The detection of polyps and adenomas doubles when colonoscopy screening begins at age 45 instead of age 50, whether or not people have a personal or family history of polyps or cancer, results from a new study show.
"Colonoscopy screening programs for average-risk populations usually enroll patients over 50 years, but we routinely detect polyps or cancer before age 50," said David Karsenti, MD, from the Clinique de Bercy in Charenton le Pont, France.
And although the reasons are not clear, "we know that the incidence of colorectal cancer in those under 50 years is on the rise," Dr Karsenti said here at United European Gastroenterology Week 2017.
This finding adds to the growing recognition that clinical observations might not completely align with guidelines — such as those from American College of Gastroenterology and the French Society of Digestive Endoscopy — for the screening of average-risk patients 50 to 75 years of age.
We know that the incidence of colorectal cancer in those under 50 years is on the rise.
In their prospective study, Dr Karsenti and his colleagues evaluated 6027 consecutive colonoscopies performed in the endoscopy unit of a large French referral center in 2016. Partial and interventional colonoscopies were excluded from the analysis.
Median withdrawal time was 470 seconds (almost 8 minutes). Mean age was 57 years, and 55% of the cohort was female.
The rate of detection of any polyp was 34.0%, of adenomas was 32.0%, of large polyps (1 cm or larger) was 8.0%, and of neoplasia of 3.6%.
"Now for the most important results," Dr Karsenti said. When risk for adenoma and neoplasia detection was stratified by 5-year increments, rates in people younger than 30 years were "very low, and before 45 they remain low. At age 45, however, there was a very important increase," he reported.
For the 4438 people older than 50 years when they were screened, the average polyp detection rate exceeded 35% and the average neoplasia detection rate exceeded 5%.
For the 515 people 45 to 49 years when they were screened, the average polyp detection rate was elevated — at 26% — and the average neoplasia detection rate was nearly 4%.
For the 1076 people 44 years and younger, these rates were markedly lower.
Even when the researchers excluded higher-risk patients with a personal or family history of polyps or cancer, detection rates remained significantly higher in people 45 to 49 years than in younger people.
Table. Detection by Age Group
| Detection | 45 to 49 Years | 44 Years and Younger | P Value |
|---|---|---|---|
| Mean number of polyps | 0.39 | 0.26 | <.001 |
| Adenoma rate | 22.5% | 13.6% | <.001 |
| Neoplasia rate | 5.1% | 1.1% | <.001 |
"This was a real-life population we studied, so the findings can be applied to screening populations," Dr Karsenti pointed out.
On the basis of these findings, he said he recommends that colonoscopy screening programs begin at age 45 to improve the prevention of colorectal cancer. "We think we must break the 50-year-old barrier."
After the presentation, a member of the audience asked whether Dr Karsenti has changed his clinical practice.
He now shows the data to patients 45 years and older, he explained, and approaches the screening decision on an individual basis. Although the FIT test is more common in France, he said he recommends colonoscopy to younger patients because American data have shown that it is most effective for screening.
These adenoma detection rates, we all know, include very small adenomas, such as those smaller than 5 mm.
"This study shows that even without a family history, risk rises sharply at age 45, which I think is interesting," said session comoderator Jaroslaw Regula, MD, from the Sklodowska-Curie Memorial Cancer Centre at the Institute of Oncology in Warsaw, Poland.
"This finding can be the stimulus for us to look in our databases to check if we see the same result, including in patients with a family history," he told Medscape Medical News.
However, "these adenoma detection rates, we all know, include very small adenomas, such as those smaller than 5 mm," Dr Regula noted. It is not clear whether removing small adenomas immediately or waiting 5 years, until after age 50, is necessary. "I don't have the answer," he said.
Dr Karsenti and Dr Regula have disclosed no relevant financial relationships.
United European Gastroenterology (UEG) Week 2017. Presented October 30, 2017.
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