University of California, Los Angeles, California.
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Gastroenterology. 2021 May;160(6):2018-2028.e13. doi: 10.1053/j.gastro.2021.02.015. Epub 2021 Feb 9.
BACKGROUND & AIMS: Colorectal cancer (CRC) incidence at ages younger than 50 years is increasing, leading to proposals to lower the CRC screening initiation age to 45 years. Data on the effectiveness of CRC screening at ages 45-49 years are lacking.
We studied the association between undergoing colonoscopy at ages 45-49 or 50-54 years and CRC incidence in a retrospective population-based cohort study using Florida's linked Healthcare Cost and Utilization Project databases with mandated reporting from 2005 to 2017 and Cox models extended for time-varying exposure.
Among 195,600 persons with and 2.6 million without exposure to colonoscopy at ages 45-49 years, 276 and 4844 developed CRC, resulting in CRC incidence rates of 20.8 (95% CI, 18.5-23.4) and 30.6 (95% CI, 29.8-31.5) per 100,000 person-years, respectively. Among 660,248 persons with and 2.4 million without exposure to colonoscopy at ages 50-54 years, 798 and 6757 developed CRC, resulting in CRC incidence rates of 19.0 (95% CI, 17.7-20.4) and 51.9 (95% CI, 50.7-53.1) per 100,000 person-years, respectively. The adjusted hazard ratios for incident CRC after undergoing compared with not undergoing colonoscopy were 0.50 (95% CI, 0.44-0.56) at ages 45-49 years and 0.32 (95% CI, 0.29-0.34) at ages 50-54 years. The results were similar for women and men (hazard ratio, 0.48; 95% CI, 0.40-0.57 and hazard ratio, 0.52; 95% CI, 0.43-0.62 at ages 45-49 years, and hazard ratio, 0.35; 95% CI, 0.31-0.39 and hazard ratio, 0.29; 95% CI, 0.26-0.32 at ages 50-54 years, respectively).
Colonoscopy at ages 45-49 or 50-54 years was associated with substantial decreases in subsequent CRC incidence. These findings can inform screening guidelines.
50 岁以下人群的结直肠癌（CRC）发病率正在上升，这导致有人提议将 CRC 筛查起始年龄降低至 45 岁。45-49 岁人群进行 CRC 筛查的有效性数据尚缺乏。
我们使用佛罗里达州的强制性报告的 Healthcare Cost and Utilization Project 数据库进行了一项回顾性基于人群的队列研究，使用 Cox 模型对 2005 年至 2017 年的数据进行了时间变化暴露的扩展，研究了 45-49 岁或 50-54 岁行结肠镜检查与 CRC 发病之间的相关性。
在 195600 名接受和 260 万名未接受 45-49 岁结肠镜检查的人群中，分别有 276 人和 4844 人发生 CRC，导致 CRC 发病率分别为每 100000 人年 20.8（95%CI，18.5-23.4）和 30.6（95%CI，29.8-31.5）。在 660248 名接受和 240 万名未接受 50-54 岁结肠镜检查的人群中，分别有 798 人和 6757 人发生 CRC，导致 CRC 发病率分别为每 100000 人年 19.0（95%CI，17.7-20.4）和 51.9（95%CI，50.7-53.1）。与未行结肠镜检查相比，行结肠镜检查后 CRC 的调整后的发病风险比分别为 45-49 岁时 0.50（95%CI，0.44-0.56）和 50-54 岁时 0.32（95%CI，0.29-0.34）。女性和男性的结果相似（45-49 岁时，风险比为 0.48；95%CI，0.40-0.57，风险比为 0.52；95%CI，0.43-0.62，50-54 岁时，风险比为 0.35；95%CI，0.31-0.39，风险比为 0.29；95%CI，0.26-0.32）。
45-49 岁或 50-54 岁行结肠镜检查与随后 CRC 发病率的显著下降相关。这些发现可以为筛查指南提供信息。
