*EMBARGOED All research presented at the 2018 ACG Annual Scientific Meeting and Postgraduate Course is strictly embargoed until Monday, October 8, 2018, at 8:00 am EDT.
P0111 Does Everyone Need Early Colonoscopy? Select Group of Patients Might Benefit From Early Screening for Colorectal Cancer—An Update
Author Insight from Mohammad Bilal, MD, University of Texas Medical Branch
What’s new here and important for clinicians?
Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer among adults in the United States and the second leading cause of cancer-related deaths. Recent studies have shown an increasing incidence of CRC in younger patients. This has led to increasing interests in identifying patient populations who might be at increased risk of developing CRC. The U.S. Multi-Society Task Force of Colorectal Cancer (MSTF) recommends that CRC screening should begin at age 50 in average-risk persons. However, recently the American Cancer Society (ACS) have published recommendations to begin CRC screening at age 45 years in the average-risk patient population. These recommendations were primarily based of modeling studies because there is little outcomes data in younger age groups regarding prevention and detection of CRC. Despite these new ACS recommendations, there is limited direct evidence to support CRC screening at a younger age. In our study, we have evaluated the predictors of increased prevalence of adenomas in the 40-49-year-old individuals undergoing colonoscopy.
The results of our study show that in addition to family history of colorectal carcinoma, the patient’s age, male gender, body mass index and chronic kidney disease are independent predictors of increased ADR in patients between 40 and 49 years of age. Our study suggests that rather than performing early colonoscopy on everyone, a select group of individuals (obese males with chronic kidney disease) might benefit from early institution of CRC screening. Further large multi-center prospective studies are needed to validate these finding.
Strengths of Study
- One of the largest sample size studies in 40-49-year-old individuals
- Prior to this study, there is limited data on prevalence of adenomatous polyps in this age group
- Bridges the knowledge gaps and provides clinical outcomes data lacking in the microsimulation models
Issues Raised by Our Study
- Colorectal carcinoma is usually developed through the “adenoma-carcinoma” pathway
- This means that adenomatous polyps are precursors to carcinoma
- Our study raises question that increased incidence of colorectal carcinoma in younger patients is perhaps not related to the adenoma-carcinoma pathway
- Identifying a higher-risk “select group” of individuals in the younger population might be more cost-effective
- If screening colonoscopy is instituted at 45 years of age, then, based on our findings, new quality indicator benchmark for ADR will need to be identified
What do patients need to know?
- The incidence of colorectal carcinoma is increasing in a younger patient population
- Screening for colorectal carcinoma is essential
- Ask your doctors about non-invasive methods for colon cancer screening if you are younger than 50 years of age
- Obesity is an independent risk factor for increased prevalence of adenomatous polyps
Mohammad Bilal, MD, University of Texas Medical Branch
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