Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
Cancer Epidemiol Biomarkers Prev. 2022 Sep 2;31(9):1701-1709. doi: 10.1158/1055-9965.EPI-21-1330.
In May 2021, the U.S. Preventive Services Task Force began recommending initiating colorectal cancer screening at age 45 (vs. 50) years.
We estimated prevalence of colorectal cancer screening (by colonoscopy, sigmoidoscopy, CT colonography, or stool-based tests) in adults ages 50 to 75 years using data from the National Health Interview Survey in 2000, 2003, 2005, 2008, 2010, 2013, 2015, and 2018. For each survey year, we estimated prevalence by age, race/ethnicity, educational attainment, family income, and health insurance. We also compared increases in prevalence of screening from 2000 to 2018 in 5-year age groups (50-54, 55-59, 60-64, 65-69, and 70-75 years).
Overall, prevalence of colorectal cancer screening increased from 36.7% in 2000 to 66.1% in 2018. Screening prevalence in 2018 was lowest for age 50 to 54 years (47.6%), Hispanics (56.5%), Asians (57.1%), and participants with less than a high school degree (53.6%), from low-income families (56.6%), or without insurance (39.7%). Increases in prevalence over time differed by five-year age group. For example, prevalence increased from 28.2% in 2000 to 47.6% in 2018 (+19.4%; 95% CI, 13.1-25.6) for age 50 to 54 years but from 46.4% to 78.0% (+31.6%; 95% CI, 25.4%-37.7%) for age 70 to 75 years. This pattern was consistent across race/ethnicity, educational attainment, family income, and health insurance.
Prevalence of colorectal cancer screening remains low in adults ages 50 to 54 years.
As new guidelines are implemented, care must be taken to ensure screening benefits are realized equally by all population groups, particularly newly eligible adults ages 45 to 49 years. See related commentary by Brawley, p. 1671.
2021 年 5 月，美国预防服务工作组开始建议将结直肠癌筛查的起始年龄定为 45 岁（而非 50 岁）。
我们利用 2000 年、2003 年、2005 年、2008 年、2010 年、2013 年、2015 年和 2018 年全国健康访谈调查的数据，估算了 50 岁至 75 岁成年人中结直肠癌筛查（通过结肠镜检查、乙状结肠镜检查、CT 结肠成像或粪便检测进行）的流行率。对于每个调查年份，我们按年龄、种族/民族、教育程度、家庭收入和医疗保险情况来估计筛查的流行率。我们还比较了 2000 年至 2018 年 5 岁年龄组（50-54 岁、55-59 岁、60-64 岁、65-69 岁和 70-75 岁）筛查流行率的变化情况。
总体而言，结直肠癌筛查的流行率从 2000 年的 36.7%上升到 2018 年的 66.1%。2018 年，50 岁至 54 岁人群的筛查率最低（47.6%），其次是西班牙裔（56.5%）、亚裔（57.1%）、受教育程度较低（53.6%）、收入较低（56.6%）、无保险（39.7%）的人群。随时间推移，筛查流行率的增加情况因年龄组而异。例如，50 岁至 54 岁人群的筛查率从 2000 年的 28.2%上升到 2018 年的 47.6%（增加 19.4%；95%CI，13.1%-25.6%），而 70 岁至 75 岁人群的筛查率从 46.4%上升到 78.0%（增加 31.6%；95%CI，25.4%-37.7%）。这种模式在种族/民族、教育程度、家庭收入和医疗保险方面都是一致的。
50 岁至 54 岁成年人的结直肠癌筛查流行率仍然较低。
随着新指南的实施，必须确保所有人群，特别是新纳入的 45 岁至 49 岁人群，都能平等地从筛查中获益。详见 Brawley 等人的相关评论，第 1671 页。
