Adenoma Detection Rate at Different Age Intervals Suggests Starting Colorectal Cancer Screening at 45 Years of Age
DOI:
https://doi.org/10.52787/agl.v53i1.292Keywords:
Adenoma detection rate, screening, colorectal cancerAbstract
Introduction. It is uncertain whether starting screening at 45 years old would improve colorectal cancer prevention and currently available studies in adults younger than 50 years old are limited.
Aim. To evaluate the adenoma detection rate at different age intervals.
Materials and methods. Colonoscopies performed on adult outpatients were analyzed. Adenoma detection was recorded in the total population and in patients with screening indication. First, patients were divided into two groups: 50 years or older (group A) and younger than 50 years (group B). Then, we analyzed the different age segments: up to 44 years (group 1) 45 to 49 (group 2), 50 to 54 (group 3), and 55 or older (group 4).
Results. A total of 5090 patients were included, 2877 with indication for screening. Patients were divided as follows: 3883 in group A, 1207 in group B, 811 in group 1, 396 in group 2, 749 in group 3 and 3134 in group 4. In the total population, adenoma detection was 20.5%: 23.5% in group A, 10.5% in group B (p = 0.000); 8.3% in group 1, 14.8% in
group 2, 18.1% in group 3, and 24.8% in group 4 (group 1
vs. group 2: p = 0.001, group 2 vs. group 3: p = 0.189, and
group 3 vs. group 4: p = 0.000). In the screening population,
adenoma detection was 20.5%: 21.4% in group A, 14.8%
in group B (p = 0.004); 13.1% in group 1, 17.0% in group
2, 16.1% in group 3, and 22.8% in group 4 (group 1 vs.
group 2: p = 0.31; group 2 vs. group 3: p = 0.81; and group
3 vs. group 4: p = 0.001). Conclusion. Adenoma detection
is not different between 45 to 49 and 50 to 54 years of age,
and is lower below 45 years of age, which suggests starting
colorectal cancer screening at this age.
References
-1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.
-2. Corley D, Jensen C, Marks A. Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 2014;370:1298-306.
-3. Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst 2017;109:djw322.
-4. Brenner H, Stock C, Hoffmeister M. Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomized controlled trials and observational studies. BMJ 2014;348:g2467.
-5. Kaminski MF, Wieszczy P, Rupinski M, Wojciechowska U, Didkowska J, Kraszewska E, Kobiela J, Franczyk R, Rupinska M, Kocot B, Chaber-Ciopinska A, Pachlewski J, Polkowski M, Regula J. Increased Rate of Adenoma Detection Associates With Reduced Risk of Colorectal Cancer and Death. Gastroenterology. 2017 Jul;153(1):98-105.
-6. Rex DK, Petrini JL, Baron TH, Chak A, Cohen J, Deal SE, Hoffman B, Jacobson BC, Mergener K, Petersen BT, Safdi MA, Faigel DO, Pike IM; ASGE/ACG Taskforce on Quality in Endoscopy. Quality indicators for colonoscopy. Am J Gastroenterol. 2006 Apr;101(4):873-85
-7. Viola LA, Cassella F, Wonaga A, Arnao Dellamea G, Di Paola L, Ubeira Salim R, Fernández JL. Implementation of a program to improve the quality of colonoscopy increases the neoplasia detection rate: a prospective study. Endosc Int Open. 2016 Jan;4(1):E68-72
-8. Maratt JK, Kahi CJ. Who is at risk for early-onset colorectal cancer? Clin Gastroenterol Hepatol 2020;2020;18:2686-8.
-9. Strum WB, Boland CR. Characterization and identification of colorectal cancer in persons younger than 50 years. Clin Gastroenterol Hepatol 2019;17:2600-2.
-10. Gausman V, Dornblaser D, Anand S, Hayes RB, O'Connell K, Du M, Liang PS. Risk Factors Associated With Early-Onset Colorectal Cancer. Clin Gastroenterol Hepatol. 2020 Nov;18(12):2752-2759
-11. Rex DK, Boland CR, Dominitz JA, Giardiello FM, Johnson DA, Kaltenbach T, Levin TR, Lieberman D, Robertson DJ. Colorectal Cancer Screening: Recommendations for Physicians and Patients From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2017 Jul;153(1):307-323.
-12. Siegel RL, Miller KD, Jemal A. Colorectal cancer mortality rates in adults aged 20 to 54 years in the United States, 1970-2014. JAMA 2017;318:572-4.
-13. Peterse EFP, Meester RGS, Siegel RL, Chen JC, Dwyer A, Ahnen DJ, Smith RA, Zauber AG, Lansdorp-Vogelaar I. The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline. Cancer. 2018 Jul 15;124(14):2964-2973.
-14. Anderson JC, Samadder NJ. To screen or not to screen adults 45-49 years of age: that is the question. Am J Gastroenterol 2018;113:1750-53.
-15. Imperiale TF, Kahi CL, Rex DK. Lowering the starting age for colorectal cancer screening to 45 years: who will come and should they? Clin Gastroenterol Hepatol 2018;16:1541-4.
-16. Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation Scale. Gastrointest Endosc 2010;72:686-92.
-17. Gutiérrez BR, Fernández J, Cassella F, Viola LA. Does the analysis of adenoma detection rate at different intervals of age support the recommendation to start colorectal cancer screening at 45 years old? (abstract). Gastrointest Endosc 2019;89 Suppl:AB404.
-18. Diamond SJ, Enestvedt BK, Jiang Z, Holub JL, Gupta M, Lieberman DA, Eisen GM. Adenoma detection rate increases with each decade of life after 50 years of age. Gastrointest Endosc. 2011 Jul;74(1):135-40
-19. Malvezzi M, Carioli G, Bertuccio P, Boffetta P, Levi F, La Vecchia C, Negri E. European cancer mortality predictions for the year 2018 with focus on colorectal cancer. Ann Oncol. 2018 Apr 1;29(4):1016-1022
-20. Wonaga A, Gutiérrez B, Cassella F, Graciano J, Fernández JL, Viola LA. Is adenoma detection rate increasing in patients younger than age 50? (abstract). UEG J 2019;7:265-266.
-21. Qaseem A, Denberg TD, Hopkins RH Jr, Humphrey LL, Levine J, Sweet DE, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012 Mar 6;156(5):378-86.
-22. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM; American College of Gastroenterology. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009 Mar;104(3):739-50.
-23. Mannucci A, Zuppardo RA, Rosati R, Di Leo M, Perea J, Cavestro GM. Colorectal cancer screening from 45 years of age: Thesis, antithesis and synthesis. World J Gastroenterol 2019;25:2565-80.
-24. Basu P, Ponti A, Anttila A, Ronco G, Senore C, Vale DB, Segnan N, Tomatis M, Soerjomataram I, Primic Žakelj M, Dillner J, Elfström KM, Lönnberg S, Sankaranarayanan R. Status of implementation and organization of cancer screening in The European Union Member States-Summary results from the second European screening report. Int J Cancer. 2018 Jan 1;142(1):44-56.
-25. Syed A, Abdul-Baki H, Tang A, Thakkar P, Farah K, Thakkar S. Colorectal cancer in young adults: identifying potential risks factors (abstract). Gastroenterology 2018;154 Suppl 1:S-777.
-26. Hemmasi G, Sohrabi M, Zamani F, Ajdarkosh H, Rakhshani N, Khoonsari M, Ameli M, Hatami K. Prevalence of colorectal adenoma in an average-risk population aged 40-50 versus 50-60 years. Eur J Cancer Prev. 2015 Sep;24(5):386-90.
-27. Karsenti D, Tharsis G, Burtin P, Venezia F, Tordjman G, Gillet A, Samama J, Nahon-Uzan K, Cattan P, Cavicchi M. Adenoma and advanced neoplasia detection rates increase from 45 years of age. World J Gastroenterol. 2019 Jan 28;25(4):447-456.
-28. Ferlitsch M, Reinhart K, Pramhas S, Wiener C, Gal O, Bannert C, Hassler M, Kozbial K, Dunkler D, Trauner M, Weiss W. Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA. 2011 Sep 28;306(12):1352-8.
-29. Dasari CS, Desai M, Hassan S, Jegadeesan R, Patel HK, Duvvuri A. Should screening for colorectal cancer start at age 45? Gastroenterology 2019;156 Suppl 1:S-949.
-30. Bilal M, Singh S, Le T-T, Al-Saadi Y, Guturu P. Select group of patients might benefit from early colonoscopic screening for colorectal cancer. Surg Endosc 2020;34:4463-71.
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Copyright (c) 2023 Bleenis Gutiérrez Castro, José Luis Fernández, Federico Cassella, Andrés Wonaga, Luis Viola
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