Risk Score Identifies Young Adults at Increased Risk for Advanced Colorectal Neoplasia
In Digestive Diseases and Sciences, a newly developed clinical prediction model offers a tool to estimate the likelihood of advanced colorectal neoplasia (AN) in adults under age 45, a population increasingly affected by early-onset colorectal cancer (CRC).
In this cross-sectional study of 9,446 adults aged 18 to 44 who underwent colonoscopy between 2011 and 2021 at a tertiary center, researchers identified 346 cases of AN (3.7%). Using a multivariable logistic regression approach, they created a prediction model based on significant clinical factors, then validated the model in a separate subset of patients.
Key risk factors included elevated BMI, family history of CRC, and tobacco use. Specifically, having a first-degree relative diagnosed with CRC before age 60 was strongly associated with AN (p < 0.0001). Both current (p = 0.0015) and former (p = 0.0009) tobacco use were also significant predictors.
In the validation cohort, the model demonstrated moderate discriminatory power with a c-statistic of 0.645. The resulting risk score stratified patients into tiers of AN probability, ranging from 1.8% for individuals with the lowest score (1) to over 14% for those with a score of 9 or higher.
“We developed and internally validated a simple score using clinical factors which successfully predicts the likelihood of AN in adults < 45 years undergoing colonoscopy,” the authors wrote.
Importantly, the model provides a quantitative framework for evaluating younger adults who may benefit from earlier colonoscopy. “Once externally validated, the proposed risk score may be useful for individualized CRC screening strategies,” the authors concluded.
For gastroenterologists, this tool may support clinical decision-making in determining which patients under 45 should undergo colonoscopy despite not meeting current guideline thresholds.
Reference
Wehbe S, Thomas RJ, Bolwell J, et al. A score to predict advanced colorectal neoplasia in adults younger than age 45. Dig Dis Sci. Published online February 13, 2025. doi:10.1007/s10620-025-08861-y
