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How Much Will Screening 45- to 49-Year-Olds Affect ADR?

Douglas K. Rex, MD, MASGE, reviewing Shaukat A, et al Gastroenterology 2021 Sep 16.

With the advent of screening average-risk persons beginning at age 45, many are wondering whether minimum acceptable adenoma detection rate (ADR) thresholds will need adjustment, and even whether 45- to 49-year-olds should be included in the ADR measurement.

In the largest study to date addressing the prevalence of adenomas in this age group, 99 endoscopists performed screening colonoscopy on 4841 persons aged 45 to 49 years, 58,914 patients aged 50 to 54, and 154,976 individuals aged 50 to 75. ADRs in the 3 age groups were 28.4%, 31.1%, and 35.6%, respectively. For advanced neoplasia, the detection rates were 3.28%, 3.43%, and 3.5%, respectively.

Douglas K. Rex, MD, FASGE


It has not yet been decided whether ADR measurement should routinely include 45- to 49-year-olds undergoing screening colonoscopy. These data suggest that inclusion of the youngest age group would only lower ADRs slightly, but in the long run, the impact depends on how many people in this age group show up for screening. Given that the current threshold of 25% for a mixed-gender patient population is considered a minimum acceptable threshold (optimal or “aspirational” threshold is near 50%) and is easy to reach for most endoscopists, it seems unlikely there will be pressure to lower the minimum acceptable threshold if it’s decided to include 45- to 49-year-olds in the ADR measurement.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Shaukat A, Rex DK, Shyne M, Church TR, Perdue DG. Adenoma detection rates for 45-49 year old screening population. Gastroenterology 2021 Sep 16. (Epub ahead of print) (

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