Cleveland Clinic Develops Prediction Score to Estimate Risk of Early-Onset Colorectal Cancer and Precancerous Polyps

Risk score helps to personalise colorectal cancer screening for patients under 45 years old

Monday, March 3, 2025, CLEVELAND: Cleveland Clinic researchers developed and validated a prediction model that estimates the risk of developing colorectal cancer and advanced precancerous polyps in adults under 45 years old.

The paper was published in Digestive Diseases and Sciences.

“Currently, for individuals at average risk of developing colorectal cancer, the recommended age to start screening is 45 years old,” said Carole Macaron, M.D., lead author of the study and a gastroenterologist at Cleveland Clinic.

“However, data show that about half of the patients diagnosed with early-onset colorectal cancer are younger than 45.”

A diagnosis of colorectal cancer before the age of 50 is considered early-onset.

The American Cancer Society reported that among adults younger than 50, “colorectal cancer is the leading cause of cancer death in men and the second-leading cause in women.”

Colorectal cancer develops from polyps, which are clumps of abnormal cells that form on the inside lining of the colon or rectum.

Several factors can increase the risk of developing colorectal cancer.

This Cleveland Clinic study developed and validated a risk-prediction model that confirmed the following four factors are associated with early-onset colorectal cancer and precancerous polyps: a family history of colorectal cancer, body mass index (BMI), sex, and smoking.

Based on the selected risk factors, a prediction score estimates the likelihood of early-onset colorectal cancer and advanced precancerous polyps in adults under 45 years old.

With a score equal to or greater than 9 (out of 12), the likelihood of having cancer or an advanced pre-cancerous lesion is above 14%.

“With the score, we can determine whether a patient under 45 years old is at high risk of developing colorectal cancer,” said Dr. Macaron.

“Our study shows that an adult in the 18 to 44 age group with a score 9 and above is likely to benefit from colorectal cancer screening.”

The study included 9,446 patients between 18 and 44 years old who underwent a colonoscopy at Cleveland Clinic between January 2011 and December 2021.

Of those, 3,681 (39%) patients were male and 5,765 (61%) were female.

The average BMI was 28.7, which is generally classified as overweight.

Most patients (80.3%) had no family history of colorectal cancer.

Among the study participants, 3,468 (39.7%) reported current or former tobacco use and 6,489 (70.9%) reported current or former alcohol use.

Following the colonoscopy, early-onset colorectal cancer and/or advanced precancerous polyps were detected in 346 patients and a control group of 9,100 patients was formed.

Among the study participants in the control group, 8,040 (88.4%) had no lesions and 1,060 (11.6%) had non-advanced precancerous lesions found during the screening exam.

Researchers developed the risk prediction model based on significant associations between risk factors and the presence of cancerous or advanced precancerous lesions.

“Young adults under 45 are at risk of developing colorectal cancer, but the recommended screening age is currently 45 for an average-risk individual” said Dr. Macaron.

“The prediction score helps personalise screening recommendations for patients under 45 years old.”

Dr. Macaron plans to expand on this research with the inclusion of additional study sites.

Source: Cleveland Clinic