Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA.
Am J Gastroenterol. 2021 Jan 1;116(1):171-179. doi: 10.14309/ajg.0000000000000820.
Data are needed to further inform the American Cancer Society recommendation to begin colorectal cancer (CRC) screening at age 45. We used the New Hampshire Colonoscopy Registry to compare the prevalence of advanced neoplasia (AN) in an "average-risk screening equivalent" group aged 45-49 years with patients aged 50-54 years and older receiving screening colonoscopy.
Colonoscopies in adults older than 50 years of age usually have diagnostic indications of varying clinical significance. We combined patients older than 50 years with diagnostic indications (abdominal pain and constipation) expected to yield AN prevalence similar to screening low AN risk and those with a screening indication to form an "average-risk screening equivalent" group. We excluded high-risk indications (e.g., bleeding and anemia), surveillance examinations, and patients with a first-degree family history of CRC, incomplete examinations, and poor bowel preparation. We calculated prevalence/adjusted risks for AN (≥1 cm, villous, high-grade dysplasia, and CRC) and clinically significant serrated polyps (large [≥1 cm] hyperplastic polyps, sessile serrated polyp, traditional serrated adenomas, and proximal hyperplastic polyp ≥ 5 mm).
In our sample (n = 40,812), AN prevalence was as follows: <40 years (1.1%), 40-44 years (3.0%), 45-49 years (3.7%), 50-54 years (3.6%), 55-59 years (5.1%), and 60+ years (6.7%) (P < 0.0001 across all groups). The prevalence of both AN and clinically significant serrated polyp was similar in the 45-49 and 50-54 years' age groups. Furthermore, the prevalence of AN increased significantly in the 40-44 group as compared to that in the <40 years group. Adjusted analyses confirmed these results. The diagnostic indications considered to have low risk were not predictive of AN.
New Hampshire Colonoscopy Registry data, demonstrating an increase in AN risk starting at age 40 and a similar prevalence for individuals aged 45-49 and those ages 50-54, provide clinically useful evidence for optimization of prevention and the age to start screening. However, this is a complex issue involving additional considerations that will need to be addressed.
为进一步为美国癌症协会推荐的 45 岁开始结直肠癌（CRC）筛查提供数据，我们使用新罕布什尔州结肠镜检查登记处，比较了年龄在 45-49 岁的“平均风险筛查等效”组与年龄在 50-54 岁及以上接受筛查结肠镜检查的患者中晚期肿瘤（AN）的患病率。
50 岁以上成年人的结肠镜检查通常具有不同临床意义的诊断指征。我们将年龄大于 50 岁的患者与预期具有 AN 患病率相似的诊断指征（腹痛和便秘）结合起来，这些指征与筛查低 AN 风险的患者和筛查指征的患者形成“平均风险筛查等效”组。我们排除了高危指征（例如，出血和贫血）、监测检查以及具有 CRC 一级家族史、检查不完整和肠道准备不佳的患者。我们计算了 AN（≥1cm、绒毛状、高级别发育不良和 CRC）和临床显著锯齿状息肉（大[≥1cm]增生性息肉、无蒂锯齿状息肉、传统锯齿状腺瘤和近端增生性息肉≥5mm）的患病率/调整风险。
在我们的样本（n=40812）中，AN 的患病率如下：<40 岁（1.1%）、40-44 岁（3.0%）、45-49 岁（3.7%）、50-54 岁（3.6%）、55-59 岁（5.1%）和 60 岁以上（6.7%）（所有组之间 P<0.0001）。45-49 岁和 50-54 岁年龄组的 AN 和临床显著锯齿状息肉的患病率相似。此外，与<40 岁组相比，40-44 岁组的 AN 患病率显著增加。调整分析证实了这些结果。被认为具有低风险的诊断指征不能预测 AN。
新罕布什尔州结肠镜检查登记处的数据表明，40 岁时 AN 风险开始增加，45-49 岁和 50-54 岁之间的患病率相似，为优化预防和开始筛查的年龄提供了有用的临床证据。然而，这是一个涉及需要解决的其他问题的复杂问题。
