Department of Gastroenterology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA.
Dig Dis Sci. 2011 May;56(5):1503-8. doi: 10.1007/s10620-011-1565-6. Epub 2011 Feb 1.
The USPSTF recommends beginning colorectal cancer screening at age 50. A recent study showed prevalence of colorectal adenomas among individuals aged 40-49 was similar to that among those aged 50-59.
To assess the prevalence of colorectal neoplasia, detected during colonoscopy, by age among average-risk patients.
Nine-hundred and ninety-four colonoscopies were analyzed (247 ages 40-49, 747 ages 50-59). We included consecutive patients of ages 40-59 undergoing their first colonoscopy. Colonoscopies that did not reach the cecum and patients at increased risk of colorectal cancer were excluded. The primary endpoint was the prevalence of colorectal neoplasia by age. Secondary endpoints included the prevalence of colorectal neoplasia by gender, ethnicity, and BMI.
The prevalence of colorectal neoplasia was 12.1% in patients aged 40-49 and 22.6% in those aged 50-59. Compared with individuals aged 40-49 there was a significantly greater prevalence of adenomas (chi-squared = 12.72, P = 0.0004) and of advanced adenomas or cancer (chi-squared = 5.73, P = 0.01) in individuals aged 50-59. After adjusting for gender, race, and BMI the effect of age remained significant (OR 0.5, 95% CI 0.33-0.76). Higher BMI was associated with increased risk of colorectal neoplasia (OR 1.03, 95% CI 1.00-1.06). The number that had to be screened to detect one advanced lesion in the 40-49 age group was 49 compared with 20 in those aged 50-59.
Individuals aged 40-49 have a lower but measurable risk of colorectal neoplasia compared with those aged 50-59. Although there may be population subgroups for which screening below the age of 50 may be indicated, our results do not support lowering the age threshold for colonoscopy in the general population.
USPSTF 建议 50 岁开始进行结直肠癌筛查。最近的一项研究表明，40-49 岁人群的结直肠腺瘤患病率与 50-59 岁人群相似。
评估普通风险患者中结肠镜检查时按年龄分组的结直肠肿瘤的患病率。
分析了 994 例结肠镜检查（247 例年龄 40-49 岁，747 例年龄 50-59 岁）。我们纳入了首次接受结肠镜检查且年龄在 40-59 岁的连续患者。排除了未到达盲肠的结肠镜检查和结直肠癌风险增加的患者。主要终点是按年龄分组的结直肠肿瘤患病率。次要终点包括按性别、种族和 BMI 分组的结直肠肿瘤患病率。
40-49 岁患者的结直肠肿瘤患病率为 12.1%，50-59 岁患者为 22.6%。与 40-49 岁患者相比，50-59 岁患者的腺瘤患病率（卡方=12.72，P=0.0004）和高级别腺瘤或癌症患病率（卡方=5.73，P=0.01）显著更高。在调整性别、种族和 BMI 后，年龄的影响仍然显著（OR 0.5，95%CI 0.33-0.76）。较高的 BMI 与结直肠肿瘤患病风险增加相关（OR 1.03，95%CI 1.00-1.06）。在 40-49 岁年龄组中，需要筛查的人数为 49 人才能发现一例高级病变，而在 50-59 岁年龄组中，需要筛查的人数为 20 人。
与 50-59 岁人群相比，40-49 岁人群的结直肠肿瘤患病风险虽然较低，但仍有一定风险。尽管可能存在需要在 50 岁以下进行筛查的人群亚组，但我们的结果不支持将普通人群的结肠镜检查年龄阈值降低。
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