Original article
Alimentary tract
Prevalence of and Risk Factors for Colorectal Neoplasia in Asymptomatic Young Adults (20–39 Years Old)

https://doi.org/10.1016/j.cgh.2018.07.011Get rights and content

Background & Aims

The incidence of colorectal cancer is increasing among persons 50 years old or younger. However, data on the epidemiology of young-onset colorectal neoplasia (CRN) are limited. Although some studies have investigated the epidemiology of CRN in persons younger than 50 years, most have focused on persons 40 years or older. We evaluated the prevalence of and risk factors for CRN in adults younger than 40 years.

Methods

We performed a cross-sectional analysis of 72,356 asymptomatic individuals, 20–39 years old, who underwent colonoscopies as participants in the Kangbuk Samsung Health Study in South Korea, from August 2004 through December 2015. Data on medical history and health-related behavior were collected from self-administered questionnaires. Patients were divided into groups based on age (20–29 years, n = 7340 or 30–39 years, n = 65,016), and χ2 tests were used to compare categorical variables between groups. A multivariate logistic regression model was used to assess the risk factors for overall and advanced CRN.

Results

The prevalence of overall CRN in group of 20–29 years was 5.9% and in the group of 30–39 years was 9.5% (P < .001); prevalence values for advanced CRN were 0.6% and 0.9%, respectively (P = .005). In the group of 30–39 years, age, smoking, alcohol intake, obesity, and abdominal obesity were independent risk factors for overall and advanced CRN. Additionally, male sex and metabolic syndrome were independent risk factors for overall CRN, whereas regular exercise reduced risk of overall CRN. Even in the 20-29 years group, obesity, abdominal obesity, and increased levels of triglycerides were independent risk factors for overall and advanced CRN, whereas age, increased blood pressure, and increased fasting blood glucose level were independent risk factors for overall CRN.

Conclusion

In a retrospective analysis of 72,356 asymptomatic persons under 40 years of age evaluated by colonoscopy in Korea, we found modifiable factors, such as smoking, alcohol intake, obesity, and metabolic syndrome, to be significant risk factors for CRN—even in persons of 20–39 years old. Colorectal cancer screening strategies should consider these risk factors.

Section snippets

Study Population

The Kangbuk Samsung Health Study is a cohort study of South Korean men and women aged ≥18 years who underwent a comprehensive annual or biennial health examination at the Kangbuk Samsung Hospital Total Healthcare Center in Seoul and Suwon, South Korea. The study population consisted of a subset of Kangbuk Samsung Health Study participants aged 20–39 years who underwent colonoscopy as part of a health check-up from August 2004 to December 2015 (n = 94,805). We retrospectively analyzed data

Baseline Characteristics of the Study Population

We reviewed the medical records of 94,805 participants aged 20–39 years who underwent colonoscopy. Of them, 22,449 were excluded because of a prior colonic examination, colorectal surgery, or CRN (n = 11,995); history of inflammatory bowel disease (n = 197); family history of CRC (n = 2345); and poor bowel preparation (n = 7912). Ultimately, 72,356 participants were analyzed. The mean age of the study participants was 34.0 ± 3.4 years, and the proportion of male patients was 68.6%.

Of the 72,356

Discussion

In this very large study of an asymptomatic young population, we found that CRN in subjects aged 20–29 years and those 30–39 years was 5.9% and 9.5%, respectively. In subjects aged 20–29 years, obesity, abdominal obesity, and elevated triglyceride were independent risk factors for both overall and advanced CRN, while age, elevated blood pressure, and elevated FBG were also independent risk factors for overall CRN. In subjects aged 30–39 years, age, smoking, alcohol intake, obesity, and

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    Conflicts of interest The authors disclose no conflicts.

    Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT) (NRF-2017R1A2B4004988).

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