Insights from age-stratified endoscopic detection metrics support initiating colorectal cancer screening at age 45

Abstract

Background and aim: All major U.S. guidelines now validate average-risk colorectal cancer (CRC) screening at 45-49 years of age. We aimed to highlight the importance of promoting colonoscopy among younger populations as part of a comprehensive strategy to reduce the burden of CRC.

Methods: Our study analyzed data from 235,782 colonoscopy reports of individuals, which were categorized into six age groups: 45-49 years, 50-54 years, 55-59 years, 60-64 years, 65-69 years, and 70-74 years. Parameters such as age, gender, histopathology of polyps, quantity of polyps, and polyp detection rate (PDR) were assessed.

Results: Our study shows a progressive increase in colonoscopy uptake among individuals aged 45-54. PDR increased significantly with age, from 25.7% in the 45-49 group to 40.2% in the 70-74 group (p < 0.05). Notably, the PDR difference between the 45-49 and 50-54 groups was not statistically significant (25.7% vs. 26.8%, p = ns), indicating comparable polyp burden. Carcinoma detection rates followed a similar pattern, with no significant difference between the 45-49 (0.29%) and 50-54 (0.29%) groups, while a substantial rise occurred from age 55 onwards (p < 0.05).

Conclusions: Individuals screened in the 45-49 age group exhibited comparable PDR and carcinoma detection rates to those in the 50-54 age range.

Keywords: Colonoscopy; Colorectal cancer; Colorectal cancer screening; Polyp detection rate (PDR).

Fig. 1

Flowchart of study population selection. Out of 235,782 colonoscopy records identified between 2016 and 2022, a total of 34,352 cases (14.5%) were excluded based on predefined criteria. The final analytic cohort comprised 201,430 individuals (85.5%) stratified into six age groups: 45–49 (11.0%), 50–54 (22.2%), 55–59 (18.2%), 60–64 (17.9%), 65–69 (17.5%), and 70–74 (12.8%)

Fig. 2

Gender distribution of the study cohort. Among the 201,430 individuals included in the final analysis, 54% were male and 46% were female, indicating a slight male predominance in the screened population

Fig. 3

Bowel preparation type and quality for the inclusion population. a The proportion of patients receiving different bowel preparation regimens. b The distribution of bowel preparation quality is categorized according to the Boston scale as good and very good

Fig. 4

Annual distribution of colonoscopy procedures by age group from 2016 to 2022. The bar chart displays the total number of colonoscopies performed annually across six predefined age categories: 45–49, 50–54, 55–59, 60–64, 65–69, and 70–74 years

Fig. 5

Age-stratified distribution of polyp prevalence, representing the percentage of patients with at least one polyp detected per colonoscopy across different age groups. The line graph illustrates the percentage of patients with 1 to 10 polyps detected during colonoscopy, stratified by age groups: 45–49 years (blue), 50–55 years (orange), and 55 years or older (green)

Fig. 6

Age-stratified polyp detection rates (PDR). The bar chart presents PDR across six age groups ranging from 45 to 74 years (*P < 0.05)

Fig. 7

Carcinoma detection rates by age group. The bar chart presents the Carcinoma detection rate across six age groups ranging from 45 to 74 years (*P < 0.05)