Aims: To establish independent predictive risk factors for APA in averagerisk population. Methods: From 1988 to 1998 screening total colonoscopy was performed in consecutive average-risk people, with strict exclusion criteria. Clinical, biochemical, endoscopic and histologic data were recorded. The term advanced was used for adenomas with villous component, moderate-severe dysplasia or ≥1cm. Adenomas were defined as distal if they came from the descending colon or distally. Univariate comparisons were assesed using the Chi2 Test and logistic regression. Backward stepwise logistic regression was used for multivariate analyses. Results: APA were detected in 125 of 2210 subjects (5.66%); 56 (44.8%) had no index distal adenoma. Independent predictors for presenting APA, after adjustment for the endoscopist who performed the endoscopy, are shown in the table. Conclusions: Almost half cases with APA did not present a distal index lesion. Distal polyp characteristics which were independent risk factors for APA were villous component and moderate-severe dysplasia.This multivariate model offers guidelines for clinicians in the approach to patients with distal tubular adenomas.