Early screening with endoscopy for colorectal cancer lowers incident risk: JAMA

USA: In a new study conducted by Wenjie Ma and the team, it was shown that beginning endoscopy before the age of 50 was related to a lower risk of colorectal cancer (CRC), including colorectal cancer detected before the age of 55. The findings of this study were published in the Journal of American Medical Association - Oncology. 

To address the rising prevalence of colorectal cancer in persons under the age of 50, the American Cancer Society and the US Preventive Services Task Force modified their recommendations to begin colorectal cancer screening at 45 years of age over the last four years. However, there is a paucity of empirical research examining the potential advantages of screening in younger groups. The purpose of this study was to look at the relationship between endoscopy beginning at different ages and the risk of CRC in women in the United States.

The data for this prospective cohort study came from the Nurses' Health Study II, which tracked female health professionals in the United States from 1991 to 2017. From August 2020 through June 2021, data was analyzed. The major criterion was age at the time of beginning of sigmoidoscopy or colonoscopy for screening or symptoms. Pathology reports, medical records, and the National Death Index all indicate the occurrence of CRC. The cumulative incidence of CRC in each group was approximated using age as the time scale, and the absolute risk decrease associated with beginning endoscopy at various ages up to 60 years was determined. In the multivariable models, Cox proportional hazards regression was utilized, stratified by age and calendar year of questionnaire cycle, and adjusted for CRC risk variables.

The key findings of this study were as follows:

1. 519 incident CRC cases were reported during 26 years, spanning 2 509 358 person-years of follow-up, among 111 801 women aged 26 - 46 years at enrolment.

2. In the multivariable analysis, having endoscopy was linked with a substantially decreased risk of incident CRC for age at the beginning before 45 years, 45 - 49 years, 50 - 54 years, and 55 years or older when compared to no endoscopy.

3. The absolute reduction in the anticipated cumulative incidence of CRC through 60 years of age for beginning endoscopy at 45 to 49 years of age versus 50 to 54 years of age was 72 per 100 000 people.

4. When compared to no endoscopy, beginning endoscopy before the age of 50 was likewise related to a lower risk of CRC diagnosed before the age of 55.

In conclusion, the findings of this study back up guidelines from the previous four years that encourage CRC screening at 45 years of age and give empirical information for patients, clinicians, and policymakers to evaluate when making choices about CRC screening in a younger group.

Reference:

Ma W, Wang M, Wang K, et al. Age at Initiation of Lower Gastrointestinal Endoscopy and Colorectal Cancer Risk Among US Women. JAMA Oncol. Published online May 05, 2022. doi:10.1001/jamaoncol.2022.0883