In the past four years, the American Cancer Society and the American preventive association service working group have updated the recommendation to start colorectal cancer (CRC) screening at the age of 45 to address the increased incidence of colorectal cancer in adults under the age of 50. However, there is little empirical evidence to assess the potential benefits of screening in young people.
The aim of this study was to assess the association between the initiation of endoscopy at different ages and the risk of colorectal cancer in women.
This is a prospective cohort study using data from the nurses' Health Study II, which included female medical professionals in the United States from 1991 to 2017. The age of onset of sigmoidoscopy or colonoscopy (routine examination or family history) and onset of symptoms were collected. Colorectal cases were confirmed by medical records, pathological reports and the National Death Index. The cumulative incidence of colorectal cancer in each group was estimated using age as a time scale, and the absolute risk reduction associated with endoscopy from different ages to 60 years old was calculated. Data analysis will be conducted from August 2020 to June 2021.
Age at start of screening and risk ratio of colorectal cancer
A total of 111801 women aged 26-46 years (median age 36 years, age at enrollment) were recruited. A total of 519 cases of colorectal cancer were recorded during the 26 year follow-up (2509358 individuals per year). In multivariable analysis, compared with subjects without endoscopy, subjects who received endoscopy before the age of 45 had a significantly lower risk of colorectal cancer (hazard ratio [hr] 0.37), and subjects who began endoscopy at the age of 45-49, 50-54 and ≥ 55 had a significantly lower risk of colorectal cancer (HR 0.43, 0.47 and 0.46, respectively).
Incidence of colorectal cancer at the beginning of screening in different age groups
The absolute decrease in the cumulative incidence of colorectal cancer before the age of 60 at the time of endoscopy at the age of 45-49 was 72 cases / 100000 people, compared with that at the age of 50-54. Compared with no endoscopy, starting endoscopy before the age of 50 was also associated with a reduced risk of colorectal cancer before the age of 55 (<45 years: HR 0.45; 45-49 years: HR 0.43).
In conclusion, in this cohort study, starting endoscopy before the age of 50 was associated with a lower risk of colorectal cancer than not doing endoscopy. Starting screening before age 50 was more associated with an absolute reduction in colorectal cancer risk than starting screening at age ≥ 50.
Original source:
Ma W, Wang M, Wang K, et al. Age at Initiation of Lower Gastrointestinal Endoscopy and Colorectal Cancer Risk Among US Women. JAMA Oncol. Published online May 05, 2022. doi:10.1001/jamaoncol. two thousand and twenty-two point zero eight eight three
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