Skip to main content
SpringerLink
Log in

Risk Factors Such as Male Sex, Smoking, Metabolic Syndrome, Obesity, and Fatty Liver Do Not Justify Screening Colonoscopies Before Age 45

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Recently, many studies have reported that male sex, smoking, fatty liver, metabolic syndrome (MetS), and obesity are risk factors for colorectal neoplasia (CRN). However, current guidelines recommend that persons at average risk of colorectal cancer begin screening colonoscopy at age 50 years without consideration of those risk factors.

Aim

To investigate an appropriate time to start screening colonoscopies in persons with risk factors for CRN.

Methods

We performed a cross-sectional study on 27,894 Korean aged ≥30 years who underwent a first colonoscopy as part of a health screening program. To compare the efficacy of colonoscopic screening for the detection of advanced CRN among age groups with risk factors, we calculated the number needed to screen (NNS) to identify 1 patient with advanced CRN.

Results

The NNS for those 30–39 years old with all risk factors, male gender, smoking (≥10 pack-years), MetS, obesity, and fatty liver, was higher than that for ≥50-year-old female subjects (55.4 vs. 26.4). The NNS for those 40–44 years old with all risk factors (37.1) was also higher than that for ≥50-year-old female subjects. However, the NNS for those 45–49 years old with risk factors (16.9–22.9) was lower than that for ≥50-year-old women.

Conclusions

The efficacy of colonoscopic screening in people 30–44 years old with multiple risk factors is lower than that in ≥50-year-old women. Risk factors such as male sex, smoking, MetS, obesity, and fatty liver do not justify starting screening colonoscopies before age 45.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lee BI, Hong SP, Kim SE, et al. Korean guidelines for colorectal cancer screening and polyp detection. Clin Endosc. 2012;45:25–43.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sung JJ, Lau JY, Young GP, et al. Asia Pacific consensus recommendations for colorectal cancer screening. Gut. 2008;57:1166–1176.

    Article  CAS  PubMed  Google Scholar 

  3. Rex DK, Johnson DA, Anderson JC, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739–750.

    Article  PubMed  Google Scholar 

  4. Lin OS, Kozarek RA, Cha JM. Impact of sigmoidoscopy and colonoscopy on colorectal cancer incidence and mortality: an evidence-based review of published prospective and retrospective studies. Intest Res. 2014;12:268–274.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kim ER, Kim YH. Clinical application of genetics in management of colorectal cancer. Intest Res. 2014;12:184–193.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cha JM. Colonoscopy quality is the answer for the emerging issue of interval cancer. Intest Res. 2014;12:110–116.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Botteri E, Iodice S, Raimondi S, et al. Cigarette smoking and adenomatous polyps: a meta-analysis. Gastroenterology. 2008;134:388–395.

    Article  PubMed  Google Scholar 

  8. Shrubsole MJ, Wu H, Ness RM, et al. Alcohol drinking, cigarette smoking, and risk of colorectal adenomatous and hyperplastic polyps. Am J Epidemiol. 2008;167:1050–1058.

    Article  PubMed  Google Scholar 

  9. Abrams JA, Terry MB, Neugut AI. Cigarette smoking and the colorectal adenoma-carcinoma sequence. Gastroenterology. 2008;134:617–619.

    Article  PubMed  Google Scholar 

  10. Okabayashi K, Ashrafian H, Hasegawa H, et al. Body mass index category as a risk factor for colorectal adenomas: a systematic review and meta-analysis. Am J Gastroenterol. 2012;107:1175–1185; quiz 1186.

  11. Jinjuvadia R, Lohia P, Jinjuvadia C, et al. The association between metabolic syndrome and colorectal neoplasm: systemic review and meta-analysis. J Clin Gastroenterol. 2013;47:33–44.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stadlmayr A, Aigner E, Steger B, et al. Nonalcoholic fatty liver disease: an independent risk factor for colorectal neoplasia. J Intern Med. 2011;270:41–49.

    Article  CAS  PubMed  Google Scholar 

  13. Wong VW, Wong GL, Tsang SW, et al. High prevalence of colorectal neoplasm in patients with nonalcoholic steatohepatitis. Gut. 2011;60:829–836.

    Article  PubMed  Google Scholar 

  14. Hong SN, Kim JH, Choe WH, et al. Prevalence and risk of colorectal neoplasms in asymptomatic, average-risk screenees 40 to 49 years of age. Gastrointest Endosc. 2010;72:480–489.

    Article  PubMed  Google Scholar 

  15. Chung SJ, Kim YS, Yang SY, et al. Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40–49 years undergoing screening colonoscopy. J Gastroenterol Hepatol. 2010;25:519–525.

    Article  PubMed  Google Scholar 

  16. Chang LC, Wu MS, Tu CH, et al. Metabolic syndrome and smoking may justify earlier colorectal cancer screening in men. Gastrointest Endosc. 2014;79:961–969.

    Article  PubMed  Google Scholar 

  17. Jung YS, Ryu S, Chang Y, et al. Risk factors for colorectal neoplasia in persons aged 30 to 39 years and 40 to 49 years. Gastrointest Endosc. 2015;81:637–645.e7.

    Article  PubMed  Google Scholar 

  18. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–2752.

    Article  PubMed  Google Scholar 

  19. Wen CP, David Cheng TY, Tsai SP, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 2009;12:497–506.

    Article  PubMed  Google Scholar 

  20. Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844–857.

    Article  PubMed  Google Scholar 

  21. Imperiale TF, Wagner DR, Lin CY, et al. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169–174.

    Article  CAS  PubMed  Google Scholar 

  22. Lieberman DA, Holub J, Eisen G, et al. Prevalence of polyps greater than 9 mm in a consortium of diverse clinical practice settings in the United States. Clin Gastroenterol Hepatol. 2005;3:798–805.

    Article  PubMed  Google Scholar 

  23. Choe JW, Chang HS, Yang SK, et al. Screening colonoscopy in asymptomatic average-risk Koreans: analysis in relation to age and sex. J Gastroenterol Hepatol. 2007;22:1003–1008.

    Article  PubMed  Google Scholar 

  24. Cha JM, Kozarek RA, La Selva D, et al. Findings of diagnostic colonoscopy in young adults versus findings of screening colonoscopy in patients aged 50 to 54 years: a comparative study stratified by symptom category. Gastrointest Endosc. 2015;82:138–145.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-746, Korea

    Yoon Suk Jung & Dong Il Park

  2. Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea

    Kyung Eun Yun, Yoosoo Chang & Seungho Ryu

  3. Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea

    Yoosoo Chang & Seungho Ryu

Authors
  1. Yoon Suk Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyung Eun Yun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoosoo Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seungho Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dong Il Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dong Il Park.

Ethics declarations

Conflict of interest

There was no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jung, Y.S., Yun, K.E., Chang, Y. et al. Risk Factors Such as Male Sex, Smoking, Metabolic Syndrome, Obesity, and Fatty Liver Do Not Justify Screening Colonoscopies Before Age 45. Dig Dis Sci 61, 1021–1027 (2016). https://doi.org/10.1007/s10620-015-3912-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-015-3912-5

Keywords

Search

Navigation