Alarming endoscopic data in young and older asymptomatic people: Results of an open access, unlimited age colonoscopic screening for colorectal cancer

Abstract

There is a lack of a national organized screening program for colorectal cancer in Greece, and asymptomatic detection is usually the result of individual decisions. The collection of epidemiologic endoscopic data from a population of interest would therefore provide valuable information for future treatment guidance, especially during periods of economic austerity. The current cross-sectional study included 380 asymptomatic, average risk individuals undergoing screening colonoscopy for the first time, during the period of one year in a tertiary public hospital in Athens. Descriptive and analytic epidemiologic data were analyzed. The prevalence of adenomas and advanced lesions were compared between the younger and older cohort, and a regression model was applied for risk evaluation. The mean age of participants was 63 years, and 53% were male. A significant proportion of patients presented with polyps (51.5%) and 25% of them had lesions in the proximal colon. The prevalence of adenomas and advanced adenomas was 29.5 and 11.8%, respectively. Similar high prevalence rates of lesions were identified in the cohort of individuals <50 years of age and the older cohort (>50 years of age). Regression models identified age, number and size of polyps as the major risk factors for the detection of adenomas. The increase of advanced lesions in the older and younger cohort requires confirmation by larger studies. Overall, the results of the present study indicate the requirement for a well-organized screening colonoscopy program starting from as early as 40 years of age. This program may confer an additional endoscopic burden with socioeconomic consequences in a country with limited health resources.

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

“…Meta-analysis was performed on additional age categories delineated as younger than 40 years, 37,45,48 40-44 years 37,40,43,45,48 and 45-49 years. [38][39][40]43,45,[47][48][49] Neoplasia outcomes were significantly different by age groups (c 2 ¼ 13.038; P ¼ .001). Pooled rates of EAO-CRN 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 ages younger than 40 years, 40-44 years, and 45-49 years, respectively (Figure 3A).…”

“…The most common reason for excluding full-text articles was that higher-than-averagerisk individuals were included in the study, such as those with a family history of CRC or symptoms prompting the colonoscopy examination. There were 17 total articles included with 51,811 individuals younger than 50 years [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] (Figure 1, Supplementary Table 2). Seven studies were from East Asia (4 from South Korea, 2 from Taiwan, and 1 from China), 5 from the United States, 3 from Europe (Romania, Germany, and Greece), and 2 from the Middle East (Israel and Iran).…”

“…Funnel plot analyses of studies assessing findings of EAO-aCRN showed some asymmetry but no significant publication bias (Egger's test P value .72) (Supplementary Figure 1B). The majority of included articles were large studies with low rates of aCRN, with the exceptions of Friedenberg et al 39 and Panteris et al 49 Study heterogeneity was noted for EAO-CRN (I 2 ¼ 97%; s 2 ¼ 0.19; c 2 14 ¼ 321.92; P < .01) and EAO-aCRN (I 2 ¼ 95%; s 2 ¼ 0.36; c 2 14 ¼ 324.06; P < .01). Sensitivity analysis excluding studies reporting EAO-CRN and EAO-aCRN rates that were outside of the 95% CI of the pooled estimate did not change the results (Supplementary Figure 2A and B).…”

“…Meta-analysis by sex in age group 45-49 years 40,43,48,49 showed higher prevalence of EAO-CRN in men (17.1%; 95% CI, 0.129%-0.224%) compared with women (10.8%; 95% CI, 0.074%-0.155%), for a relative risk of 1.531 (95% CI, 1.270-1.846) (Supplementary Figure 7). A similar pattern was seen for EAO-aCRN, with higher prevalence in men (4.4%; 95% CI, 0.019%-0.097%) compared with women (3.2%; 95% CI, 0.013%-0.077%), for a relative risk of 1.342 (95% CI, 1.039%-1.734%).…”

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, 14.5-21.6) and advanced colorectal neoplasia of 3.6% (95% CI, 1.9-6.7).…”