To Screen or Not to Screen Adults 45-49 Years of Age: That is the Question

Anderson, Joseph C.; Samadder, Jewel

doi:10.1038/s41395-018-0402-3

Cited by 35 publications

(23 citation statements)

References 29 publications

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“…Early-onset colorectal cancer (EOCRC) incidence rates are increasing, and controversy exists regarding whether average-risk screening should begin at 45 or 50 years of age. 1 In 2018, the American Cancer Society recommended that average-risk screening start at 45 years of age. 2 Others recommend screening at 50 years of age, although the US Multi-Society Task Force on Colorectal Cancer recommends screening African American individuals at age 45 years of age owing to higher incidence, mortality, and earlier-onset disease.…”

Section: Introductionmentioning

confidence: 99%

Trends in Incidence of Early-Onset Colorectal Cancer in the United States Among Those Approaching Screening Age

Abualkhair

Zhou

Ahnen³

et al. 2020

JAMA Netw Open

114

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IMPORTANCE Early-onset colorectal cancer incidence rates among patients aged 45 to 49 years have been considered much lower compared with the rates among patients aged 50 to 54 years, prompting debate about earlier screening benefits at 45 years. However, the observed incidence rates in the Surveillance, Epidemiology, and End Results (SEER) registries may underestimate colorectal cancer case burdens in those younger than 50 years compared with those older than 50 years because average-risk screening is generally not performed to detect preclinical cases of colorectal cancer. Finding steep incidence increases of invasive stage (beyond in situ) cases of colorectal cancer from age 49 to 50 years would be consistent with high rates of preexisting, undetected cancers in younger patients ultimately receiving a diagnosis of colorectal cancer after undergoing screening at 50 years.OBJECTIVE To assess the preclinical burden of colorectal cancer by analyzing its incidence in 1-year age increments, focusing on the transition between ages 49 and 50 years. DESIGN, SETTING, AND PARTICIPANTSData from the SEER 18 registries, representing 28% of the US population, were used to conduct a cross-sectional study of colorectal cancer incidence rates from January 1, 2000, to December 31, 2015, in 1-year age increments (ages 30-60 years) stratified by US region (South, West, Northeast, and Midwest), sex, race, disease stage, and tumor location. Statistical analysis was conducted from November 1, 2018, to December 15, 2019. MAIN OUTCOMES AND MEASURES Incidence rates of colorectal cancer. RESULTS A total of 170 434 cases of colorectal cancer were analyzed among 165 160 patients (92 247 men [55.9%]; mean [SD] age, 51.6 [6.7] years). Steep increases in the incidence of colorectal cancer in the SEER 18 registries were found from 49 to 50 years of age (46.1% increase: 34.9 [95% CI, 34.1-35.8] to 51.0 [95% CI, 50.0-52.1] per 100 000 population). Steep rate increases from 49 to 50 years of age were also seen in all US regions, men and women, white and black populations, and in colon and rectal cancers. The rate ratio incidence increase in the SEER 18 registries from 49 to 50 years of age (1.46 [95% CI, 1.42-1.51]) was significantly higher than earlier 1-year age transitions. Steep rate increases in the SEER 18 registries were found from 49 to 50 years of age in localized-stage (75.9% increase: 11.2 [95% CI, 10.7-11.7] to 19.7 [95% CI, 19.0-20.3] per 100 000) and regional-stage (30.3% increase: 13.2 [95% CI, 12.7-13.8] to 17.2 [95% CI, 16.7-17.8] per 100 000) colorectal cancers. A total of 8799 of the 9474 cases (92.9%) of colorectal cancer in the SEER 18 registries from 2000 to 2015 that were diagnosed among individuals aged 50 years were invasive. CONCLUSIONS AND RELEVANCE Steep incidence increases between 49 and 50 years of age are consistent with previously undetected colorectal cancers diagnosed via screening uptake at 50 years. These cancers are not reflected in observed rates of colorectal cancer in the SEER registries among individuals y...

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Section: Introductionmentioning

confidence: 99%

Trends in Incidence of Early-Onset Colorectal Cancer in the United States Among Those Approaching Screening Age

Abualkhair

Zhou

Ahnen³

et al. 2020

JAMA Netw Open

114

View full text Add to dashboard Cite

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“…Although some of the rapid increases in early-onset CRC are reminiscent of the Korean thyroid cancer ‘epidemic’ that resulted from widespread ultrasound screening,49 overdetection of early-onset CRC is unlikely because screening before age 50 is rare in most countries, and mortality rates have also begun to rise 12 50. After an extensive evidence review, the American Cancer Society recently lowered the recommended age to begin screening from 50 to 45 because disease risk in individuals under 50 has shifted substantially51 and Cancer Intervention and Surveillance Modeling Network modelling studies found a greater benefit to burden ratio for initiation at age 45 compared with 50 52–54. The US Preventive Services Task Force, the other US entity that issues cancer screening guidelines, is currently in the process of conducting an evidence review and expected to issue an updated recommendation by 2020–2021.…”

Section: Discussionmentioning

confidence: 99%

Global patterns and trends in colorectal cancer incidence in young adults

Siegel

Torre

Soerjomataram

et al. 2019

Gut

592

417

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ObjectiveEarly-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking.DesignWe extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20–49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA).ResultsDuring 2008–2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with long-term data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)).ConclusionCRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis.

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“…CRC diagnosis and treatment have different costs across countries. It is estimated that CRC diagnosis and treatment can exceed $ 100000 in the United States[114], or €23500-36600 in stages I-IV in the Netherlands[115]. In Europe, the economic burden of CRC encompasses over €13 billion[116], after considering the direct and indirect costs; Luengo-Ferndandez and colleagues employed the human capital approach to estimate these costs, by including the costs of temporary disability, reduced hours, and permanent departure from the workforce, alongside premature mortality costs.…”

Section: Antithesis: Why Not Screen Before the Age Of 50?mentioning

confidence: 99%

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

Mannucci

Zuppardo

Rosati

et al. 2019

WJG

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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.

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To Screen or Not to Screen Adults 45-49 Years of Age: That is the Question

Cited by 35 publications

References 29 publications

Trends in Incidence of Early-Onset Colorectal Cancer in the United States Among Those Approaching Screening Age

Trends in Incidence of Early-Onset Colorectal Cancer in the United States Among Those Approaching Screening Age

Global patterns and trends in colorectal cancer incidence in young adults

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

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