Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2016; 22(32): 7365-7372
Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7365
Prevalence of colorectal neoplasms in young, average risk individuals: A turning tide between East and West
Ari Leshno, Menachem Moshkowitz, Maayan David, Lior Galazan, Alfred I Neugut, Nadir Arber, Erwin Santo
Ari Leshno, Menachem Moshkowitz, Maayan David, Lior Galazan, Nadir Arber, Erwin Santo, Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv 6997801, Israel
Menachem Moshkowitz, Nadir Arber, Erwin Santo, Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
Alfred I Neugut, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, United States
Alfred I Neugut, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, United States
Alfred I Neugut, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States
Author contributions: Leshno A and Moshkowitz M contributed equally to this work; Santo I and Arber N designed the study; David M and Galazan L participated in the acquisition and initial analysis of the data; Leshno A and Moshkowitz M analyzed and interpreted the data, and drafted the initial manuscript; Neugut AI, Arber N and Santo E revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the Tel-Aviv Sourasky Medical Center Helsinki Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nadir Arber, MD, MHA, MSc, Professor, Head, Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel. nadira@tasmc.health.gov.il
Telephone: +972-3-6974968 Fax: +972-3-6974867
Received: March 15, 2016
Peer-review started: March 18, 2016
First decision: April 14, 2016
Revised: May 11, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: August 28, 2016

To determine the prevalence of colorectal neoplasia in average risk persons 40-59 years of age in Israel and to compare the results with other populations.


We reviewed the results of asymptomatic average-risk subjects, aged 40 to 59 years, undergoing their first screening colonoscopy between April 1994 and January 2014. The detection rates of adenoma, advanced adenoma (AA) and colorectal cancer (CRC) were determined in the 40’s and 50’s age groups by gender. The prevalence of lesions was compared between age groups. After meticulous review of the literature, these results were compared to published studies addressing the prevalence of colorectal neoplasia in similar patient groups, in a variety of geographical locations.


We included first screening colonoscopy results of 1750 individuals. The prevalence of adenomas, AA and CRC was 8.3%, 1.0% and 0.2% in the 40-49 age group and 13.7%, 2.4% and 0.2% in the 50-59 age group, respectively. Age-dependent differences in adenoma and AA rates were significant only among men (P < 0.005). Literature review disclosed 17 relevant studies. As expected, in both Asian and Western populations, the risks for overall adenoma and advanced adenoma was significantly higher in the 50's age group as compared to the 40's age group in a similar fashion. The result of the current study were similar to previous studies on Western populations. A substantially higher rate of adenoma, was observed in studies conducted among Asian populations in both age groups.


The higher rate of colorectal neoplasia in Asian populations requires further investigation and reconsideration as to the starting age of screening in that population.

Keywords: Colonoscopy, Adenoma, Colorectal cancer, Average risk, Young, Asian, Western

Core tip: This research focuses on evaluating detection rates of colorectal neoplasia among average risk individuals aged 40-59 years and comparing the detection rates between the fifth and sixth decades. In this prospective study of first screening colonoscopy from 1750 consecutive average risk subjects aged 40-59, we found that the prevalence of colorectal neoplasia is age and gender dependent. In addition we did an extensive search of the literature that revealed a markedly higher adenoma detection rate among Asians, and in particular Koreans compares to Western populations.