Department of Medicine, Division of Gastroenterology, Duke University, Durham, NC, USA.
Exact Sciences Corporation, Madison, WI, USA.
Curr Med Res Opin. 2021 Jun;37(6):1005-1010. doi: 10.1080/03007995.2021.1908244. Epub 2021 Apr 16.
While most guidelines still recommend colorectal cancer (CRC) screening initiation at age 50 years in average-risk individuals, guideline-creating bodies are starting to lower the recommended age of initiation to 45 years to mitigate the trend of increasing CRC rates in younger populations. Using CRC-AIM, we modeled the impact of lowering the CRC screening initiation age, incorporating theoretical and reported adherence rates, for triennial multi-target stool DNA (mt-sDNA) or annual fecal immunochemical test (FIT) screening.
Screening strategies were simulated for individuals without CRC at age 40 and screened from ages 50 to 75 or 45 to 75 years. Outcomes included CRC incidence, CRC mortality, and life-years gained (LYG) per 1000 individuals screened (compared with no screening). Models used theoretically perfect (100%) and previously reported (71% mt-sDNA; 43% FIT) adherence rates.
With perfect adherence, mt-sDNA and FIT resulted in 22.2 and 23.4 more predicted LYG, respectively, with screening initiation at age 45 versus 50 years; reported adherence resulted in 23.9 and 24.4 more LYG, respectively. With perfect adherence, screening initiation at age 45 versus 50 years resulted in 26.1 and 28.6 CRC cases, respectively, with mt-sDNA and 22.8 and 25.5 cases with FIT; with reported real-world adherence there were 28.5 and 31.2 cases, respectively, with mt-sDNA and 37.1 and 40.2 cases with FIT. Similar patterns were observed for CRC deaths. With screening initiation at age 45 and reported adherence, mt-sDNA averted 8.6 more CRC cases and 3.3 more deaths per 1000 individuals than FIT.
Estimated CRC screening outcomes improved by lowering the initiation age from 50 to 45 years. Incorporating reported adherence rates yields greater benefits from triennial mt-sDNA versus annual FIT screening.
尽管大多数指南仍建议在平均风险人群中于 50 岁开始进行结直肠癌（CRC）筛查，但制定指南的机构正开始将建议的起始年龄降低至 45 岁，以减轻年轻人群 CRC 发病率上升的趋势。我们使用 CRC-AIM 模型，针对年龄在 40 岁且无 CRC 的个体，模拟了降低 CRC 筛查起始年龄的影响，纳入了理论和报告的依从率，用于每 3 年一次的多靶点粪便 DNA（mt-sDNA）或每年一次的粪便免疫化学检测（FIT）筛查。
对 50 岁至 75 岁或 45 岁至 75 岁进行筛查的无 CRC 个体进行筛查策略模拟。结果包括 CRC 发病率、CRC 死亡率和每 1000 名筛查者的预期寿命增加（LYG）（与不筛查相比）。模型使用理论上的完美（100%）和先前报告的（mt-sDNA 为 71%；FIT 为 43%）依从率。
如果完美依从，与 50 岁开始筛查相比，45 岁开始 mt-sDNA 和 FIT 分别预测 LYG 分别增加 22.2 和 23.4；如果实际依从率为 71% mt-sDNA 和 43% FIT，则分别增加 23.9 和 24.4。如果完美依从，与 50 岁开始筛查相比，45 岁开始筛查 mt-sDNA 和 FIT 分别导致 26.1 和 28.6 例 CRC 病例，分别为 22.8 和 25.5 例；如果实际报告现实世界中的依从率分别为 28.5 和 31.2 例 mt-sDNA 和 37.1 和 40.2 例 FIT。mt-sDNA 和 FIT 也观察到类似的 CRC 死亡模式。如果起始年龄为 45 岁，且报告依从率，mt-sDNA 每 1000 名个体可避免 8.6 例 CRC 病例和 3.3 例死亡，优于 FIT。
将起始年龄从 50 岁降低到 45 岁可提高估计的 CRC 筛查结果。纳入报告的依从率后，与每年进行 FIT 筛查相比，每 3 年进行一次 mt-sDNA 筛查可带来更大的收益。
