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Title: Study Confirms Most Adults Under Age 50 Rarely Need Colorectal Screening
URL: http://www.pslgroup.com/dg/22DF96.htm
Doctor's Guide
October 1, 2008

BALTIMORE, Md -- October 1, 2008 -- Young adults without a family history of bowel disease are unlikely to develop adenomas, according to a study in the September issue of the journal, Clinical Gastroenterology and Hepatology.

The finding supports current cancer screening guidelines recommending adults in general undergo screening colonoscopies starting at age 50.

The study also showed that white patients more often had adenomas on the left side of the colon, whereas African Americans had lesions more often on the right side. The take-home lesson, according to the authors, is that screening and diagnostic evaluations of African Americans should include a colonoscopy rather than a sigmoidoscopy, because the latter evaluates only part of the colon.

The study assessed the natural history and occurrence of colorectal polyps by reviewing records of 3,558 autopsies performed at the Johns Hopkins Hospital, Baltimore, Maryland, between 1985 and 2004 on patients aged 20 to 89 years.

The review categorised patients by sex, race, and 10-year age groups, then compared the prevalence and location of adenomas between younger adults (20-49 years) and older adults (50-89 years).

The review identified a low but increasing prevalence of colorectal adenomas -- from 1.72% to 3.59% -- from the third to the fifth decade of life, with the presence of adenomas sharply increasing after age 50. Prevalence ranged from 10% to 12% from the sixth to ninth decade of life.

"Our study affirmed that the greatest increase in prevalence was in older adults, abruptly starting in the sixth decade," said lead author Francis M. Giardiello, MD, Johns Hopkins Hospital.

The average number of adenomas spotted in most young adults was 1. In older adults, the average number of adenomas ranged from 1.6 to 1.9.

The researchers found that in young adults, adenomas were slightly more prevalent in men than in women and in whites than in blacks. In older adults, the prevalence of adenomas also was greater in men than in women, but greater in blacks than in whites.
In addition, the study found that in both younger and older adults, the overall prevalence of left-sided adenomas was higher than right-sided adenomas. Compared with younger adults, older adults had an increased prevalence of adenomas on both sides of the colorectum, but a relatively greater prevalence of right-sided adenomas.

SOURCE: Johns Hopkins Medical Institutions

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