Chiu Han-Mo, Chen Sam Li-Sheng, Su Chiu-Wen, Yen Amy Ming-Fang, Hsu Wen-Feng, Hsu Chen-Yang, Lin Ting-Yu, Lee Yi-Chia, Wu Ming-Shiang, Chen Tony Hsiu-Hsi
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
JAMA Oncol. 2025 Jun 12. doi: 10.1001/jamaoncol.2025.1433.
The rising incidence of young-onset colorectal cancer (CRC) has prompted health policymakers to consider lowering the recommended starting age for screening. However, population-based evidence supporting the long-term effectiveness of early-age screening remains limited.
To evaluate whether initiating fecal immunochemical test (FIT) screening at ages 40 to 49 years, rather than at the currently recommended age of 50 years, reduces CRC incidence and mortality.
DESIGN, SETTING, AND PARTICIPANTS: This study analyzed a community-based screening cohort of Taiwanese residents aged 40 to 49 years, categorized into 4 subcohorts based on participation in early screening (age 40 to 49 years) and continuation of nationwide regular screening (50 years and older). The cohort was followed up until 2019 to compare CRC incidence and mortality across subcohorts. To mitigate self-selection bias, a delayed screening design and efficient propensity score matching was used, restricting analyses to participants attending regular screening. To validate the findings, an extended nonadherence adjustment was applied to all 4 subcohorts. Data were collected from January 2001 to December 2019, and data were analyzed from January 2021 to December 2024.
Biennial FIT screening was initiated for the early screening group at ages 40 to 49 years and for the regular screening group at age 50 years, with follow-up continuing under Taiwan's national screening program.
Primary outcomes were CRC incidence and mortality rates, reported as cases per 100 000 person-years, with adjusted relative risks (aRRs) comparing early vs regular screening groups.
Of 263 125 included participants, 146 796 (55.8%) were female. A total of 39 315 participated in early and regular screening, and 223 810 participated in regular screening only. The early screening group exhibited lower CRC incidence (26.1 [95% CI, 22.3-29.9] vs 42.6 [95% CI, 40.5-44.7] per 100 000 person-years) and mortality (3.2 [95% CI, 1.9-4.6] vs 7.4 [95% CI, 6.5-8.2] per 100 000 person-years). In propensity score-matched analyses, early screening significantly reduced CRC incidence (aRR, 0.79; 95% CI, 0.67-0.94) and mortality (aRR, 0.61; 95% CI, 0.38-0.98). Findings were consistent in the extended nonadherence adjustment model, showing a 25% reduction in incidence (aRR, 0.75; 95% CI, 0.72-0.77) and a 34% reduction in mortality (aRR, 0.66; 95% CI, 0.62-0.71).
This study found that initiating FIT screening at age 40 to 49 years was associated with further reduction in CRC mortality and incidence compared with starting screening at age 50 years. These results provide strong empirical support for lowering the CRC screening age, with substantial public health implications.
青年期结直肠癌（CRC）发病率的上升促使卫生政策制定者考虑降低推荐的筛查起始年龄。然而，支持早期筛查长期有效性的基于人群的证据仍然有限。
评估在40至49岁开始粪便免疫化学检测（FIT）筛查，而非目前推荐的50岁开始筛查，是否能降低CRC发病率和死亡率。
设计、设置和参与者：本研究分析了一个基于社区的40至49岁台湾居民筛查队列，根据参与早期筛查（40至49岁）和继续全国常规筛查（50岁及以上）分为4个亚组。对该队列进行随访至2019年，以比较各亚组的CRC发病率和死亡率。为减轻自我选择偏倚，采用了延迟筛查设计和有效的倾向评分匹配，将分析限制在参加常规筛查的参与者中。为验证研究结果，对所有4个亚组应用了扩展的不依从性调整。数据收集于2001年1月至2019年12月，数据分析于2021年1月至2024年12月。
早期筛查组在40至49岁开始每两年进行一次FIT筛查，常规筛查组在50岁开始，后续继续按照台湾的国家筛查计划进行。
主要结局为CRC发病率和死亡率，以每10万人年的病例数报告，比较早期筛查组与常规筛查组的调整后相对风险（aRRs）。
在纳入的263125名参与者中，146796名（55.8%）为女性。共有39315人参加了早期和常规筛查，223810人仅参加了常规筛查。早期筛查组的CRC发病率（每10万人年26.1[95%CI,22.3 - 29.9]对42.6[95%CI,40.5 - 44.7]）和死亡率（每10万人年3.2[95%CI,1.9 - 4.6]对7.4[95%CI,6.5 - 8.2]）较低。在倾向评分匹配分析中，早期筛查显著降低了CRC发病率（aRR，0.79；95%CI，0.67 - 0.94）和死亡率（aRR，0.61；95%CI，0.38 - 0.98）。在扩展的不依从性调整模型中结果一致，显示发病率降低25%（aRR，0.75；95%CI，0.72 - 0.77），死亡率降低34%（aRR，0.66；95%CI，0.62 - 0.71）。
本研究发现，与50岁开始筛查相比，40至49岁开始FIT筛查与CRC死亡率和发病率的进一步降低相关。这些结果为降低CRC筛查年龄提供了有力的实证支持，具有重大的公共卫生意义。
