TY - JOUR
T1 - Early-Age Onset Colorectal Neoplasia in Average-Risk Individuals Undergoing Screening Colonoscopy
T2 - A Systematic Review and Meta-Analysis
AU - Kolb, Jennifer M.
AU - Hu, Junxiao
AU - DeSanto, Kristen
AU - Gao, Dexiang
AU - Singh, Siddharth
AU - Imperiale, Thomas
AU - Lieberman, David A.
AU - Boland, C. Richard
AU - Patel, Swati G.
N1 - Funding Information:
Funding J. M. Kolb was supported in part by the National Institutes of Health Gastrointestinal Diseases Training Grant (T32-DK007038). J. Hu and Dexiang Gao were supported in part by the University of Colorado Cancer Center Support Grant (P30CA046934) and its population health shared resources.
Funding Information:
This article is dedicated to our beloved mentor, colleague, and dear friend Dennis J. Ahnen, who was a champion for colorectal cancer prevention. His legacy lives on in the global research efforts he inspired in early-age onset colorectal cancer. The authors thank Dr Wandong Hong (Wenzhou Medical University), Dr Mirela Ionescu (Elias Emergency University Hospital), and Dr Han-Mo Chiu (National Taiwan University), Dr Vasileios Panteris (Sismanogleio-Amalia Flemig General Hospital), Dr Jan M Eberth and Dr Franklin G. Berger (University of South Carolina), and Dr Frank Friedenberg (Temple University). Jennifer M. Kolb, MD, MS (Conceptualization: Equal; Data curation: Equal; Investigation: Equal; Writing ? original draft: Lead). Junxiao Hu, PhD (Formal analysis: Lead; Methodology: Equal; Writing ? review & editing: Equal). Kristen DeSanto, MSLS (Data curation: Equal; Methodology: Equal; Writing ? review & editing: Equal). Dexiang Gao, PhD (Formal analysis: Supporting; Methodology: Equal; Writing ? review & editing: Equal). Siddharth Singh, MD (Methodology: Equal; Writing ? review & editing: Equal). Thomas Imperiale, MD (Writing ? review & editing: Equal). David A. Lieberman, MD (Writing ? review & editing: Equal). C. Richard Boland, MD (Investigation: Supporting; Writing ? review & editing: Equal). Swati G. Patel, MD, MS (Conceptualization: Lead; Data curation: Equal; Investigation: Equal; Writing ? review & editing: Lead). Funding J. M. Kolb was supported in part by the National Institutes of Health Gastrointestinal Diseases Training Grant (T32-DK007038). J. Hu and Dexiang Gao were supported in part by the University of Colorado Cancer Center Support Grant (P30CA046934) and its population health shared resources.
Publisher Copyright:
© 2021 AGA Institute
PY - 2021/10
Y1 - 2021/10
N2 - Background & Aims: Incidence and mortality associated with early-age onset colorectal cancer (EAO-CRC) is increasing, prompting professional society recommendations to lower the screening age in average-risk individuals. The yield of screening individuals younger than 50 years is not known. Methods: A systematic review of 3 databases from inception through July 2020 was performed in all languages that reported colonoscopy findings in average-risk individuals younger than 50 years. The primary outcomes were EAO colorectal neoplasia (CRN) and advanced colorectal neoplasia (aCRN) prevalence. Subgroup analyses were performed based on sex, geographic location, time period, and age, including comparison with those aged 50–59 years. Generalized linear mixed model with random intercept logistic regression and fixed subgroup effects were performed. Results: Of 10,123 unique articles, 17 studies published between 2002 and 2020, including 51,811 average-risk individuals from 4 continents, were included. The pooled rate of EAO-CRN was 13.7% (95% confidence interval [CI], 0.112%–0.168%) and EAO-aCRN was 2.2% (95% CI, 0.016%–0.031%). Prevalence of CRC was 0.05% (95% CI, 0.00029%–0.0008%). Rates of EAO-CRN were higher in men compared with women (relative risk, 1.71%; 95% CI, 1.49%–1.98%), and highest in the United States (15.6%; 95% CI, 12.2%–19.7%) compared with Europe (14.9%; 95% CI, 6.9%–29.3%), East Asia (13.4%; 95% CI, 10.3%–17.2%), and the Middle East (9.8%; 95% CI, 7.8%–12.2%) (P = .04) The rate of EAO-CRN in age groups 45–49 years and 50–59 years was 17.8% (95% CI, 14.5%–21.6%) and 24.8% (95% CI, 19.5%–30.8%), respectively (P = .04). The rate of EAO-aCRN in age group 45–49 years was 3.6% (95% CI, 1.9%–6.7%) and 4.2% (95% CI, 3.2%–5.7%), respectively (P = .69). Conclusions: The rate of aCRN in individuals aged 45–49 years was similar to the rate observed in individual aged 50–59 years, suggesting that expanding screening to this population could yield a similar impact on colorectal cancer risk reduction.
AB - Background & Aims: Incidence and mortality associated with early-age onset colorectal cancer (EAO-CRC) is increasing, prompting professional society recommendations to lower the screening age in average-risk individuals. The yield of screening individuals younger than 50 years is not known. Methods: A systematic review of 3 databases from inception through July 2020 was performed in all languages that reported colonoscopy findings in average-risk individuals younger than 50 years. The primary outcomes were EAO colorectal neoplasia (CRN) and advanced colorectal neoplasia (aCRN) prevalence. Subgroup analyses were performed based on sex, geographic location, time period, and age, including comparison with those aged 50–59 years. Generalized linear mixed model with random intercept logistic regression and fixed subgroup effects were performed. Results: Of 10,123 unique articles, 17 studies published between 2002 and 2020, including 51,811 average-risk individuals from 4 continents, were included. The pooled rate of EAO-CRN was 13.7% (95% confidence interval [CI], 0.112%–0.168%) and EAO-aCRN was 2.2% (95% CI, 0.016%–0.031%). Prevalence of CRC was 0.05% (95% CI, 0.00029%–0.0008%). Rates of EAO-CRN were higher in men compared with women (relative risk, 1.71%; 95% CI, 1.49%–1.98%), and highest in the United States (15.6%; 95% CI, 12.2%–19.7%) compared with Europe (14.9%; 95% CI, 6.9%–29.3%), East Asia (13.4%; 95% CI, 10.3%–17.2%), and the Middle East (9.8%; 95% CI, 7.8%–12.2%) (P = .04) The rate of EAO-CRN in age groups 45–49 years and 50–59 years was 17.8% (95% CI, 14.5%–21.6%) and 24.8% (95% CI, 19.5%–30.8%), respectively (P = .04). The rate of EAO-aCRN in age group 45–49 years was 3.6% (95% CI, 1.9%–6.7%) and 4.2% (95% CI, 3.2%–5.7%), respectively (P = .69). Conclusions: The rate of aCRN in individuals aged 45–49 years was similar to the rate observed in individual aged 50–59 years, suggesting that expanding screening to this population could yield a similar impact on colorectal cancer risk reduction.
KW - Colon Cancer Screening
KW - Colon Polyp
KW - Colorectal Cancer
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U2 - 10.1053/j.gastro.2021.06.006
DO - 10.1053/j.gastro.2021.06.006
M3 - Article
C2 - 34119517
AN - SCOPUS:85110466294
VL - 161
SP - 1145-1155.e12
JO - Gastroenterology
JF - Gastroenterology
SN - 0016-5085
IS - 4
ER -