For years, people in the US were encouraged to be screened for colorectal cancer at the age of 50 years, but the American Cancer Society (ACS) has announced the need to reduce the age of five years.

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This step taken by the ACS in 2018, was made in response to the increased frequency of the incidence of colorectal cancer in people under the age of 50. However, other organizations (Task Force on Preventive Services and the US National Comprehensive Cancer Network) did not support the lowering of the age for screening.

Should we reduce the age from the strengthening of cases of colorectal cancer? - The experts expressed their views at the symposium on gastrointestinal cancer in 2020.

If the age for screening reduced by five years, it can help prevent about 30 000 cases of colorectal cancer and 11 000 deaths at the national level.

"This will require about 11 million additional colonoscopies ... and the cost will be about $ 10 billion," - said Dr. Uri Ladabaum from Stanford University. He supported the lowering of the age of 45 years.

The scientist pointed out the extent of the problem, recalling the 2017 study. Then the researchers found that the incidence of colorectal cancer since the mid-1980s to grow at 1-2,4% among those aged 20 to 39 years and 0.5% -1.3% since the mid-1990s in people aged 40 to 54 years. The incidence of colorectal cancer has grown even more rapidly, but about 3.2% annually from 1974 to 2013, people aged 20 to 29 years old.

In general, people who were born in 1990 and later have double the risk of developing colon cancer and quadruple the risk of developing colorectal cancer, according to srvaneniyu with those born in 1950 or so.

The scientist answered the question whether the benefit / risk screening is different in younger and older adults. He said that now it is difficult to determine, since the data bit and today makes no controlled studies that can solve this problem. One study of Taiwanese researchers, which reviewed the results of the fecal immunochemical test (FIT), has shown that in different age groups the ratio of the risk for cancer in patients with positive results is higher in more patients of younger age.

Finally, the scientist said, whether profitable economically be screened earlier. According to forecasts Lambauma and his colleagues screened 45 years could prevent about 4 cases of colorectal cancer and 2 cases of death from the disease in a group of 1,000 people, and the cohort will receive about 14 years of life adjusted for quality.

"Incremental costs per year of life adjusted for quality is acceptable They are within what is considered in the United States cost-effective -. Up to 35 thousand dollars for a colonoscopy and 0000 to 8 dollars for fecal immunochemical tests," - said the researcher .

David Weinberg, chairman of the department of medicine at Fox Chase Cancer Center in Philadelphia, also spoke on the issue, arguing against reducing the entry age.

Although scientists agree with Ladabaumom that the risk of cancer developing in young people increased from 5.9 per 100,000 to 7.2 per 100,000, and the relative increase of 22%, he said: "This is the absolute risk - only 1.3 people on 100 000 . in fact, at 99.9% of people 40+ do not develop colon cancer. "

He noted that it is important to identify the factors contributing to the increased incidence of kolrektalnym cancer in young people, and suggested that some of them may be caused by screening, as well as factors such as obesity and diabetes.

Weinberg also noted that although there are "clear evidence of benefit," the new recommendations of the American Cancer Society, it is unclear "whether the benefits really outweigh the harm."

The scientist also questioned the assumption that the age should be the only criterion for stratification of cancer. He remembered a study that and colon cancer in young adults (18-49 years) compared to cancer in people over 50 years and the respective control groups. In addition to age, the study identified several non-modifiable risk factors associated with early cancer, namely, sex, race, history of inflammatory bowel disease and a family history of colorectal cancer.

He also recalled another study, which used data from the national database of cancer in the period from 2004 to 2015. Then the scientists have identified another set of factors associated with colon cancer in young people. The study showed that the number of cases of cancer before reaching patients 50 years of age was increased only in the non-Hispanic white men, Hispanic and non-Hispanic white women, as well as those who live in urban and rural areas.

The scientist noted that it is important to carefully weigh the benefits and risks. The basic principle of population-based screening is to provide more health benefits than harm, and if the screening age is reduced, will be held a few million extra colonoscopies.

"Colonoscopy reduces the risk of death from colorectal cancer by about 75%, and the incidence is 7.2 per 100,000 in the younger age group. But the death rate, which is characteristic for a colonoscopy is associated with a mortality rate 7100000. We should not forget about the risks associated with the procedure -! said Weinberg.

Source: https://www.medscape.com/viewarticle/925351

Date of publication: 
Wednesday, February 19, 2020