New data support lowering screening age to 45 for colorectal cancer


By Reuters Staff

NEW YORK (Reuters Health) - A new study confirms an increasing incidence of young-onset precancerous colorectal neoplasia among adults younger than age 50 and supports updated recommendations to start colorectal cancer (CRC) screening at age 45 for all average-risk individuals, researchers say.

"Colon cancer used to be considered a disease of old age, and that is no longer true. The data confirm what we have been seeing in the clinic - that 45 is now the new 50," Dr. Steven Itzkowitz of the Icahn School of Medicine at Mount Sinai, in New York City, said in a news release.

"Our findings also suggest that messaging aimed at young individuals should begin in the years leading up to this new screening age. We know that most patients do not call their doctors on their 50th birthday to schedule a colonoscopy, so we will need to be diligent to reach this much younger cohort before they turn 45," Dr. Itzkowitz added.

The researchers analyzed findings from more than 562,000 high-quality colonoscopies performed at 123 endoscopy centers across 29 states that report their results to the GI Quality Improvement Consortium registry. About 131,000 of the colonoscopies were performed in adults age 40 to 49 years old.

Colonoscopies performed for surveillance or therapeutic reasons were excluded, as were higher-risk patients with a personal history of polyps, colorectal cancer, or a hereditary colorectal syndrome.

Increasing age, male sex, white race, family history of CRC or polyps and bleeding or screening as the indication for colonoscopy were all associated with higher likelihood of advanced premalignant lesions (APLs), the researchers report in Gastroenterology.

Among patients aged 45 to 49, 32% had any neoplasia, 7.5% had APLs, and 0.58% had CRC. Rates were almost as high in those aged 40 to 44, they report.

Among all age groups, the prevalence of any neoplasia and APL gradually increased between 2014 and 2020.

"Many clinicians are surprised when they find a precancerous polyp in someone younger than age 45," Dr. Itzkowitz said in the release.

"Our data provide new insights into how common these lesions are. Our data also suggest that clinically important lesions occur about five years earlier in individuals with a family history of colorectal cancer, compared to those without a family history. That is why it is very important to take a good family history," he said.

"Colorectal cancer is the second leading cause of cancer death in the United States, but it is one of the most preventable cancers," added co-author Dr. Jay Popp, medical director for AMSURG, a leading provider of colonoscopies.

SOURCE: Gastroenterology, online January 7, 2022.

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