E0165 - Is There a Lower Adenoma Detection Rate in Patients Age 45-49 Who Undergo a Screening Colonoscopy?

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

NS

Neeraj K. Sachdeva, MD

Raleigh Medical Group
Raleigh, NC

Grace Hawley, BA¹, Dillan Jagannath, ², Priya Verma, BS¹, Rishi Desai, BSPH¹, Raja Vadlamudi, MD, MPH¹, Neeraj K. Sachdeva, MD³
¹Raleigh Medical Group Gastroenterology, Raleigh, NC; ²RMG Gastroenterology, Raleigh, NC; ³Raleigh Medical Group, Raleigh, NC

Introduction: Colorectal cancer (CRC) is the #2 cancer killer in the US.1 Recently, the USPSTF guidelines reduced the CRC screening age to 45 yo for normal-risk individuals.2 The adenoma detection rate (ADR) of 25% (20% F, 30% M) is an accepted benchmark of a quality colonoscopy in 50-75 yo. Since prevalence of adenomas increases with age, it has been suggested that a 1-3% reduction in ADR can be anticipated in 45-49 yo patients undergoing a screening colonoscopy.3 No studies have evaluated the ADR among 45-49 yo screened in 2021, since the integration of the new guidelines.

Aim: To compare the ADR in screening colonoscopies for patients ages 45-49 yo vs. older cohorts in 2021.

Methods: A retrospective analysis of records was performed on 6386 asymptomatic 45-75 yo patients who underwent a screening colonoscopy. Exclusion criteria included: (1) prior screening test, (2) incomplete colonoscopy, (3) inadequate bowel preparation, or (4) hereditary CRC syndrome/CRC family history. ADR is defined as the percentage of colonoscopies with ≥1 tubular adenoma (TA), tubulovillous adenoma (TVA), or sessile serrated adenoma (SSA).3 An advanced lesion was defined as a TA/SSA >10 mm, villous or high grade dysplasia, traditional serrated adenoma, or >5 adenomas or SSA in any combination, or cancer.3

Results: 5985 colonoscopies (2857 M,3128 F) were performed with an average withdrawal time ~11 minutes. Table 1 shows ADR results.

The 45-49 yo cohort represented 10.9% of the screened population. The ADR in the 45-49 age range was 32.1% vs 38.7% (P< 0.0097) for the 50-75 age cohort.

Discussion: In our study, 10.9% of the screened population was between 45-49 years old. The ADR was significantly lower in the 45-49 yo cohort as compared to the 50-75 yo cohort; however, the 32% ADR remains well above the accepted benchmark of 25%. The APC is lower in 45-49 yo patients, and a larger sample size may show reduction in ADR when compared to 50-54 yo. Gastroenterologists can expect only a slightly lower ADR in the newest screening cohort (age 45-49), but it remains critical that physicians emphasize the importance of average-risk CRC in the younger demographic.

1. Siegel RL, et al. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7-34.
2. US Preventive Services Task Force. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA 2021;325:1965-1977.
3. Shaukat A, et al. Adenoma detection for 45- to 49-year-old screening population. Gastroenterology 2022;162:957-959.

	45-49 y n = 654	50-54 y n = 2563	P value (compared with 45-49)	50-75 y n = 5331	P value (compared with 45-49)
Overall ADR (%)	32.1	36.2	0.1158	38.7	0.0097
ADR (%) in men n=2857	37.2	41.6	0.2951	44.2	0.0885
ADR (%) in women n=3128	28.2	30.6	0.4586	33.6	0.0888
APC	0.56	0.69	0.0005	0.77	< 0.0001
CRC detected	1	2	0.5757	10	0.8452

Table: Table 1. Adenoma Detection Rates in Screening Colonoscopies.

ADR: adenoma detection rate; APC: adenoma per colonoscopy; CRC: colorectal cancer

Disclosures:

Grace Hawley indicated no relevant financial relationships.

Dillan Jagannath indicated no relevant financial relationships.

Priya Verma indicated no relevant financial relationships.

Rishi Desai indicated no relevant financial relationships.

Raja Vadlamudi indicated no relevant financial relationships.

Neeraj Sachdeva indicated no relevant financial relationships.

Grace Hawley, BA¹, Dillan Jagannath, ², Priya Verma, BS¹, Rishi Desai, BSPH¹, Raja Vadlamudi, MD, MPH¹, Neeraj K. Sachdeva, MD³. E0165 - Is There a Lower Adenoma Detection Rate in Patients Age 45-49 Who Undergo a Screening Colonoscopy?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.