Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
Gastrointest Endosc. 2017 Nov;86(5):892-899. doi: 10.1016/j.gie.2017.03.1531. Epub 2017 Apr 3.
The fecal immunochemical test (FIT) can be an alternative screening method for colorectal cancer in individuals aged <50 years. However, debate continues concerning the age at which commencing FIT is beneficial.
We reviewed the records of participants who had undergone a colonoscopy and FIT as part of a comprehensive health screening program. To determine the age for commencing screening via FIT, participants aged <50 years were classified into 4 age subgroups as follows: 30 to 34, 35 to 39, 40 to 44, and 45 to 49 years. Average-risk participants aged 50 to 59 years comprised the control group.
We analyzed the data of 19,808 participants aged 30 to 49 years and 2233 average-risk participants aged 50 to 59 years. The advanced colorectal neoplasia (ACRN) prevalence in average-risk participants aged 50 to 59 years was 3.8%. In the subgroups of FIT-positive participants, the proportion of participants with ACRN was 2.9% (95% confidence interval [CI], 1.1%-7.4%), 9.7% (95% CI, 5.8%-15.6%), 7.7% (95% CI, 4.5%-12.8%), and 14.6% (95% CI, 8.7%-23.5%) in groups 30 to 34, 35 to 39, 40 to 44, and 45 to 49 years, respectively. The proportion of FIT-positive participants with ACRN in the groups aged 35 to 39, 40 to 44, and 45 to 49 years was higher than that in average-risk participants aged 50 to 59 years (P = .001, P = .014, and P < .001, respectively), whereas that in FIT-positive participants aged 30 to 34 years was not (P = .566).
FIT-positive individuals aged 35 to 49 years had a higher risk of ACRN compared with average-risk individuals aged 50 to 59 years. FIT-positive individuals aged 35 to 49 years may benefit from screening colonoscopy, thus justifying the possibility of commencing FIT from age 35 years.
粪便免疫化学检测（FIT）可作为<50 岁人群结直肠癌的一种替代筛查方法。然而，关于开始进行 FIT 的最佳年龄仍存在争议。
我们回顾了参加全面健康筛查计划并接受结肠镜检查和 FIT 的参与者的记录。为了确定通过 FIT 开始筛查的年龄，<50 岁的参与者被分为以下 4 个年龄亚组：30 至 34 岁、35 至 39 岁、40 至 44 岁和 45 至 49 岁。50 至 59 岁的平均风险参与者为对照组。
我们分析了 19808 名 30 至 49 岁的平均风险参与者和 2233 名 50 至 59 岁的平均风险参与者的数据。50 至 59 岁平均风险参与者中高级结直肠肿瘤（ACRN）的患病率为 3.8%。在 FIT 阳性参与者的亚组中，ACRN 患者的比例分别为 2.9%（95%置信区间[CI]，1.1%-7.4%）、9.7%（95%CI，5.8%-15.6%）、7.7%（95%CI，4.5%-12.8%）和 14.6%（95%CI，8.7%-23.5%），分别在 30 至 34 岁、35 至 39 岁、40 至 44 岁和 45 至 49 岁组中。35 至 39 岁、40 至 44 岁和 45 至 49 岁组中 FIT 阳性参与者中 ACRN 的比例高于 50 至 59 岁平均风险参与者（P<.001，P=.014，P<.001），而 30 至 34 岁 FIT 阳性参与者的比例则无统计学差异（P=.566）。
与 50 至 59 岁的平均风险个体相比，35 至 49 岁的 FIT 阳性个体发生 ACRN 的风险更高。35 至 49 岁的 FIT 阳性个体可能受益于结肠镜筛查，因此，从 35 岁开始进行 FIT 是合理的。
