Copyright ©The Author(s) 2019.
World J Gastroenterol. Jun 7, 2019; 25(21): 2565-2580
Published online Jun 7, 2019. doi: 10.3748/wjg.v25.i21.2565
Table 1 Model-estimated benefits and burden of colorectal cancer screening starting at age 45 vs 50 per 1000 screened over a lifetime[27]
Screening testAge of start and stopLife years gainedNumber of colonoscopiesRecommendable?
Colonoscopy every 10 yr45-754295646Yes
CTC every 5 yr45-753902666Yes
Flexible sigmoidoscopy every 5 yr45-754033761Yes
FIT every year45-754032698Yes
HSgFOBT every year45-754033364No
mt-sDNA every 3 yr45-753762640No
Table 2 Reasons in favor of and against colorectal cancer screening from 45 years of age
Reasons favoring earlier screeningReasons against earlier screening
Burden of disease
The incidence of eoCRC is increasing, and metastatic diseases are increasing faster. 11% and 10% of all males’ and females’ CRC cases occur before the age of 50; of all years of potential life lost from CRC, 10% were from the 45-49 age groupThe absolute risk of eoCRC is still considerably smaller than the older counterpart; incidence reaches 34 vs 60:100000, respectively
Expected benefits
In the absence of data from randomized controlled studies, three computational models predicted a benefit from lowering the age of screeningComputational models have several limits. They assume an unrealistic 100% adherence rate; they failed to consider CRC as a multifactorial disease where other risk factors influence one’s risk (i.e., sex, diabetes, diet, lifestyle and others)
Earlier screening is economically feasible in the United States, and it might be similarly feasible in most European countries; some European countries have also reported a shortage of gastroenterologistsEarlier screening will create care costs that may not balance the reduced incidence and mortality; implementing earlier screening might produce resource diversion. Enhancing compliance rates to colorectal screening is an equally important task that might be overlooked if excessive emphasis is placed on earlier screening
Society guidelines
The ACS recommends screening from 45 years of age. ACG and ASGE support screening from 45 years of age for African Americans, whose incidence of eoCRC is superimposable on CaucasiansUSPSTF, USMSTF and ECCSGWG support screening from 50 years of age