| Summary: | The use of colonoscopy as a primary screening test for colorectal
cancer (CRC) in average risk adults is a subject of controversy. Our primary
objective was to build a predictive model based on a few simple variables that
could be used as a guide for identifying average risk adults more suitable for
examination with colonoscopy as a primary screening test. METHODS: The prevalence
of advanced adenomas was assessed by primary screening colonoscopy in 2210
consecutive adults at least 40 yr old, without known risk factors for CRC. Age,
gender, and clinical and biochemical data were compared among people without
adenomas, those with non-advanced adenomas, and those with any advanced neoplasm.
A combined score to assess the risk of advanced adenomas was built with the
variables selected by multiple logistic regression analysis. RESULTS: Neoplastic
lesions were found in 617 subjects (27.9%), including 259 with at least one
neoplasm that was 10 mm or larger, villous, or with moderate-to-severe dysplasia,
and 11 with invasive cancers. Advanced lesions were more frequent among men,
older people, and those with a higher body mass index (BMI). These three
variables were independent predictors of advanced adenomas in multivariate
analysis. A score combining age, sex, and BMI was developed as a guide for
identifying individuals more suitable for screening colonoscopy. CONCLUSIONS:
Age, gender, and BMI can be used to build a simple score to select those average
risk adults who might be candidates for primary screening colonoscopy
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