Assistant Professor The Ohio State University Wexner Medical Center Columbus, OH
Award: Category Award (Colorectal Cancer Prevention)
Award: Presidential Poster Award
Hisham Hussan, MD, FACG1, Samuel Akinyeye, MD1, Kyle Porter, MAS2, Peter P. Stanich, MD1, Darrell Gray, MD, MPH, FACG1, Bryson Katona, MD, PhD3, Violeta Popov, MD, PhD4, Folasade P. May, MD, PhD, MPhil5, John Carethers, MD6; 1The Ohio State University Wexner Medical Center, Columbus, OH; 2The Ohio State University Center for Biostatistics, Columbus, OH; 3University of Pennsylvania Health System, Philadelphia, PA; 4New York University Langone Medical Center, New York, NY; 5UCLA Health, Los Angeles, CA; 6University of Michigan Medical Center, Ann Arbor, MI
Introduction: Early-onset colorectal cancer (CRC diagnosed < 50 years) is on the rise, making prevention a public health priority. However, debate still exists on whether to initiate CRC screening at age 45 vs. 50. Further, fifty percent of early-onset CRC is diagnosed < 45 years of age. We hypothesize a gradual increase in the rate of advanced colorectal neoplasia (i.e., CRC or high-risk polyps) with advancing years of age as opposed to a spike at age 50. We also propose that lack of CRC screening in ages 40-49 underestimates the true burden of advanced neoplasia in that age group. Methods: We performed a cross-sectional analysis of adults aged 20-60 years who underwent colonoscopies in 2017-2020. All subjects were average-risk for CRC with a complete colonoscopy and adequate bowel preparation. Our primary outcome was the rate and number of detected colorectal neoplasia in 1-year age increments, focusing on the transition between ages 40-44, 45-49, and 50-54 years. We compared advanced neoplasia, high-risk polyps (size ≥10, villous morphology or high-grade dysplasia), and non-high-risk polyps. Results: The cohort included 8,593 adults aged 20-60 (55.9% female and 21.3% racial/ethnic minorities). The majority of adults (n = 5,927 or 68.9%) had a colonoscopy ≥ 50, mainly for CRC screening (Fig.1a). Advanced neoplasia rates increased gradually per age-year between 20 and 60 (Fig.1b). Specifically, the mean rate of advanced neoplasia was not statistically different from 40-44 (5.4%) to 45-49 (8.0%) to 50-54 (8.4%), although it was higher in 50-54 vs. 40-44 (Table 1). In contrast, there was a steep increase in detection of advanced neoplasia at age 50. Specifically, the number of adults with newly diagnosed advanced neoplasia increased by 103% from 40-44 to 45-49 and by 340% from 45-49 to 50-54 (Fig. 2a). This rise was mainly due to uptake of CRC screening that increased the detection of advanced neoplasia by 67% in ages 45-49 and 467% in 50-54, as opposed to undergoing diagnostic colonoscopies alone (Fig 2b). Discussion: We report slow rise in rates of advanced neoplasia as adults approach age 50. Our data also solidify the impact of CRC screening uptake with a spike in advanced neoplasia burden ≥50. Combined, these findings supports an opportunity to detect neoplasia earlier, and prevent early-onset CRC, by starting screening at age 45 or 40. Future studies assessing novel, cost-effective, strategies to achieve earlier screening are urgently needed.
Table 1: Comparison of neoplasia detection rates in adults approaching the screening age (40-44, 45-49 and 50-54)
Figure 1: Colonoscopy volumes by indication (a) and neoplasia detection rate (b), per year of age for ages 20-60 years old
Figure 2: Increase in detection of neoplasia in 40-44 to 45-49 and 45-49 to 50 – 54 and impact of uptake of CRC screening (bars indicate 95% CI)
Disclosures: Hisham Hussan indicated no relevant financial relationships. Samuel Akinyeye indicated no relevant financial relationships. Kyle Porter indicated no relevant financial relationships. Peter Stanich indicated no relevant financial relationships. Darrell Gray indicated no relevant financial relationships. Bryson Katona indicated no relevant financial relationships. Violeta Popov indicated no relevant financial relationships. Folasade May indicated no relevant financial relationships. John Carethers indicated no relevant financial relationships.