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TOPLINE:

Compared with patients with average-onset colorectal cancer (CRC), those with early-onset CRC do not have an increased risk for advanced neoplasia and, thus, do not require more frequent colonoscopy surveillance than recommended by current guidelines.

METHODOLOGY:

• Despite the increasing incidence of early-onset CRC, there are no specific guidelines in the United States regarding optimal colonoscopy surveillance intervals for these individuals.
• This retrospective chart review compared the findings of surveillance colonoscopy between patients with early-onset CRC and those with average-onset CRC who underwent surveillance colonoscopy at least once during the study period.
• The time to the first surveillance colonoscopy was determined according to the initial curative intent surgery, with the index colonoscopy defined as the first surveillance colonoscopy conducted after the curative surgery.
• The primary outcome was the comparison of the incidence of overall and advanced neoplasia (defined as CRC and/or advanced polyps) detected during surveillance colonoscopies in patients with early-onset or average-onset CRC.

TAKEAWAY:

• Investigators identified 612 patients with early-onset CRC (average age, 42.7 years) and 647 patients with average-onset CRC (average age, 61.2 years).
• Both the early-onset and average-onset cohorts had an average of 12.6 months between surgery and the first surveillance colonoscopy; the mean interval between the first and second surveillance colonoscopies was 20.8 and 23.9 months, respectively, and between the second and third surveillance colonoscopies was 22.7 and 27.4 months, respectively.
• The risk for advanced neoplasia from the initial surgery to the first surveillance colonoscopy was 29% lower in the early-onset CRC cohort than in the average-onset CRC cohort.
• During the index colonoscopy, patients with early-onset CRC were less likely to have advanced polyps than those with average-onset CRC (12.4% vs 16.0%).
• Patients with early-onset CRC did not exhibit increased occurrences of cancers, advanced adenomas, or nonadvanced adenomas on second and third surveillance colonoscopies.
• The likelihood of developing advanced polyps was 1.7 times higher in patients with advanced-onset CRC than in those with early-onset CRC.

IN PRACTICE:

"[Early-onset CRC] patients do not necessitate more intense colonoscopy surveillance strategies. Individual and personalized strategies should be adopted for these patients based on the individual's risk profile and clinical history," the authors wrote.

SOURCE:

This study, led by Robin B. Mendelsohn, MD, Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

The study was retrospective in nature and was performed at a single institution. Owing to the lack of US guidelines for surveillance strategies among patients with early-onset CRC, inconsistencies in follow-up exam timing may have occurred. The findings may not have been representative of the larger and more diverse US population.

DISCLOSURES:

This study received grant support from the National Cancer Institute–designated Cancer Center and Memorial Sloan Kettering Cancer Center for Young Onset Colorectal and Gastrointestinal Cancers. Some of the authors declared serving as consultants or advisors or receiving research funding or research support from various sources.