Authors
Godson Senyondo, Ahmed Shehadah, Ailsa K Lee, Warren H Megere, Imroz H Apon, Pranaya Baskaran, Jael M Nalukenge, AbdulSubhan Talpur, Sakhawat Usama, Minhaz Ahmad
Published in
Cureus. Volume 18. Issue 9. Pages e115892. Epub Sep 07, 2026.
Abstract
Background Early-onset colorectal cancer is increasing, but diagnostic colonoscopy yield below the routine screening age remains incompletely characterized. We evaluated histologically confirmed colorectal polyps in adults younger than 45 years undergoing non-screening colonoscopy. Methods This retrospective cohort study included 727 patients aged 18-44 years who underwent non-screening colonoscopy within a community health system during 2023-2024. Screening, surveillance, prior colorectal polyps or cancer, high-risk family history, inflammatory bowel disease, and hereditary colorectal cancer/polyposis syndromes were excluded. Outcomes required endoscopic identification and final histopathology. Logistic regression examined age, recorded sex, and body mass index (BMI), with aggregated indication and continuous-variable sensitivity analyses and a parsimonious neoplastic lesion model. Results Histologically confirmed polyps were present in 217/727 patients (29.8%; 95% confidence interval (CI), 26.6%-33.3%); yields were 17.4%, 33.0%, and 46.2% at ages 18-29, 30-39, and 40-43 years. Neoplastic lesions occurred in 139/727 (19.1%) and advanced colorectal neoplasia in 33/727 (4.5%), including four invasive cancers and one intramucosal carcinoma. In the primary model (n=724), adjusted odds ratios were 2.03 (95% CI, 1.35-3.06) for ages 30-39, 3.84 (95% CI, 2.31-6.38) for ages 40-43, and 1.85 (95% CI, 1.31- 2.62) for male sex. Obesity-class estimates were non-monotonic; class II was imprecise (1.84; 1.01-3.32), including after indication adjustment (1.79; 0.98-3.25). Primary model discrimination was modest (area under the curve, 0.692). The continuous age and the secondary neoplastic lesion model supported the age association; spline analysis suggested a non-linear association between BMI and polyp presence. Conclusion Histologically confirmed polyps and neoplastic lesions were not uncommon in this selected non-screening cohort. Findings support timely diagnostic evaluation when clinically indicated but do not establish population prevalence, justify screening before age 45, or validate a clinical prediction tool.
PMID:
42845707
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.
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