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Comparative Study
. 2021 May;160(6):2018-2028.e13.
doi: 10.1053/j.gastro.2021.02.015. Epub 2021 Feb 9.

Colorectal Cancer Incidence After Colonoscopy at Ages 45-49 or 50-54 Years

Maanek Sehgal  1 , Uri Ladabaum  2 , Alka Mithal  3 , Harminder Singh  4 , Manisha Desai  5 , Gurkirpal Singh  6
Affiliations
Comparative Study

Colorectal Cancer Incidence After Colonoscopy at Ages 45-49 or 50-54 Years

Maanek Sehgal et al. Gastroenterology. 2021 May.

Abstract

Background & aims: Colorectal cancer (CRC) incidence at ages younger than 50 years is increasing, leading to proposals to lower the CRC screening initiation age to 45 years. Data on the effectiveness of CRC screening at ages 45-49 years are lacking.

Methods: We studied the association between undergoing colonoscopy at ages 45-49 or 50-54 years and CRC incidence in a retrospective population-based cohort study using Florida's linked Healthcare Cost and Utilization Project databases with mandated reporting from 2005 to 2017 and Cox models extended for time-varying exposure.

Results: Among 195,600 persons with and 2.6 million without exposure to colonoscopy at ages 45-49 years, 276 and 4844 developed CRC, resulting in CRC incidence rates of 20.8 (95% CI, 18.5-23.4) and 30.6 (95% CI, 29.8-31.5) per 100,000 person-years, respectively. Among 660,248 persons with and 2.4 million without exposure to colonoscopy at ages 50-54 years, 798 and 6757 developed CRC, resulting in CRC incidence rates of 19.0 (95% CI, 17.7-20.4) and 51.9 (95% CI, 50.7-53.1) per 100,000 person-years, respectively. The adjusted hazard ratios for incident CRC after undergoing compared with not undergoing colonoscopy were 0.50 (95% CI, 0.44-0.56) at ages 45-49 years and 0.32 (95% CI, 0.29-0.34) at ages 50-54 years. The results were similar for women and men (hazard ratio, 0.48; 95% CI, 0.40-0.57 and hazard ratio, 0.52; 95% CI, 0.43-0.62 at ages 45-49 years, and hazard ratio, 0.35; 95% CI, 0.31-0.39 and hazard ratio, 0.29; 95% CI, 0.26-0.32 at ages 50-54 years, respectively).

Conclusions: Colonoscopy at ages 45-49 or 50-54 years was associated with substantial decreases in subsequent CRC incidence. These findings can inform screening guidelines.

Keywords: Colonoscopy; Colorectal Cancer; Incidence; Screening.

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Conflict of interest statement

Conflicts of interest

These authors disclose the following: Uri Ladabaum serves as advisor to Universal Dx and Lean Medical, and as consultant to Clinical Genomics, Medtronic, Guardant Health, and Freenome. Harminder Singh has consulted for Amgen, Bristol-Myers Squibb Canada, Sandoz Canada, Roche Canada, Takeda Canada, and Guardant Health. The remaining authors disclose no conflicts.

Figures

Figure 1.
Figure 1.
Proportions of persons free of CRC over time in cohorts exposed vs not exposed to colonoscopy at ages 45–49 years (A) or 50–54 years (B). Adjusted Cox models extended to accommodate time-varying exposures showed hazard ratios of 0.50 (95% CI, 0.44–0.56; P < .0001) and 0.32 (95% CI, 0.29–0.34; P < .0001) for developing CRC in the cohorts exposed vs not exposed to colonoscopy at ages 45–49 years and 50–54 years, respectively.
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