Detroit Medical Center/Wayne State University Detroit, MI
Introduction: Recent guidelines have lowered the age for initiation of colorectal cancer (CRC) screening to 45. The current benchmark for adenoma detection rate (ADR) for screening colonoscopy in men and women 50 years and older are 30% and 20%, respectively. It is unclear if the adenoma detection rate (ADR) will need to be lowered to accommodate for a younger patient population with a presumably lower adenoma burden. Our study’s objective was to evaluate the ADR in a largely African American population comparing 45–49-year-old men and women to those 50 and older
Methods: We performed a retrospective review of our endoscopy database for all patients ages 45-73 who underwent average-risk screening colonoscopy at our institution. All average-risk screening colonoscopies for patients 50 years and older in the year 2017 and colonoscopies for patients younger than 50 from 2017 to 2021. We analyzed patients’ race, age, pathologic findings, and bowel preparation. Colonoscopies were excluded if the cecum was not reached, or the bowel preparation was inadequate. Statistical analysis was performed utilizing Chi-square testing with significance set at a P < 0.05
Results: A total of 1267 average-risk colonoscopies were performed for patients between 45-73 years. After applying our exclusion criteria, 1152 colonoscopies were analyzed, Table 1. The overall ADR was 35.4%, with a statistically significant difference between patients ≥50 years and < 50 years (38.4% vs 28.7%, p=0.002). ADR correlated with age, Figure 1. ADR for males was higher than females (41.4% vs 30.4%, p< 0.001). There was no statistically significant difference in ADR between African Americans and non-African Americans (35.2% vs 35.6%, p=0.822)
Discussion: In our predominantly African American patient population undergoing average-risk screening colonoscopy, we found an increase in ADR with age. Despite the inclusion of patients 45-49 years of age with a lower adenoma burden, ADR thresholds recommended by the GI societies were still attainable in this patient population. Endoscopists with a large young patient panel should expect a lower ADR but should not expect a drop in the ADR below the 25% benchmark
