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Recently, the American Cancer Society made a qualified recommendation to start colorectal cancer (CRC) screening at 45 years of age in all average-risk individuals. In this study, our primary aim is to calculate the prevalence and also evaluate the predictors of increased prevalence of detected adenomas in the 40–49-year-old individuals undergoing colonoscopy. A retrospective cross-sectional study was performed using our endoscopy database. Study subjects included all 40–49-year-old patients undergoing their first colonoscopy at our institution from January 1, 2010 to September 30, 2017. Exclusion criteria included patients who underwent colonoscopy for overt gastrointestinal bleeding, inflammatory bowel disease, a history of familial adenomatous polyposis, hereditary non-polyposis CRC. Univariate analysis and multivariate analysis were performed to identify factors associated with increased adenoma detection rate (ADR). A total of 2059 patients were included in the study, and 317 of these patients had family history (FH) of CRC. Patients with FH of CRC had significantly higher ADR (27.8% vs. 19.7%, p = 0.001) as compared to those without FH of CRC. There was no significant difference in ADR in patients between 40–44 years and 45–49 years of age (17.7% vs. 21.4%, p = 0.058). On a multivariate analysis while adjusting for multiple patient and procedural variables, FH of CRC, male sex, BMI > 30 kg/m2, chronic kidney disease, and age were associated with high ADR. Our study shows that in addition to FH of CRC, age, male sex, BMI, and CKD are independent predictors of increased ADR in patients between 40 and 49 years of age.

Background: Recently the American Cancer Society made a qualified recommendation to start screening for colorectal cancer (CRC) at 45 years of age in all average risk individuals. In this study, our primary aim is to calculate the prevalence and also evaluate the predictors of increased prevalence of detected adenomas in the 40 to 49-year-old individuals undergoing colonoscopy. Methods: A retrospective cross sectional study was performed using our electronic endoscopy database. Study subjects included all 40 to 49-year-old patients undergoing their first colonoscopy at our institution from January 1, 2010 to September 30, 2017. Exclusion criteria included patients who underwent colonoscopy for overt gastrointestinal bleeding, inflammatory bowel disease, a history of familial adenomatous polyposis, hereditary non polyposis CRC. Univariate analysis and multivariate analysis was performed to identify factors associated with increased adenoma detection rate (ADR). Findings: A total of 2059 patients were included in the study and 317 of these patients had family history (FH) of CRC. Patients with FH of CRC had significantly higher ADR (27.8% versus 19.7%, p=0.001) as compared to those without family history of CRC. There was no significant difference in ADR in patients between 40-44-years versus 45-49-years of age (17.7% vs 21.4%, p=0.058). On a multivariate analysis while adjusting for multiple patient and procedural variables; FH of CRC, male gender, BMI > 30 kg/m2, chronic kidney disease, and age were associated with high ADR. Interpretation: Our study shows that in addition to FH of CRC, age, male gender, BMI, and CKD are independent predictors of increased ADR in patients between 40 to 49 years of age. Funding Statement: The authors state: " No funding sources to be declared." Declaration of Interests: The authors report no conflicts of interest. Ethics Approval Statement: The study protocol was approved by the institutional review board (IRB) at the University of Texas Medical Branch, Galveston, TX.