COLORECTAL CANCER SCREENING IN PATIENTS BETWEEN 45-49 YEARS OLD: IS IT WORTHWHILE?

Aims Colorectal cancer (CRC) incidence is rising in young adults and recent US guidelines recommend CRC screening in individuals between 45-49yo. We aim to assess the utility of CRC screening colonoscopy in a younger Portuguese population.

Methods Retrospective cross-sectional study including average-risk individuals for CRC screening between 45-49yo, who performed a high-quality screening or diagnostic colonoscopy. A control group of average-risk individuals between 50-75yo was included. High-risk polyps (HRP) were defined as polyps≥10mm, with tubulovillous histology or high-grade dysplasia.

Results 268 individuals were included, 135 between 45-49 yo (47yo, IQR 46-49) and 133 in the control group (62yo, IQR 55-67). There was a significantly higher number of males in the control group (51.9% vs 34.1%, p=0.003). The polyp detection rate (PDR) (60.9% vs 28.1%, p<0.001) and the adenoma detection rate (ADR) (44.4% vs 17.0%, p<0.001) were significantly higher in the group between 50-75yo. There were no significant differences in the number of HRP (27.2% vs 13.2%, p=0.09) and mean number of polyps detected per colonoscopy [2.6 (95%CI 2.0-3.2) vs 2.0 (95%CI 1.5-2.5), p=0.12]. The PDR and ADR were still significantly lower in the younger group, even after adjusting for gender (OR 0.28, 95%CI 0.16-0.47, p<0.001 and OR 0.29, 95%CI 0.16-0.51, p<0.001, respectively). The number needed to screen (NNS) to detect polyps in the younger group was 3 and to detect adenomas was 4.

Conclusions Although there is a lower PDR and ADR in young individuals, the low NNS suggest that CRC screening could be considered in younger individuals. Further cost-effectiveness analyses are needed.

Publication History

Article published online:
14 April 2022