LAUSR

BACKGROUND AND AIMS A disturbing increase in early-onset colorectal cancer (EOCRC) has prompted recent guidelines to recommend lowering the CRC screening starting age from 50 to 45 years old for average risk individuals. Little is known about the prevalence of colorectal neoplasia in individuals between 45-49 years old, or even younger, in the United States. We analyzed a large, nationally representative dataset of almost 3 million outpatient colonoscopies to determine the prevalence of, and risk factors for, colorectal neoplasia among patients aged 18-54. METHODS Findings from high-quality colonoscopies were analyzed from AMSURG ambulatory endoscopy centers (ASCs) that report their results in the GI Quality Improvement Consortium (GIQuIC) Registry. Logistic regression was used to identify risk factors for EOCRC. RESULTS Increasing age, male sex, white race, family history of CRC, and examinations for bleeding or screening were all associated with higher odds of advanced premalignant lesions (APLs) and CRC. Among patients aged 45-49, 32% had any neoplasia, 7.5% had APLs, and 0.58% had CRC. Rates were almost as high in those aged 40-44. Family history of CRC portended neoplasia rates 5 years earlier. Rates of APLs were higher in Asians and American Indian/Alaskan Natives, but lower among Blacks and Hispanics, compared to white counterparts. The prevalence of any neoplasia and APL gradually increased between 2014-2020, in all age groups. CONCLUSIONS These data provide support for lowering the screening age to 45 for all average risk individuals. Early messaging to patients and providers in the years leading up to age 45 is warranted, especially in those with a family history of CRC.