Male sex, increasing age links to higher rates of colorectal neoplasia
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Researchers found higher rates of colorectal neoplasia correlated with male sex and increased age, according to a presentation at Digestive Disease Week.
“Over the past few decades, there's been a decrease in overall incidence and mortality of colorectal cancer, largely due to screening and colonoscopy with polypectomy. In contrast, the incidence and mortality associated with CRC in young adults aged less than 50 years old is increasing,” Jennifer Kolb, MD, University of California, Irvine, said. “There's limited clinical data regarding the yield of screening younger patients; therefore, our study aim was to describe the prevalence of early age onset colorectal neoplasia (EAO-CRN) in average risk individuals less than 50 years old.”
In a systematic review and meta-analysis, researchers evaluated 16 studies that reported colonoscopy findings in 25,626 patients aged under 50 years. They further evaluated patients for incidence of EAO-CRN and early age onset advanced CRN (EAO-aCRN).
According to analysis, the pooled rate for EAO-CRN was 14.2% (95% CI, 10.18-18.3) and the pooled rate for EAO-aCRN was 2.2% (95% CI, 1.5-3.2). Researchers noted male sex compared with female sex (EAO-CRN: 12.5% vs. 8.4%; EAO-aCRN: 1.9% vs. 1.2%) and age 45 years to 49 years (EAO-CRN: 17.4%; 95% CI, 11.9-24.7; EAO-aCRN: 2.8%; 95% CI, 1.6-4.7) correlated with higher neoplasia rates.
“Decreasing the screening age to 45 may provide the opportunity to identify and remove precancerous lesions,” Kolb concluded. “These results can inform quality metrics, service point estimates and ranges for future micro-simulation models. However, large scale prospective studies are needed in young adults to characterize high-risk subgroups who would benefit most from earlier screening.”
Perspective
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The burden of early onset CRC is rising but the risk factors are unclear. Kolb and colleagues performed a systematic review of 16 studies on 25,626 patients and report a pooled early-onset advanced colorectal neoplasia rate of 2.2% and a rate of any neoplasia of 14.2%, with male sex and age as risk factors. As the screening age is lowered, and as we accumulate evidence on yield of neoplasia, the impact of screening will become more clear.
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Kolb J, et al. Abstract 872. Presented at: Digestive Disease Week; May 21-23, 2021 (virtual meeting).
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