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. 2025 Apr 1.
doi: 10.14309/ajg.0000000000003431. Online ahead of print.

Raising the Age for Starting Colonoscopy to 35 Years for Individuals With path_MSH6 Carriers May Lead to Missed Opportunities for Detecting Advanced Neoplasia in a Notable Percentage of Carriers

Maya Aharoni Golan  1 , Lior Katz  2   3 , Ido Laish  4   5 , Rakefet Chen-Shtoyerman  6   7 , Naim Abu-Freha  8   9 , Revital Kariv  5   10 , Nathan Gluck  5   10 , Guy Rosner  5   10 , Hana Strul  5   10 , Rachel Gingold-Belfer  5   11 , Hadar Edelman-Klapper  5   11 , Tom Konikoff  5   11 , Alex Vilkin  5   11 , Itai Maza  12   12 , Gili Reznick-Levi  13 , Aasem Abu Shataya  14 , Yael Goldberg  5 , Elizabeth E Half  12   12 , Zohar Levi  5   11
Affiliations

Raising the Age for Starting Colonoscopy to 35 Years for Individuals With path_MSH6 Carriers May Lead to Missed Opportunities for Detecting Advanced Neoplasia in a Notable Percentage of Carriers

Maya Aharoni Golan et al. Am J Gastroenterol. .

Abstract

Introduction: Recent guidelines for Lynch syndrome recommend starting a colonoscopy at 30-35 years for path_MSH6 carriers. This study aimed to measure the rate of advanced neoplasia (AN) in these carriers up to age 35.

Methods: A multicenter retrospective analysis of endoscopic and pathological data was performed for path_MSH6 carriers who underwent endoscopic surveillance at specialized high-risk clinics. Advanced colorectal neoplasia was defined as colorectal cancer (CRC) or advanced polyp (AP).

Results: The study included 197 participants from 141 unrelated families, 60.9% of whom were women, and 90.9% completed follow-up by the age of 35 years or reached the outcome. Eleven individuals (5.58%; 1/18) were diagnosed with AN at 35, with a median age of 29 (interquartile range: 26-31). Among these cases, 6 (3.05%) had AP and 5 (2.54%) were diagnosed with CRC. Among the CRC cases, 1 was classified as American Joint Committee on Cancer stage I, 3 as stage IIA, and 1 as stage IV. Four of the 11 AN cases were detected through screening, accounting for 36.3% of AN cases and 2.03% of the total cohort (1 of 50). This included 1 case of American Joint Committee on Cancer stage I and 3 cases of AP.

Discussion: Our findings suggest that the recommendation to raise the age for initiating colonoscopy to 35 years for path_MSH6 carriers merits careful consideration because there is a possibility that AN may not be detected. Given the limited size of our study and the potential for ascertainment bias, we encourage further research to explore and validate our findings.

Keywords: Lynch syndrome; MSH6; advanced neoplasia; advanced polyp; age to start colonoscopy; colonoscopy; colorectal cancer; early-age; guidelines.

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