The risk prediction model confirmed that four factors may be associated with early-onset colorectal cancer and precancerous polyps: a family history of colorectal cancer, BMI, sex, and smoking status.
Conclusions
“With the score, we can determine whether a patient under 45 years old is at high risk of developing colorectal cancer. Our study shows that an adult in the 18 to 44 age group with a score 9 and above is likely to benefit from colorectal cancer screening,” emphasized Dr. Macaron. “Young adults under 45 are at risk of developing colorectal cancer, but the recommended screening age is currently 45 for an average-risk individual. The prediction score helps personalize screening recommendations for patients under 45 years old,” she continued.
The researchers plan to expand on this research with the inclusion of additional study sites to better understand the efficacy of their novel prediction score.
Disclosure: For full disclosures of the study authors, visit link.springer.com.
