Prevalence of Precancerous CRC Lesions Warrants Screening in Younger Population

Author(s):

A significant incidence of advanced neoplasia and colorectal cancer was identified in individuals between the ages of 45 and 49 years, emphasizing the importance of adhering to recent recommendations from the United Services Preventive Services Task Force to lower the CRC screening age from 50 to 45 years.

Steven H Itzkowitz, MD

A significant incidence of advanced neoplasia and colorectal cancer (CRC) was identified in individuals between the ages of 45 and 49 years, emphasizing the importance of adhering to recent recommendations from the United Services Preventive Services Task Force to lower the CRC screening age from 50 to 45 years.^1,2

A neoplastic finding was identified in 25.4% of procedures in patients 30 to 49 years of age, of which 6.1% were advanced neoplasias. Moreover, the prevalence of neoplastic findings increased with age, ranging from 13.0% for 30-year-olds to 39.7% for 54-year-olds.

Among patients aged 45 to 49 years, 7.9% had an advanced neoplasia and 0.56% had CRC. In the 40- to 44-year-old age group, 6.1% and 0.50% had an advanced neoplasia and CRC, respectively. Similar trends were seen between patients with and without a positive family history and screening and diagnostic colonoscopies.

“These findings are significant and can make a meaningful difference in the health care system’s ability to save patients’ lives. With early and routine colonoscopies, we can prevent polyps from becoming cancerous and even detect and remove cancerous polyps while giving patients a better chance of recovery and survival. These data support efforts to begin screening at age 45 and communicate the importance of on-time screening by early messaging to patients and providers,” said John Popp, MD, medical director for AMSURG, in a press release.

Following recent guidance to lower the CRC screening age from 50 to 45 years, investigators sought to evaluate the incidence of precancerous lesions in individuals under the age of 50 years.

Pathological findings in adults 30 to 54 years old who underwent colonoscopy for reasons other than surveillance were identified through a nationally representative endoscopic registry.

A subset of the GI Quality Improvement Consortium registry of outpatient colonoscopies performed between 2014 and 2020 at 123 ambulatory surgical centers were evaluated. Included in the analysis were data from 1074 providers spanning 29 states.

To be eligible for inclusion in the analysis, individuals had to be between the ages of 30 and 54 years, have had a high-quality colonoscopy, and screening or diagnostic colonoscopy.

Individuals were excluded if they had had a prior colonoscopy or a personal history of colorectal polyps, cancer, inflammatory bowel disease or inherited CRC syndrome.

From these records, the prevalence of adenocarcinomas, advanced adenomas, non-advanced adenomas, advanced sessile serrated polyps, and sessile serrated polyps was calculated across 1-year age groups.

Advanced neoplasia was defined as CRC, advanced adenomas, or advanced sessile serrated polyps.

Additional results indicated that 203,409 procedures (25.4% screening, 74.6% diagnostic) were performed in patients 30 to 49 years of age. The patient population was 58.8% female; 62.4% White, 10.5% Black/African American, 3.1% Asian, 0.3% Native American, and 23.7% other or unknown; and 8.1% Hispanic. Moreover, 3.4% of individuals had a family history of CRC, and 15.3% had a family history including adenomas or polyp.

“This study can inform additional research directed at CRC screening in younger populations. More importantly, it helps physicians inform patients about the importance of early screening several years before they reach screening age; we believe that this will encourage younger patients to get routine screenings on time, at the appropriate age, and with close attention to the individual’s risk factors and symptoms,” said Steven Itzkowitz, MD, lead study author and professor of medicine, Oncological Sciences and Medical Education, and director of the GI Fellowship Program at the Icahn School of Medicine at Mount Sinai.

References

AMSURG and Mount Sinai Health System release new research on early-onset colorectal cancer. News release. Mount Sinai. May 24, 2021. Accessed May 26, 2021. https://bit.ly/3ustitb
Aditi M, D Parth T, Melissa M, et al. Prevalence of young-onset colorectal neoplasia in a nationally representative colonoscopy registry. Presented at: Digestive Disease Week; May 21-23, 2021; virtual.