Simple Risk Score May Guide CRC Screening Before Age 45: Daily Dose

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On March 28, 2025, we reported on a study published in Digestive Diseases and Sciences that was designed to develop and validate a model estimating the likelihood of advanced colorectal neoplasia (AN) in adults age < 45 years.

The study

Researchers conducted a retrospective cross-sectional analysis of 9446 people aged 18-44 years (mean age, 36.8 years; 61% women) who underwent colonoscopy at Cleveland Clinic between 2011 and 2021. AN was defined as a tubular adenoma ≥ 10 mm or any adenoma with villous features or high-grade dysplasia, sessile serrated polyp ≥ 10 mm, sessile serrated polyp with dysplasia, traditional serrated adenoma, or invasive adenocarcinoma. Individuals with AN constituted the case group while those with a normal colonoscopy or non-advanced neoplasia (NAN) formed the control group. Researchers used backward elimination multivariable logistic regression methods to construct a model based on significant associations (P < .05) between risk factors and the presence of AN in a randomly selected training set and confirmed the associations in a validation set, according to the study.

The findings

AN was detected in 346 (3.7%) of the 9446 participants included, researchers reported. A multivariate logistic regression model identified 3 independent risk factors significantly associated with advanced neoplasia: Higher body mass index (BMI; P = .0157), former and current tobacco use (P = .0009 and P = .0015, respectively), and having a first-degree relative with colorectal cancer (CRC) < 60 years (P < .0001) or other family history of CRC (P = .0117). The model demonstrated “moderate” discriminatory power in the validation set (C-statistic: 0.645), indicating that it can effectively differentiate between individuals at a higher and lower risk for advanced neoplasia.

Authors' comments

"We developed and internally validated a simple score using clinical factors which successfully predicts the likelihood of AN in adults < 45 years undergoing colonoscopy. Once externally validated, the proposed risk score may be useful for individualized CRC screening strategies."

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