Early-Age Onset Colorectal Neoplasia in Average-Risk Individuals Undergoing Screening Colonoscopy: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND & AIMS: Incidence and mortality associated with early-age onset colorectal cancer (EAO-CRC) is increasing, prompting professional society recommendations to lower the screening age in average-risk individuals. The yield of screening individuals younger than 50 years is not known. METHODS: A systematic review of 3 databases from inception through July 2020 was performed in all languages that reported colonoscopy findings in average-risk individuals younger than 50 years. The primary outcomes were EAO colorectal neoplasia (CRN) and advanced colorectal neoplasia (aCRN) prevalence. Subgroup analyses were performed based on sex, geographic location, time period, and age, including comparison with those aged 50-59 years. Generalized linear mixed model with random intercept logistic regression and fixed subgroup effects were performed. RESULTS: Of 10,123 unique articles, 17 studies published between 2002 and 2020, including 51,811 average-risk individuals from 4 continents, were included. The pooled rate of EAO-CRN was 13.7% (95% confidence interval [CI], 0.112%-0.168%) and EAO-aCRN was 2.2% (95% CI, 0.016%-0.031%). Prevalence of CRC was 0.05% (95% CI, 0.00029%-0.0008%). Rates of EAO-CRN were higher in men compared with women (relative risk, 1.71%; 95% CI, 1.49%-1.98%), and highest in the United States (15.6%; 95% CI, 12.2%-19.7%) compared with Europe (14.9%; 95% CI, 6.9%-29.3%), East Asia (13.4%; 95% CI, 10.3%-17.2%), and the Middle East (9.8%; 95% CI, 7.8%-12.2%) (P ¼ .04) The rate of EAO-CRN in age groups 45-49 years and 50-59 years was 17.8% (95% CI, 14.5%-21.6%) and 24.8% (95% CI, 19.5%-30.8%), respectively (P ¼ .04). The rate of EAO-aCRN in age group 45-49 years was 3.6% (95% CI, 1.9%-6.7%) and 4.2% (95% CI, 3.2%-5.7%), respectively (P ¼ .69). CONCLUSIONS: The rate of aCRN in individuals aged 45-49 years was similar to the rate observed in individual aged 50-59 years, suggesting that expanding screening to this population could yield a similar impact on colorectal cancer risk reduction.

Updates on Age to Start and Stop Colorectal Cancer Screening: Recommendations From the U.S. Multi-Society Task Force on Colorectal Cancer

“…Studies with available data for individuals ages 45 to 49 reported nonadvanced adenoma rates ranging from 8.2% to 20.2% and advanced adenoma rates of 1.2% to 12.5%. [42][43][44][45] Kolb et al 46 conducted a systematic review and meta-analysis of screening colonoscopy performed in 51,811 average-risk individuals under age 50 from 17 international studies published from 2002 to 2020, 5 of which were performed in the United States. Among those ages 45 to 49, this systematic review and meta-analysis reported a pooled rate of any colorectal neoplasia of 17.8% (95% CI, ) and advanced colorectal neoplasia of 3.6% (95% CI, 1.9-6.7).…”

“…Based on these pooled rates, 28 average-risk individuals ages 45 to 49 need to undergo screening colonoscopy to detect (and remove) 1 advanced polyp. 46 Butterly et al 47 recently reported rates of neoplasia in 45-to 49-year-olds using data from the New Hampshire Colonoscopy Registry. Because many adults younger than 50 years have colonoscopies for diagnostic indications as opposed to screening, they excluded symptoms shown to be associated with a high risk for advanced neoplasia, such as rectal bleeding, to better approximate an average-risk screening population.…”

“…Despite the limitations noted, these studies show that clinically significant neoplasia rates in 45-to 49-year-olds approaches the rates observed in 50-to 59-year-olds. Kolb et al 46 compared neoplasia rates in 45-to 49-year-olds with rates observed in 50-to 59-year-olds within the same studies. The rate of advanced colorectal neoplasia in 45-to 49-year-olds and 50-to 59-year-olds was 3.6% (95% CI, 1.9-6.7) and 4.2% (95% CI, 3.1-5.7), respectively (P ¼ .69).…”

Response to Yoo and Sonnenberg & Braillon

“…Interestingly, there is evidence that sigmoidoscopy is less effective in women than in men and may be ineffective for older women (18,19). At present, there are no data to support a specific screening modality over others for younger individuals, and recent data suggest that there is a substantial proportion of advanced colorectal neoplasia in the proximal colon of average-risk individuals younger than 50 years (3)(4)(5)(6). Thus, until additional data are available regarding the optimal screening modality in younger individuals, we stand behind our recommendation to offer a tiered menu of screening options, as we do for those older than 50 years.…”

Darmkrebs-Screening 2022 – Positionspapier der Stiftung LebensBlicke

“…Gerade die Adipositas und der Diabetes mellitus Typ 2 sind weitere wichtige Risikofaktoren für die Entstehung von Darmkrebs. Es sollte auch der Hinweis enthalten sein, dass Menschen unter 50 Jahren mit Risikofaktoren ein erhöhtes Darmkrebsrisiko haben 7 8 .…”