Systematic Review of Prevalence, Risk Factors, and Risk for Metachronous Advanced Neoplasia in Patients With Young-Onset Colorectal Adenoma

Ngozi Enwerem, Moo Y. Cho, Joshua Demb, Ashley Earles, Karen M. Heskett, Lin Liu, Siddharth Singh, Samir Gupta

Research output: Contribution to journalReview articlepeer-review

Abstract

Background & Aims: The incidence and mortality of early-onset colorectal cancer (CRC) are increasing. Adenoma detection, removal, and subsequent endoscopic surveillance might modify risk of CRC diagnosed before age 50 years (early-onset CRC). We conducted a systematic review of young-onset adenoma (YOA) prevalence, associated risk factors, and rate of metachronous advanced neoplasia after YOA diagnosis. Methods: We performed a systematic search of multiple electronic databases through February 12, 2019 and identified studies of individuals 18 to 49 years old that reported prevalence of adenoma, risk factors for adenoma, and/or risk for metachronous advanced neoplasia. Summary estimates were derived using random effects meta-analysis, when feasible. Results: The pooled overall prevalence of YOA was 9.0% (95% CI, 7.1%–11.4%), based on 24 studies comprising 23,142 individuals. On subgroup analysis, the pooled prevalence of YOA from autopsy studies was 3.9% (95% CI, 1.9%–7.6%), whereas the prevalence from colonoscopy studies was 10.7% (95% CI, 8.5%–13.5). Only advancing age was identified as a consistent risk factor for YOA, based on 4 studies comprising 78,880 individuals. Pooled rate of metachronous advanced neoplasia after baseline YOA diagnosis was 6.0% (95% CI, 4.1%–8.6%), based on 3 studies comprising 1493 individuals undergoing follow-up colonoscopy, with only 1 CRC case reported. Overall, few studies reported metachronous advanced neoplasia and no studies evaluated whether routine surveillance colonoscopy decreases risk of CRC. Conclusions: In a systematic review, we estimated the prevalence of YOA to be 9% and to increase with age. Risk for metachronous advanced neoplasia after YOA diagnosis is estimated to be 6%. More research is needed to understand the prevalence, risk factors, and risk of CRC associated with YOA.

Original languageEnglish (US)
Pages (from-to)680-689.e12
JournalClinical Gastroenterology and Hepatology
Volume19
Issue number4
DOIs
StatePublished - Apr 2021
Externally publishedYes

Keywords

  • Colon
  • Neoplasm
  • Tumor
  • Young Adult

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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