Effect of family history on detection of adenomas and sessile serrated lesions in individuals aged 40s

doi:10.4253/wjge.v17.i10.109380

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Oct 16, 2025 (publication date) through Oct 19, 2025

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastrointest Endosc. Oct 16, 2025; 17(10): 109380
Published online Oct 16, 2025. doi: 10.4253/wjge.v17.i10.109380

Effect of family history on detection of adenomas and sessile serrated lesions in individuals aged 40s

Osamu Toyoshima, Toshihiro Nishizawa, Hiroki Asano, Mari Mizutani, Takeshi Uozumi, Ai Fujimoto, Masaya Sano, Shuntaro Yoshida, Keisuke Hata, Hirotoshi Ebinuma

Osamu Toyoshima, Toshihiro Nishizawa, Hiroki Asano, Mari Mizutani, Takeshi Uozumi, Ai Fujimoto, Masaya Sano, Shuntaro Yoshida, Keisuke Hata, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan

Toshihiro Nishizawa, Hirotoshi Ebinuma, Department of Gastroenterology and Hepatology, International University of Health and Welfare Narita Hospital, Narita 286-8520, Japan

Hiroki Asano, Department of Gastroenterology, The University of Tokyo, Tokyo 113-8655, Japan

Mari Mizutani, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan

Takeshi Uozumi, Endoscopy Division, National Cancer Center Hospital, Tokyo, 104-0045, Japan

Ai Fujimoto, Department of Gastroenterology and Hepatology, Faculty of Medicine, Toho University, Tokyo, 143-8540, Japan

Masaya Sano, Department of Internal Medicine, Tokai University School of Medicine, Isehara 259-1193, Japan

Keisuke Hata, Department of Gastroenterology, Nihonbashi Muromachi Mitsui Tower Midtown Clinic, Tokyo 103-0022, Japan

Co-first authors: Osamu Toyoshima and Toshihiro Nishizawa.

Author contributions: Toyoshima O, Nishizawa T, Asano H, Mizutani M, Uozumi T, Fujimoto A, Sano M, and Yoshida S contributed to endoscopic diagnosis; Toyoshima O contributed to statistical analysis; Nishizawa T contributed to literature search and article writing; Hata K contributed to patient recruitment; Ebinuma H contributed to final scrutiny of the study. Toyoshima O and Nishizawa T contributed equally to this manuscript and are co-first authors. All authors contributed to the study design, article review, and final manuscript.

Institutional review board statement: This study was approved by the Ethics Committee of the Certified Institutional Review Board of the Yoyogi Mental Clinic (Approval No. RKK227).

Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.

Conflict-of-interest statement: The authors declare no conflicts of interest associated with this manuscript.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: No additional data are available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Osamu Toyoshima, MD, Department of Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan. t@ichou.com

Received: May 9, 2025
Revised: June 12, 2025
Accepted: September 2, 2025
Published online: October 16, 2025
Processing time: 160 Days and 20 Hours

Abstract

BACKGROUND

According to the guidelines in the United States, individuals with a family history of colorectal cancer should be screened at the age of 40 years. Data on the prevalence of adenomas and sessile serrated lesions (SSLs) in individuals aged 40-49 years in Japan are lacking.

AIM

To investigate the effect of family history on the detection of adenomas and SSLs during colonoscopy in Japan.

METHODS

This retrospective, single-center cohort study included individuals aged 40-79 years who underwent colonoscopy by expert endoscopists with an adenoma detection rate (ADR) ≥ 40% between 2021 and 2024. The ADR and adenoma plus SSL detection rate (ASDR) were investigated according to age. Multivariable analyses were performed to examine the effects of first-degree family history of colorectal cancer, fecal immunochemical test, and sex on the ADR and ASDR for each age group. A binomial logistic regression model was used.

RESULTS

In 10248 participants, the overall ADR and ASDR were 53.6% and 59.1%, respectively. The ADR and ASDR increased with age. Among 2317 participants aged 40-49 years, the presence of a family history significantly increased the ADR (47.6% vs 38.2%). The odds ratio of a family history for the ADR adjusted by sex and fecal immunochemical test was 1.59 (95% confidence interval: 1.13-2.25). In contrast, there was no significant association between the ADR and family history in participants aged 50-59, 60-69, and 70-79 years. Similarly, a family history significantly increased the ASDR (58.0% vs 43.7%) in participants aged 40-49 years. The odds ratio of a family history for the ASDR was 1.92 (95% confidence interval: 1.36-2.71).

CONCLUSION

Participants with a family history exhibited significantly elevated ADR (47.6%) and ASDR (58.0%), in their 40s. Individuals with a family history should initiate colonoscopy at 40 years old.

Keywords: Age; Family history; Colorectal neoplasia; Colonoscopy; Sessile serrated lesions

Core Tip: Participants in their 40s with a family history showed a high adenoma detection rate (47.6%) when expert endoscopists performed colonoscopies using the latest endoscopic system. There was a significant increase in the adenoma detection rate in those with a family history compared to those without, among participants aged 40-49 years.