Yen Timothy, Scolaro Jack, Montminy Eric, Karlitz Jordan J, Wani Sachin, Patel Swati G
Division of Gastroenterology & Hepatology, University of Colorado Anschutz School of Medicine, Division of Gastroenterology & Hepatology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.
Division of Gastroenterology & Hepatology, Tulane University, New Orleans, Louisiana.
Clin Gastroenterol Hepatol. 2023 Mar;21(3):827-829.e3. doi: 10.1016/j.cgh.2021.11.017. Epub 2021 Nov 18.
The incidence of early onset colorectal cancer, or colorectal cancer (CRC) diagnosed before age 50, is increasing. In response, multiple societal guidelines in the United States now recommend initiating CRC screening at age 45 in average-risk individuals (ie, those without high-risk clinical characteristics, such as bleeding, or iron deficiency anemia), inflammatory bowel disease, or family history of colorectal neoplasia. The Veterans Health Administration (VHA) is the largest integrated health system in the United States and is contending with how best to expand CRC screening access to this younger population in the setting of limited colonoscopy resources. Understanding the rate and anatomic location of colorectal neoplasia in Veterans younger than age 50 can inform the expected yield of different screening modalities. Prior work has shown that individuals undergoing colonoscopy for low-risk diagnostic indications have equivalent risk of colorectal neoplasia as those undergoing average-risk screening. This study and a recent meta-analysis reported that 3.6% (95% confidence interval, 1.9%-6.7%) to 3.7% (95% confidence interval, 3.0%-4.7%) of average-risk individuals age 45-49 have advanced colorectal neoplasia (ACN), defined as an advanced polyp or carcinoma; however, data specific to the VHA population are lacking.
早发性结直肠癌，即50岁前确诊的结直肠癌（CRC）的发病率正在上升。作为应对措施，美国多个社会指南现在建议，对于平均风险个体（即没有出血或缺铁性贫血等高风险临床特征、炎症性肠病或结直肠肿瘤家族史的个体），在45岁时开始进行CRC筛查。退伍军人健康管理局（VHA）是美国最大的综合医疗系统，在结肠镜检查资源有限的情况下，正在努力探讨如何以最佳方式扩大对这一年轻人群的CRC筛查服务。了解50岁以下退伍军人结直肠肿瘤的发生率和解剖位置，可以为不同筛查方式的预期收益提供参考。先前的研究表明，因低风险诊断指征接受结肠镜检查的个体患结直肠肿瘤的风险与接受平均风险筛查的个体相当。这项研究以及最近的一项荟萃分析报告称，45至49岁的平均风险个体中有3.6%（95%置信区间，1.9%-6.7%）至3.7%（95%置信区间，3.0%-4.7%）患有进展期结直肠肿瘤（ACN），定义为进展期息肉或癌；然而，缺乏针对VHA人群的具体数据。
