Cleveland Clinic researchers have developed a new tool to predict the risk of colorectal cancer and advanced precancerous polyps in adults under 45.
This is important because current guidelines recommend screening starting at age 45 for people at average risk, but many cases of early-onset colorectal cancer occur in younger adults.
The Growing Concern of Early-Onset Colorectal Cancer
Colorectal cancer happens when abnormal growths, called polyps, form in the colon or rectum and turn cancerous over time.
It is one of the deadliest cancers in younger adults. According to the American Cancer Society, colorectal cancer is the leading cause of cancer death in men under 50 and the second-leading cause in women of the same age group.
The new prediction model, developed by Cleveland Clinic researchers, aims to identify younger adults who may be at high risk so they can get screened earlier.
Key Risk Factors and How the Model Works
The study confirmed four key risk factors linked to early-onset colorectal cancer and precancerous polyps:
- Family history of colorectal cancer
- Body mass index (BMI) (a measure of body fat based on height and weight)
- Sex (men are at higher risk)
- Smoking
Based on these factors, the model calculates a risk score ranging from 0 to 12. If a person scores 9 or higher, they have a 14% or greater chance of having cancer or advanced precancerous polyps. According to lead researcher Dr. Carole Macaron, adults under 45 with a high score could benefit from earlier screening.
How the Study Was Conducted
The researchers analyzed data from 9,446 adults aged 18 to 44 who had a colonoscopy at Cleveland Clinic between 2011 and 2021. Among them:
- 39% were men, 61% were women
- The average BMI was 28.7, classified as overweight
- 80.3% had no family history of colorectal cancer
- 39.7% were current or former smokers
- 70.9% reported alcohol use
Following the colonoscopies, 346 participants were diagnosed with early-onset colorectal cancer or advanced precancerous polyps, while the rest formed a control group. The prediction model was built based on the patterns observed in these cases.
What This Means for Screening Recommendations
This new risk score could help doctors personalize screening decisions for younger adults. Since current guidelines only recommend screening at age 45 for people at average risk, those under 45 often go undiagnosed until the disease has advanced. Dr. Macaron hopes this tool will help identify high-risk individuals earlier, potentially saving lives.
The research team plans to expand the study by including more hospitals to validate the model further. If successful, this tool could lead to changes in screening guidelines and improve early detection of colorectal cancer in young adults.
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The research findings can be found in Digestive Diseases and Sciences.
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