Advanced colorectal polyps (ACPs) are the immediate precursors of colorectal cancer. Although less common in individuals under 50, the occurrence of ACPs in this age group is an emerging concern due to the risk of malignant progression to colorectal cancer, highlighting the need to investigate associated risk factors in younger adults.

This study aims to investigate the frequency and associated factors for the development of ACPs in patients under 50 years.

We conducted a descriptive, retrospective study of 302 consecutive patients aged under 50 who underwent total colonoscopy between April 2023 and October 2024. Data were extracted from electronic medical records, including demographics, lifestyle factors (BMI, smoking, alcohol), family history, and comorbidities. Endoscopic characterization of polyps  were classified according to the NICE and CONNECT criteria. ACPs were defined as adenomas ≥ 10 mm, those with villous histology, or high-grade dysplasia. 

The study included 302 patients, with a male-to-female ratio of 1.51. The mean age was 41.13 years (range: 16–50 years). A family history of colorectal cancer was present in 10.9%. Overall, colonic polyps were found in 32.4% of the cohort, while ACPs based on polyp size and histopathological examination were detected in 4.6% (n=14). Statistical analysis identified age (p=0.002), family history of polyps (p=0.026) and macroangiopathic diabetes complications (p=0.05) as significant associated factors. Polyp-related characteristics were also strongly associated with ACPs, including polyp multiplicity (p < 0.001), polyp location (p < 0.001), and both the NICE (p < 0.001) and CONNECT classifications (p = 0.04). In addition, ACPs were significantly associated with resection-related complications (p < 0.001) and with polyp recurrence (p < 0.001).

These findings suggest that although ACPs are relatively uncommon in young adults, several demographic, clinical, and polyp-specific characteristics can help identify individuals at higher risk. Identification of these factors may allow early detection and better prevention strategies in younger individuals.