Aloysius Mark M, Nikumbh Tejas, Yadukumar Lekha, Asija Udit, Shah Niraj J, Aswath Ganesh, John Savio, Goyal Hemant
Division of Gastroenterology, Department of Medicine, State University of New York Upstate Syracuse, New York, NY 13210, USA.
Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA 18505, USA.
Medicina (Kaunas). 2024 Apr 21;60(4):673. doi: 10.3390/medicina60040673.
: Conflicting guidelines exist for initiating average-risk colorectal cancer screening at the age of 45 years. The United States Preventive Services Task Force (USPSTF) changed its guidelines in 2021 to recommend initiating screening at 45 years due to an increasing incidence of young-onset colorectal cancer. However, the American College of Physicians (ACP) recently recommended not screening average-risk individuals between 45 and 49 years old. We aim to study the national trends in the incidence of sporadic malignant polyps (SMP) in patients from 20 to 49 years old. : We analyzed the Surveillance, Epidemiology, and End Results database (2000-2017) on patients aged 20-49 years who underwent diagnostic colonoscopy with at least a single malignant sporadic colorectal polyp. : Of the 10,742 patients diagnosed with SMP, 42.9% were female. The mean age of incidence was 43.07 years (42.91-43.23, 95% CI). Approximately 50% of malignant polyps were diagnosed between 45 and 49 years of age, followed by 25-30% between 40 and 45. There was an upward trend in malignant polyps, with a decreased incidence of malignant villous adenomas and a rise in malignant adenomas and tubulovillous adenomas. : Our findings suggest that almost half of the SMPs under 50 years occurred in individuals under age 45, younger than the current screening threshold recommended by the ACP. There has been an upward trend in malignant polyps in the last two decades. This reflects changes in tumor biology, and necessitates further research and support in the USPSTF guidelines to start screening at the age of 45 years.
对于在45岁开始进行平均风险结直肠癌筛查，存在相互冲突的指南。美国预防服务工作组（USPSTF）在2021年更改了其指南，建议在45岁开始筛查，原因是青年期结直肠癌的发病率不断上升。然而，美国医师协会（ACP）最近建议不对45至49岁的平均风险个体进行筛查。我们旨在研究20至49岁患者中散发性恶性息肉（SMP）的发病率的全国趋势。
我们分析了监测、流行病学和最终结果数据库（2000 - 2017年）中年龄在20 - 49岁且接受了至少有一个散发性恶性结直肠息肉的诊断性结肠镜检查的患者。
在10742例被诊断为SMP的患者中，42.9%为女性。发病的平均年龄为43.07岁（42.91 - 43.23，95%置信区间）。大约50%的恶性息肉在45至49岁之间被诊断出来，其次是40至45岁之间的占25 - 30%。恶性息肉呈上升趋势，恶性绒毛状腺瘤的发病率下降，而恶性腺瘤和管状绒毛状腺瘤的发病率上升。
我们的研究结果表明，50岁以下的SMP中几乎一半发生在45岁以下的个体中，这比ACP目前建议的筛查阈值年龄要小。在过去二十年中，恶性息肉呈上升趋势。这反映了肿瘤生物学的变化，并且有必要在USPSTF指南中进行进一步研究并支持在45岁开始筛查。
