Yield of Screening in 45- to 49-Year-Olds May Be Same As in 50- to 54-Year-Olds

Douglas K. Rex, MD, MASGE reviewing Butterly LF, et al. Am J Gastroenterol 2020 Aug 21.

The American Cancer Society recently recommended that colorectal cancer screening begin at age 45 in all Americans, but the recommendation is not widely followed. In this study, data from the New Hampshire Colonoscopy Registry was culled to identify a “screening equivalent” cohort of persons younger than 50 years of age, based on indications that have not been associated with an increased prevalence of colon polyps or cancer in previous studies (eg, abdominal pain and constipation). 

Using this average-risk screening equivalent for the cohort younger than 50 years of age, 40,812 patients were studied. The prevalence of advanced neoplasia was 1.1% in persons younger than 40 years, 3% in individuals aged 40 to 44 years, 3.7% in those aged 45 to 49 years, 3.6% in those 50 to 54 years of age, 5.1% for 55- to 59-year-olds, and 6.7% for persons 60 years or older. The similarity in advanced neoplasia risk between 45- to 49-year-olds and 50- to 54-year-olds persisted after adjustment for available risk factors.


Previous studies established that the prevalence of cancer and advanced neoplasia at colonoscopy is similar, comparing persons with nonbleeding colonic symptoms (no hematochezia, anemia, or positive stool test) and the asymptomatic population. Although imperfect, these data do support the new recommendation to begin screening at age 45 years. Stratifying persons within the 45- to 49-year age group by risk, which includes more than 20 million Americans, is an important consideration.

Douglas K. Rex, MD, MASGE

Bio and Disclosures


Butterly LF, Siegel RL, Fedewa S, Robinson CM, Jemal A, Anderson JC. Colonoscopy outcomes in average-risk screening equivalent young adults: data from the New Hampshire Colonoscopy Registry. Am J Gastroenterol 2020 Aug 21. (Epub ahead of print) (