CAN IT BE RECOMMENDED TO DECREASE THE AGE TO BEGIN COLORECTAL CANCER POPULATION SCRENING AT 45 YEARS OLD?

Aims The current screening age covers 50-69 years, however, the possibility of starting screening at 45 years has been suggested from the American Society of Clinical Oncology. The objective of our study has been to evaluate the impact of this measure by comparing the endoscopic findings between the groups of subjects aged 45-49 and 50-54 years. Our working hypothesis was that patients between 45-49 years present a rate of neoplastic or preneoplastic lesions similar to the group of patients between 50-54 years old, which would justify a decrease in the age of onset of screening.

Methods A retrospective cohort study on an endoscopy database collected prospectively. Endoscopies performed in 2018 to subjects aged between 45-49 years were included. Those between 50-54 years were chosen as a control group. Incomplete colonoscopies, BBPS < 5, IBD, CCR high-risk patients and who with a prior history of CCR or colon polyps were excluded.

Results A total of 1379 colonoscopies were performed in the selected period. 396 were excluded, finally resulting 349 in 45-49group and 734 in 50-54group. The endoscopic findings in both groups and the comparative study is shown in table 1. In 327 patients the reason for request was an FOBT +: 15 in 45-49 and 312 in 50-54 group, with a lower detection rate of advanced pathology or neoplasia in the first group (13,3% vs 28,2%, p=0,25).

Conclusions 27% of subjects between 45-49 years have presented preneoplastic or neoplastic lesions. However, these findings are significantly lower than those found in the 50-54 year group. Prospective cost/benefit studies are required on the asymptomatic population before recommending the decrease of the age of access to population screening programs of CCR.