Detection of Colorectal Neoplasia by Colonoscopy in Average-Risk Patients Age 40–49 Versus 50–59 Years
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The USPSTF recommends beginning colorectal cancer screening at age 50. A recent study showed prevalence of colorectal adenomas among individuals aged 40–49 was similar to that among those aged 50–59.
To assess the prevalence of colorectal neoplasia, detected during colonoscopy, by age among average-risk patients.
Nine-hundred and ninety-four colonoscopies were analyzed (247 ages 40–49, 747 ages 50–59). We included consecutive patients of ages 40–59 undergoing their first colonoscopy. Colonoscopies that did not reach the cecum and patients at increased risk of colorectal cancer were excluded. The primary endpoint was the prevalence of colorectal neoplasia by age. Secondary endpoints included the prevalence of colorectal neoplasia by gender, ethnicity, and BMI.
The prevalence of colorectal neoplasia was 12.1% in patients aged 40–49 and 22.6% in those aged 50–59. Compared with individuals aged 40–49 there was a significantly greater prevalence of adenomas (chi-squared = 12.72, P = 0.0004) and of advanced adenomas or cancer (chi-squared = 5.73, P = 0.01) in individuals aged 50–59. After adjusting for gender, race, and BMI the effect of age remained significant (OR 0.5, 95% CI 0.33–0.76). Higher BMI was associated with increased risk of colorectal neoplasia (OR 1.03, 95% CI 1.00–1.06). The number that had to be screened to detect one advanced lesion in the 40–49 age group was 49 compared with 20 in those aged 50–59.
Individuals aged 40–49 have a lower but measurable risk of colorectal neoplasia compared with those aged 50–59. Although there may be population subgroups for which screening below the age of 50 may be indicated, our results do not support lowering the age threshold for colonoscopy in the general population.
- Sedjo RL, Byers T, Barrera E Jr, et al. A midpoint assessment of the American Cancer Society challenge goal to decrease cancer incidence by 25% between 1992 and 2015. CA Cancer J Clin. 2007;57:326–340. CrossRef
- Rex D, Eid E. Considerations regarding the present and future roles of colonoscopy in colorectal cancer prevention. Clin Gastroenterol Hepatol. 2008;6:506–514. CrossRef
- Screening for Colorectal Cancer. US Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2008;149:627–637.
- Davila RE, Rajan E, Baron TH, et al. ASGE Guideline: Colorectal Cancer Screening and Surveillance. Gastrointest Endosc. 2006;63:546–557. CrossRef
- Rex DK, Johnson DA, Anderson JC, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol. 2009;104:739. CrossRef
- Gross CP, Anderson MS, Krmholz HM, et al. Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer. JAMA. 2006;296:2815–2822. CrossRef
- Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–1981. CrossRef
- Levin B, Lieberman DA, McFarland B, et al. Surveillance Screening for the Early Detection of Colorectal Cancer, Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, the American College of Radiology. CA Cancer J Clin. 2008;58:130. CrossRef
- Citarda F, Tomaselli G, Capocaccia R, et al. The Italian Multicentre Study Group. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48:812–815. CrossRef
- Thiis-Evensen E, Hoff G, Sauar J, et al. Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I Scand. J Gastroenterol. 1999;34:414–420.
- Dove-Edwin I, Sasieni P, Adams J, et al. Prevention of colorectal cancer by colonoscopic surveillance in individuals with a family history of colorectal cancer: 16 year, prospective, follow-up study. BMJ. 2005;331:1047. CrossRef
- SEER Stat Fact Sheet; colon and rectum. National Cancer Institute. http://seer.cancer.gov/statfacts/html/colorect.html (Accessed September 25, 2008).
- Matanoski G, Tao XG, Almon L, et al. Demographics and tumor characteristics of colorectal cancer in the United States, 1998–2001. Cancer. 2006;107:1112–1120. CrossRef
- Rundle AG, Lebwohl B, Vogel R, Levine S, Neugut AI. Colonoscopic Screening in Average-Risk Individuals Ages 40 to 49 vs 50 to 59 Years. Gastroenterology. 2008;134:1311–1315. CrossRef
- Imperiale TF, Wagner DR, Lin CY, et al. Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med. 2002;346:1781–1785. CrossRef
- Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines, rationale. Gastroenterology. 1997;112:594. CrossRef
- O’Brien MJ, Winawer SJ, Zauber AG, et al. The National Polyp Study Patient, polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990;98:371.
- ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for colonoscopy. Am J Gastroenterol. 2006;101:873–885.
- Rex DK. Colonoscopy: A review of its yield for cancers and adenomas by indication. Am J Gastroenterol. 1995;90:353–365.
- Liebman DA, Holub JL, Moravec MD, Eisen GM, Peters D, Morris CD. Prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients. JAMA. 2008;300:1417–1422. CrossRef
- Bergstrom A, Pisani P, Tenet V, et al. Overweight as an avoidable cause of cancer in Europe. Int J Cancer. 2001;91:421–430. CrossRef
- Bird CL, Frankl HD, Lee ER, et al. Obesity, weight gain, large weight changes, and adenomatous polyps of the left colon and rectum. Am J Epidemiol. 1998;147:670–680.
- Shinchi K, Kono S, Honjo S, et al. Obesity and adenomatous polyps of the sigmoid colon. Jpn J Cancer Res. 1994;85:479–484.
- Neugut AI, Lee WC, Garbowski GC, et al. Obesity and colorectal adenomatous polyps. J Natl Cancer Inst. 1991;83:359–361. CrossRef
- Detection of Colorectal Neoplasia by Colonoscopy in Average-Risk Patients Age 40–49 Versus 50–59 Years
Digestive Diseases and Sciences
Volume 56, Issue 5 , pp 1503-1508
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- Colorectal cancer
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- 1. Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- 2. Department of Internal Medicine, Cleveland Clinic Florida, Weston, FL, USA
- 3. College of Medicine, University of South Florida, Tampa, FL, USA