Department of Medicine, NYU Langone Health, New York, New York; VA New York Harbor Health Care System, New York, New York.
GI Quality Improvement Consortium, Bethesda, Maryland.
Gastroenterology. 2022 Sep;163(3):742-753.e4. doi: 10.1053/j.gastro.2022.05.036. Epub 2022 May 26.
BACKGROUND & AIMS: Several U.S. organizations now recommend starting average-risk colorectal cancer screening at age 45 years, but the prevalence of colonic neoplasia in individuals younger than 50 years has not been well characterized. We used a national endoscopic registry to calculate age-stratified prevalence and predictors of colorectal neoplasia.
Outpatient screening colonoscopies performed during 2010-2020 in the GI Quality Improvement Consortium registry were analyzed. We measured the prevalence of advanced neoplasia and adenomas by age, sex, and race/ethnicity, as well as the prevalence ratio of neoplasia compared with the reference group of 50- to 54-year-olds. Multivariable logistic regression models were used to identify predictors of neoplasia.
We identified 3,928,727 screening colonoscopies, of which 129,736 (3.3%) were performed on average-risk individuals younger than 50 years. The prevalence of advanced neoplasia was 6.2% for 50- to 54-year-olds and 5.0% (prevalence ratio, 0.81; 95% confidence interval, 0.78-0.83) for average-risk 45- to 49-year-olds. Men had higher prevalence of neoplasia than women for all age groups. White individuals had higher prevalence of advanced neoplasia than persons of other racial/ethnic groups in most age groups, which was partially driven by serrated lesions. On multivariable regression, White individuals had higher odds of advanced neoplasia than Black, Hispanic, and Asian individuals in both younger and older age groups.
In a large U.S. endoscopy registry, the prevalence of advanced neoplasia in 45- to 49-year-olds was substantial and supports beginning screening at age 45 years. White individuals had higher risk of advanced neoplasia than Black, Hispanic, and Asian individuals across the age spectrum. These findings may inform adenoma detection benchmarks and risk-based screening strategies.
目前，有几个美国组织建议将普通风险结直肠癌筛查的起始年龄定为 45 岁，但 50 岁以下人群的结直肠肿瘤患病率尚未得到充分描述。我们使用国家内镜登记处来计算按年龄分层的结直肠肿瘤患病率和预测因素。
分析 2010 年至 2020 年期间在 GI 质量改进联盟登记处进行的门诊筛查结肠镜检查。我们按年龄、性别和种族/民族来测量高级别肿瘤和腺瘤的患病率，以及与 50 至 54 岁参考组相比肿瘤的患病率比值。采用多变量逻辑回归模型来确定肿瘤的预测因素。
我们共鉴定了 3928727 例筛查结肠镜检查，其中 129736 例（3.3%）是在 50 岁以下的普通风险个体中进行的。50 至 54 岁人群的高级别肿瘤患病率为 6.2%，45 至 49 岁普通风险人群的患病率为 5.0%（患病率比值，0.81；95%置信区间，0.78-0.83）。所有年龄组中，男性的肿瘤患病率均高于女性。在大多数年龄组中，白种人比其他种族/民族群体的高级别肿瘤患病率更高，这在一定程度上是由锯齿状病变驱动的。在多变量回归中，白种人在年轻和年长年龄组中发生高级别肿瘤的几率均高于黑种人、西班牙裔和亚裔。
在一个大型美国内镜登记处中，45 至 49 岁人群中高级别肿瘤的患病率相当高，支持将筛查起始年龄定为 45 岁。白种人在整个年龄谱中比黑种人、西班牙裔和亚裔患高级别肿瘤的风险更高。这些发现可能为腺瘤检出率基准和基于风险的筛查策略提供信息。
