P2361 - Risk Factors for Advanced Colorectal Neoplasia in Veterans Under Age 50

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Timothy Yen, MD

University of Colorado Anschutz Medical Campus
Denver, CO, United States

Timothy Yen, MD¹, Jack Scolaro, MD², Viridiana Estrada, MD², Jeannine M. Espinoza, BA², Eric M. Montminy, MD³, Jordan J. Karlitz, MD, FACG⁴, Frank I. Scott, MD, MSCE², Swati Patel, MD⁵
¹University of Colorado Anschutz Medical Campus, Denver, CO; ²University of Colorado Anschutz Medical Campus, Aurora, CO; ³Tulane University School of Medicine, New Orleans, LA; ⁴Denver Health and Hospital, Denver, CO; ⁵University of Colorado School of Medicine, Denver, CO

Introduction: Colorectal cancer (CRC) incidence and mortality in patients age < 50 is increasing. Recent guidelines have decreased the average-risk screening age from 50 to 45, however the yield of screening and risk factors for advanced colorectal neoplasia (advanced colorectal polyps or adenocarcinoma) in Veterans < 50 is unknown. Our aim was to describe the rate of and risk factors for advanced neoplasia (AN) in Veterans age < 50 and estimate the yield of expanding screening to average-risk Veterans < 50.

Methods: We conducted a single-center retrospective cohort study including Veterans age 20-49 undergoing colonoscopy for any indication from 2012-2019. We collected Veteran- and colonoscopy-level data and reported rates of non-advanced and AN. We assessed risk factors for AN with univariate and multivariable analysis. We assessed the expected yield of expanding screening to average-risk Veterans < 50 by reporting neoplasia rates in average-risk equivalent Veterans (those with low-risk diagnostic symptoms such as diarrhea, constipation, peri-operative evaluation) and compared these rates to rates of AN in 50-54 year-old average-risk Veterans.

Results: Of 2,030 Veterans included, 141 (6.9%) had AN and 831 (40.9%) had non-advanced neoplasia. Multivariable analysis identified older age (OR 10.73, 95% CI 3.73-30.87 in 45-49 vs. 20-29), male sex (OR 2.88, 95% CI 1.47-5.64), prior non-gastrointestinal cancer (3.65, 95% CI 1.49-8.92), and high-risk diagnostic indications (melena, hematochezia, iron deficiency anemia, abnormal imaging) (OR 2.33, 95% CI 1.36-4.00) as independent risk factors for AN (Table). Of the AN found in 45-49 year old average-risk equivalent Veterans, 50% of advanced lesions were located in the right colon. There was no difference in the rate of AN between average-risk equivalent Veterans age 45-49 and average-risk Veterans age 50-54 (8.5% vs 8.8%, p = 0.922) (Figure).

Discussion: Male Veterans with high-risk symptoms and prior non-gastrointestinal cancer should be prioritized for colonoscopy. The rate of AN in average-risk equivalent Veterans 45-49 was comparable to average-risk Veterans 50-54, supporting expanding screening to this population. High rates of right-sided AN require further study to determine optimal screening modality.

Figure: Advanced Colorectal Neoplasia (dark grey), Non-Advanced Colorectal Neoplasia (light grey). Single lesion may have overlapping advanced features (such as size and histology).
* Peri-operative evaluation, change in bowel habits, constipation, diarrhea, ‘other’

	Patients with Advanced Neoplasia n (%) or mean (SD)	Univariate analysis		Multivariate analysis*
	Patients with Advanced Neoplasia n (%) or mean (SD)	Odds Ratio (95% CI)	p	Odds Ratio (95% CI)	p
Age group
20-29	4 (1.7%)	Reference		Reference
30-39	31 (4.4%)	3.13 (1.09-9.01)	0.034	3.22 (1.10-9.43)	0.033
40-44	31 (7.5%)	7.22 (2.50-20.87)	< 0.001	4.81 (1.58-14.64)	0.006
45-49	75 (10.9%)	13.40 (4.81-37.32)	< 0.001	10.73 (3.73-30.87)	< 0.001
Sex
Female/Other	19 (5.0%)	Reference		Reference
Male	122 (7.4%)	1.81 (1.09-3.00)	0.021	2.88 (1.47-5.64)	0.002
Body mass index	30.7 (6.83)	1.05 (1.02-1.08)	< 0.001	1.02 (0.98-1.06)	0.291
Prior non-gastrointestinal cancer
No	129 (6.6%)	Reference		Reference
Yes	12 (13.3%)	2.5 (1.27-4.90)	0.008	3.65 (1.49-8.92)	0.005
Diagnostic Indication
Low Risk**	19 (3.8%)	Reference		Reference
High-Risk***	82 (9.0%)	2.65 (1.57-4.45)	< 0.001	2.33 (1.36-4.00)	0.002

Table: Table. Univariate and multivariable analysis of predictors of advanced colorectal neoplasia (compared to no neoplasia) in Veterans undergoing colonoscopy age < 50.
*AUC 0.755
**Peri-operative evaluation, change in bowel habits, constipation, diarrhea, other
***Abnormal imaging, Positive FIT/FOBT, Bleeding, Iron-Deficiency
SD: Standard Deviation; CI: Confidence Interval

Disclosures:

Timothy Yen indicated no relevant financial relationships.

Jack Scolaro indicated no relevant financial relationships.

Viridiana Estrada indicated no relevant financial relationships.

Jeannine Espinoza indicated no relevant financial relationships.

Eric Montminy indicated no relevant financial relationships.

Jordan Karlitz: Gastro Girl – Advisory Committee/Board Member, Other Financial or Material Support, Equity position and Chief Medical Officer. GI On DEMAND – Advisory Committee/Board Member, Other Financial or Material Support, Equity position and Chief Medical Officer.

Frank Scott indicated no relevant financial relationships.

Swati Patel: ERBE USA – Consultant. Freenome Inc. – Consultant. Olympus America – Consultant.

Timothy Yen, MD¹, Jack Scolaro, MD², Viridiana Estrada, MD², Jeannine M. Espinoza, BA², Eric M. Montminy, MD³, Jordan J. Karlitz, MD, FACG⁴, Frank I. Scott, MD, MSCE², Swati Patel, MD⁵. P2361 - Risk Factors for Advanced Colorectal Neoplasia in Veterans Under Age 50, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.