EmpiriQA LLC, Long Grove, Illinois.
Exact Sciences Corporation, Madison, Wisconsin.
Cancer Prev Res (Phila). 2020 May;13(5):443-448. doi: 10.1158/1940-6207.CAPR-19-0527. Epub 2020 Feb 6.
Colorectal cancer is a growing burden in adults less than 50 years old. In 2018, the American Cancer Society published a guideline update recommending a reduction in the colorectal cancer screening start age for average-risk individuals from 50 to 45. Implementing these recommendations would have important implications for public health. However, the approximate number of people impacted by this change, the average-risk population ages 45-49, is not well-described in the literature. Here, we provide methodology to conservatively estimate the average-risk and screening-eligible population in the United States, including those who would be impacted by a lowered colorectal cancer screening start age. Using multiple data sources, we estimated the current average-risk population by subtracting individuals with symptomatic colorectal cancer, with a family history of colorectal cancer, and with inflammatory bowel disease and hereditary nonpolyposis colorectal cancer from the total population. Within this population, we estimated the number of screening-eligible individuals by subtracting those with previous colorectal cancer screening (45- to 49-year-old) or up to date with colorectal cancer screening (50- to 74-year-old). The total average-risk population is estimated between 102.1 and 106.5 million people, of whom 43.4-45.2 million people are eligible for colorectal cancer screening. Lowering the screening age would add roughly 19 million people to the average-risk population and increase the current number of screening-eligible individuals on immediate implementation by over 60% (from 27 to 44 million). Estimating the population size impacted by lowering the recommended colorectal cancer screening start age enables more accurate decision-making for policymakers and epidemiologists focused on cancer prevention.
结直肠癌在 50 岁以下成年人中负担日益加重。2018 年，美国癌症协会发布了一份指南更新，建议将一般风险人群的结直肠癌筛查起始年龄从 50 岁降至 45 岁。实施这些建议将对公共卫生产生重要影响。然而，受这一变化影响的人数，即 45-49 岁的一般风险人群，在文献中并没有很好地描述。在这里，我们提供了一种方法，可以保守地估计美国一般风险人群和筛查合格人群，包括那些因结直肠癌筛查起始年龄降低而受到影响的人群。我们使用多种数据源，通过从总人群中减去有症状的结直肠癌患者、有结直肠癌家族史的患者、炎症性肠病和遗传性非息肉性结直肠癌患者，来估计当前的一般风险人群。在这个人群中，我们通过减去已经进行过结直肠癌筛查（45-49 岁）或及时进行结直肠癌筛查（50-74 岁）的人群，来估计筛查合格人群的数量。一般风险人群的总数估计在 1.021 亿至 1.065 亿之间，其中 4340 万至 4520 万人有资格进行结直肠癌筛查。降低筛查年龄将使一般风险人群增加约 1900 万人，并使当前立即实施的筛查合格人数增加 60%以上（从 2700 万增加到 4400 万）。估计降低推荐的结直肠癌筛查起始年龄所影响的人群规模，使政策制定者和专注于癌症预防的流行病学家能够做出更准确的决策。
