CRC found in ages 45 to 50 years supports USPSTF recommendation
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The occurrence of colorectal cancer in colonoscopies performed on patients aged between 45 and 50 years showed rates that approach those in ages 50 to 54 years, according to a presentation at Digestive Diseases Week.
“If we rewind the tape 10 or 12 years, when we started recommending colon cancer screening at age 50 back in the day, it was with numbers that looked very much like this now,” Steven Itzkowitz, MD, of the Icahn School of Medicine, told Healio. “We really feel that 45 is the new 50.”
Itzkowitz and his team examined data from AMSURG ambulatory surgical centers that used the GI Quality Improvement Consortium (GIQuIC) registry. They looked at outpatient colonoscopies performed between 2014 and 2020 from 123 ambulatory surgical centers, comprising data from 1,074 providers across 29 states. Patients were aged between 18 and 54 years with high-quality screening or diagnostic colonoscopy records. They excluded patients with previous colonoscopies or high-risk syndromes.
“We analyzed over 225,000 colonoscopies in people younger than 50 and what we found was that there was a significant amount of pathology, especially in the 45 to 49 [age] group. A third of people — one out of three people — 45 to 49 had a precancerous polyp or cancer. Of that group, almost 8% — one in 12 people — had advanced neoplasia, meaning a significant precancerous polyp that could go on to cancer within a couple of years theoretically,” Itzkowitz said.
The analysis of this database showed neoplastic findings in 25.4% of procedures in patients aged 30 to 49 years, with 6.1% having advanced neoplasia. The prevalence increased with age with 13% of 30-year-old patients and 39.7% of 54-year-olds.
Specifically, in patients in the 45- to 49-year group, 7.9% had advanced neoplasia and 0.56% had colorectal cancer found during their colonoscopy.
“That number is almost as high as people over age 50 so this supports the new recommendation to start at age 45,” Itzkowitz said.
There are caveats to the data, he added, such as only being from ASCs and looking at “all comers” who may be having colonoscopies due to symptoms or family history. Though he would like it to be replicated in other settings, as an example, Itzkowitz said this study is beneficial in that it is close to a “real-world analysis” in that patients are not being compelled to have their colonoscopies within a closed system such as the VA.
“If you take into account those caveats, I believe ... it would be very important to start screening at 45,” he said. “If we were willing as a society to start screening everybody at 50 years ago, we should certainly be willing to start at 45 now.”
Looking at current data, Itkowitz said the CRC occurrence in 50- to 54-year-olds is higher than other age groups as it takes a few years for patients to come in for that screening recommended at 50.
“We’ve known for years that patients don’t come in on their 50th birthday for their colonoscopy. There’s a big procrastination effect,” he said. “The same thing, we feel, is going to happen when the age gets lowered to 45. People are not going to come in at 45, but they will now be coming in between 45 and 50. ... Don’t start talking to your patients at 45 that they need to get their screening. Start at age 40 because there’s already pathology between 40 and 45.”
In the slightly younger age group, 40- to 45-year-olds, 6.1% had advanced neoplasia and 0.5% had CRC.
Lastly, Itzkowitz called for all physicians, particularly those in primary care, to take a detailed family history for their patients.
“Our study showed that if you have a family history of colon cancer, particularly a first degree relative who had colon cancer younger than 60, your rate of getting precancerous polyps or cancer is 5 years earlier than someone who has a negative family history. We’ve known this for decades,” he said. “If you have a family history of colon cancer, you should be getting screened at a younger age than the general population. Our data now supports that even at the younger age of 45.”
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Trivedi PD. Abstract 871. Presented at: Digestive Disease Week; May 21-24, 2021 (virtual meeting).
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