Do Patients With Young-Onset Colorectal Cancer Require More Frequent Surveillance Colonoscopy?

Current recommendations for sporadic colorectal cancer (CRC) are to perform surveillance colonoscopy 1 year after surgical resection, then at 3 years, and then at 5-year intervals.

In a single-center U.S. report, investigators followed 457 patients with young-onset colorectal cancer (YOCRC; defined as CRC diagnosed at ≤50 years) who had endoscopy records and had neither recurrent disease nor hereditary CRC. The original cancer was located in the proximal colon in 9.4% of patients, distal colon in 23%, and rectum in 67.6%. Follow-up colonoscopy demonstrated 6 lumenal recurrences and 32 “metachronous” lesions, of which 31 were high-risk adenomas (advanced adenomas or ≥3 adenomas) and 1 was described as CRC but was actually intramucosal carcinoma (better-called high-grade dysplasia). Twenty-four (63%) events occurred within 15 months of resection, and another 9 (23.7%) occurred within the 48-month time point.