Dong Xuesi, Luo Zilin, Wu Zheng, Hang Dong, Xia Changfa, Wang Fei, Zheng Yadi, Yu Yiwen, Xu Yongjie, Cao Wei, Qin Chao, Zhao Liang, Li Jiang, Ren Jiansong, Shi Jufang, Du Mulong, Chen Wanqing, Shen Hongbing, Li Ni, He Jie
Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China.
Clin Gastroenterol Hepatol. 2023 Mar;21(3):819-826.e13. doi: 10.1016/j.cgh.2022.11.005. Epub 2022 Nov 18.
BACKGROUND & AIMS: A one-size-fits-all approach to colorectal cancer (CRC) screening that does not account for CRC risk factors is not conducive to personalized screening. On the basis of the principle of equal management of equal risks, we aimed to tailor and validate risk-adapted starting ages of CRC screening for individuals with different CRC risk factors.
A multi-center community-based population cohort (N = 3,165,088) was used to evaluate the starting age of CRC screening with comprehensive consideration of risk factors. Age-specific 10-year cumulative risk curves were used to determine when individuals at greater risk for CRC reached the same risk level as the 50-year-old general population, which is currently the recommended starting age for CRC screening in China.
During the study follow-up period (2013-2021), 4,840 incident CRCs were recorded. Family history of CRC, adverse lifestyle, and comorbidities demonstrated heterogeneous associations with CRC risk (hazard ratios, 1.05-1.55; P < .05). Men and women with CRC family history and at least 2 risk factors reached the standard benchmark risk (0.28%) for screening at the age of 40, 10 years earlier than their peers without risk factors in the general population. Proposed starting ages for CRC screening were validated in an independent community-based population cohort (N = 1,023,367).
We determined a risk-adapted CRC screening starting age for individuals with various CRC risk factors. Earlier, personalized screening based on these findings could allow for scarce health resources to be dedicated to individuals who benefit most.
一种不考虑结直肠癌（CRC）风险因素的一刀切式CRC筛查方法不利于个性化筛查。基于同等风险同等管理的原则，我们旨在为具有不同CRC风险因素的个体定制并验证风险适应性CRC筛查起始年龄。
使用一个基于社区的多中心人群队列（N = 3,165,088），综合考虑风险因素来评估CRC筛查的起始年龄。采用特定年龄的10年累积风险曲线来确定CRC高风险个体何时达到与50岁普通人群相同的风险水平，50岁是目前中国推荐的CRC筛查起始年龄。
在研究随访期间（2013 - 2021年），记录了4840例新发CRC病例。CRC家族史、不良生活方式和合并症与CRC风险呈现出异质性关联（风险比，1.05 - 1.55；P < 0.05）。有CRC家族史且至少有2个风险因素的男性和女性在40岁时达到了筛查的标准基准风险（0.28%），比普通人群中无风险因素的同龄人早10年。在一个独立的基于社区的人群队列（N = 1,023,367）中验证了提议的CRC筛查起始年龄。
我们确定了针对具有各种CRC风险因素个体的风险适应性CRC筛查起始年龄。基于这些发现更早地进行个性化筛查可以使稀缺的卫生资源用于受益最大的个体。
