Colorectal cancer ‘no longer’ disease of old age, data supports lowered screening age
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Increased incidence of early-onset colorectal cancer and precancerous polyp diagnoses among patients at a younger age supported the recommendation for CRC screening at age 45 for all average risk individuals, according to a study.
“We have known for many years that rates of colorectal cancer are rising in individuals younger than 50, prompting several medical organizations to recommend lowering the screening age from 50 to 45. What has been missing until now is confirmatory data of the prevalence of precancerous polyps in younger individuals,” Steven H. Itzkowitz, MD, FACP, FACG, AGAF, of the Icahn School of Medicine at Mount Sinai, said in a press release. “Because precancerous lesions are not reportable to regional or national health agencies, we have not had this degree of information to guide our recommendations. Our study provides an important piece of the puzzle and supports the recommendation changing the screening age to 45.”
In a nationally representative retrospective study, researchers analyzed findings from 562,559 high-quality colonoscopies reported in the GI Quality Improvement Consortium registry to determine the prevalence and risk for colorectal neoplasia among patients aged 18 to 54 years.
According to study results, predictors of advanced colorectal neoplasia included increasing age, male sex (67% higher compared with female sex), white race, a family history of CRC or polyps (21% and 33% higher odds, respectively) and an indication for bleeding or screening (15% and 20% higher odds). Following adjustment, each one-year increase in age correlated with an 8% increase in advanced colorectal neoplasia discovery.
Further analysis of prevalence among patients aged 40 to 44 years, 45 to 49 years and 50 to 54 years revealed 26.59%, 32% and 37.72% had any neoplasia; 5.76%, 7.5% and 9.48% had advanced premalignant lesions; and 0.53%, 0.58% and 0.32% had CRC. Researchers noted a gradual increase in prevalence between 2014 and 2020 among all age groups.
“The data confirm what we have been seeing in the clinic — 45 is now the new 50. Colon cancer used to be considered a disease of old age and that is no longer true,” Itzkowitz said. “Our data also suggest that clinically important lesions occur about 5 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.”
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