The rate of advanced colorectal neoplasia (aCRN) in persons aged 45 to 49 is similar to that in those aged 50 to 59, suggesting that screening in this younger age group could potentially lower the risk of colorectal cancer (CRC), according to a study in Gastroenterology.
The systematic review assessed the prevalence of early age onset (EAO)-CRN and aCRN in average-risk individuals aged <50 years. The analysis included 17 articles that reported colonoscopy findings in 51,811 patients from 4 continents.
The pooled yield of EAO-CRN from 16 articles (41,111 individuals) was 13.7% (95% CI, 0.112-0.166). A meta-analysis of 15 articles (51,324 individuals) showed that the rate of EAO-aCRN was 2.2% (95% CI, 0.016-0.031).
The meta-analysis also revealed the rates of EAO-CRN were higher in men than in women, with a relative risk of 1.714 (95% CI, 1.486-1.976; I2 =0.4%; P =.43). The United States had the highest pooled rates of EAO-CRN at 15.6% (95% CI, 0.122-0.197), followed by Europe at 14.9% (95% CI, 0.069-0.293). The rates of EAO-aCRN were also highest in the United States (4%) compared with Europe (3.2%), East Asia (1.5%), and the Middle East (1.2%).
The pooled EAO-CRN rates increased from 8.1% (95% CI, 0.050-0.127) to 11.7% (95% CI, 0.092-0.149) to 17.8% (95% CI, 0.145-0.216) for individuals aged <40, 40 to 44, and 45 to 49 years, respectively. The EAO-aCRN rates also varied by age (P <.01) with rates of 0.07% (95% CI, 0.004-0.011), 1.41% (95% CI, 0.011-0.019), and 3.6% (95% CI, 0.19-0.067) in the same 3 age groups, respectively.
A total of 11 studies assessed neoplasia prevalence in participants aged 50 to 59, with a pooled EAO-CRN rate of 24.8% (95% CI, 0.195-0.308). Pairwise comparisons demonstrated that the EAO-CRN rate was higher in individuals aged 50 to 59 compared with those aged 45 to 49 (P =.04). The EAO-aCRN rate among individuals aged 50 to 59 was 4.2% (95% CI, 0.031-0.057), similar to the rate in individuals aged 45 to 49 (P =.7).
The study authors noted that their meta-analysis included articles that represent globally diverse, heterogenous populations, limiting its generalizability within specific groups. Researchers were also unable to account or adjust for colonoscopy quality or assess the outcomes of serrated or advanced serrated neoplasia.
“Strikingly, the rate of aCRN in individuals aged 45-49 in our study (3.6%) was statistically similar to the rate observed in 50–59-year-olds (4.2%), suggesting that expanding screening to this population could yield similar impact on CRC risk reduction,” stated the researchers. “Although we cannot conclude from our results the proportion of aCRN lesions detected in individuals age 45-49 which would progress to cancer before age 50, earlier identification and surveillance of patients at increased risk of metachronous neoplasia can decrease lifetime cancer risk.”
Disclosure: Some of the study authors declared affiliations with device companies. Please see the original reference for a full list of authors’ disclosures.
Kolb JM, Hu J, DeSanto K, et al. Early-age onset colorectal neoplasia in average risk individuals undergoing screening colonoscopy: a systematic review and meta-analysis. Gastroenterol. Published online June 10, 2021. doi: 10.1053/j.gastro.2021.06.006