Colorectal cancer screening from 45 years of age: Thesis, antithesis and synthesis

Abstract

Colorectal cancer incidence and mortality in patients younger than 50 years are increasing, but screening before the age of 50 is not offered in Europe. Advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age are increasing. This is not a detection-bias effect; it is a real issue affecting the entire population. Three independent computational models indicate that screening from 45 years of age would yield a better balance of benefits and risks than the current start at 50 years of age. Experimental data support these predictions in a sex- and race-independent manner. Earlier screening is seemingly affordable, with minimal impediments to providing younger adults with colonoscopy. Indeed, the American Cancer Society has already started to recommend screening from 45 years of age in the United States. Implementing early screening is a societal and public health problem. The three independent computational models that suggested earlier screening were criticized for assuming perfect compliance. Guidelines and recommendations should be derived from well-collected and reproducible data, and not from mathematical predictions. In the era of personalized medicine, screening decisions might not be based solely on age, and sophisticated prediction software may better guide screening. Moreover, early screening might divert resources away from older individuals with greater biological risks. Finally, it is still unknown whether early colorectal cancer is part of a continuum of disease or a biologically distinct disease and, as such, it might not benefit from screening at all. The increase in early-onset colorectal cancer incidence and mortality demonstrates an obligation to take actions. Earlier screening would save lives, and starting at the age of 45 years may be a robust screening option.

Incidence, Clinico-demographic Profiles and Survival Rates of Colorectal Cancer in Northern Malaysia: Comparing Patients Above and Below 50 Years of Age

“…While the Clinical Practice Guidelines of Colorectal Carcinoma recently launched by the Malaysia Health Technology Assessment Section (2017) recommends CRC screening in individuals above 50 years of age, it is noteworthy that approximately 70% of the young patients in our study were in the age range of 40 to 49 years. A similar observation was reported by the US and Taiwan (Chen et al, 2016;Mannucci et al, 2019). All these findings are suggestive of the need for adopting the proposal of the American Cancer Society to further lower the recommended age for CRC screening in Malaysia (Wolf et al, 2018).…”

AGA Clinical Practice Update on Young Adult–Onset Colorectal Cancer Diagnosis and Management: Expert Review

“…34 Proponents for the ACS recommendation to begin average-risk screening at 45 years of age purport the potential to contain the rising incidence of young adult-onset CRC, while those in opposition to this guideline cite concern that by expanding the screening population may divert resources from medically underserved people, incur excessive financial health care costs, inhibit proper randomized screening to test this guideline recommendation, and be limited because the basic biology of young adult-onset CRC may differ and thus not be amenable to the current screening modalities. [35][36][37] Though the impact of lowering the screening age will likely remain under debate for some time, [38][39][40] it is worth reiterating that 2 of the only 3 countries with declining incidence of young adult-onset CRC were the only countries that endorsed that average-risk CRC screening begin at 44 years of age (in Italy) and at 40 years of age (in Austria). 2,41…”

Clinical Pharmacists in Chronic Care

“…The overall incidence of CRC is decreasing in many high-income countries, although reported significant increase in Denmark, New Zealand, Australia, UK and Canada, mainly driven by increases in distal (left) tumors of the colon and predominant in [460][461][462][463][464][465][466][467]. Lifestyle determines around 50% to 60% incident of CRC irrespective of age [468][469][470][471]. Physical activity may prevent approximately 15% of the colon cancers [472].…”