The starting age for colorectal cancer screening has dropped to 45!

It is only a guide for medical professionals to read.
This time the amount of information is a bit large.
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Summary of this article: 1.
Traditional concept: It is enough to screen for colorectal cancer at the age of 50
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2.
At stake! The increasing incidence of colorectal cancer in the age group under 50 has attracted attention
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3.
Decline to 45 years old! The US Preventive Medicine Task Force issued a statement on the starting age for colorectal cancer screening
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4.
Comparison of Chinese and foreign guidelines: From the beginning, major organizations/institutions recommend the initial screening age
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Traditional concept: Waiting for the age of 50 to be screened for colorectal cancer is sufficient for colorectal cancer to be the third leading cause of cancer deaths in the world [1], and this is consistent with the fact that the occurrence of dead cancer is closely related to the increase of age.
According to statistics, for 49 years old In the age group, the number of new cases per 100,000 people is about 20; and once the age rises to 60 years and above, the number of new cases in this group will rise to more than five times that of the former; even if the age only rises slightly (50-59-year-old age group), the number of new cases per 100,000 people is also twice that of the 49-year-old age group
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Therefore, it is not difficult to understand that the age group over the age of 50 is the "key concern" for colorectal cancer.
There are also guidelines in China that point out that people over the age of 50 are at high risk of colorectal cancer and should be routinely screened
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However, there is no age limit for screening people with alarm symptoms
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At stake! The rising incidence of colorectal cancer in the age group under 50 has attracted attention.
However, in recent years, many researchers have found that with life>
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From 2000-2002 to 2014-2016, the incidence of colorectal cancer (especially adenocarcinoma) among 40-49-year-old adults increased by nearly 15% [2].
In the 20-29-year-old age group, colorectal cancer also increased.
Shows a slow upward trend
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Figure 1 The incidence of colorectal cancer among people under the age of 50 is rising.
The initial screening age has dropped to 45 years! Overview of the latest guidelines of the U.
S.
Preventive Medicine Task Force In May 2021, the U.
S.
Preventive Medicine Task Force (USPSTF) also updated its recommendation statement for colorectal cancer screening (hereinafter referred to as the “latest guidelines”) [3].
Update every 5 years
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The biggest highlight of the update of the new and old guidelines is that the old guidelines recommend that ordinary people start screening for colorectal cancer at the age of 50, and screen to 75; and the latest guidelines directly reduce the recommended age for screening by 5 years, and believe that some 76- People in the 85-year-old age group may benefit from colorectal cancer screening
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Figure 2 USPSTF's updated guidelines for colorectal cancer screening guidelines this year 1.
All adults aged 50-75 should be screened for colorectal cancer (recommendation level: A, clinical net benefit is significant) age is colorectal One of the most important risk factors for cancer, the incidence of colorectal cancer is positively correlated with age
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Nearly 94% of new cases of colorectal cancer occurred in adults over 45 years of age
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The USPSTF recommends screening for colorectal cancer for all adults aged 50-75
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2.
Colorectal cancer screening for adults aged 45-49 (recommendation level: B, medium clinical net benefit) Compared with people aged 50 and above, the absolute risk of adults under 50 years of age suffering from colorectal cancer It is much lower, but it has been on the rise in recent years
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People with the following characteristics are still high-risk groups and should be paid attention to, and regular screening starts from the age of 45: family history of colorectal cancer, male other risk factors (such as obesity, diabetes, long-term smoking and alcoholism), then for those who do not have the above high-risk factors People, should the screening also start at the age of 45? The answer is yes
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The USPSTF pointed out that even without these risk factors, it is recommended to start screening for colorectal cancer at the age of 45
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In addition, modeling conducted by the Cancer Intervention and Surveillance Modeling Network (CISNET) shows that compared with starting screening at the age of 50, starting colorectal cancer screening at the age of 45 can increase the life span to a certain extent and reduce the incidence and death of colorectal cancer.
Rate
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3.
Colorectal cancer screening should be selectively provided for adults aged 76-85 (recommendation level: C, with little clinical net benefit).
USPSTF believes that whether screening for this age group is mainly dependent on whether it has been carried out before.
Screened, specifically: if people in this age group have been screened for colorectal cancer before, the net benefit of re-screening is very small.
If people in this age group have never been screened before, they may be screened.
For this group of elderly patients, the hazards of colonoscopy (such as the risk of perforation and bleeding) and the risk of dehydration or electrolyte imbalance caused by CT colonography intestinal preparation are greater
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Modeling studies estimate that among average-risk adults who have previously received appropriate screening, few people over the age of 75 will experience an increase in life expectancy
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The USPSTF recommended screening intervals for colorectal cancer are as follows: high-sensitivity gFOBT or FIT once a year, sDNA-FIT every 1-3 years, CT colonography every 5 years, sigmoidoscopy every 5 years, every 10 years Perform a sigmoidoscopy + FIT once a year.
Colonoscopy every 10 years.
USPSTF recommends that while selecting the most appropriate screening method for the patient, both doctors and patients strictly follow the recommended screening interval
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Similarities and differences between Chinese and foreign guidelines: The initial screening age of the new guidelines is generally lowered, but the specific ages are different.
▌ China's guidelines: Risk assessment from 40 years old is in line with the increase in the incidence of colorectal cancer in the Chinese population from the age of 40, and starts at the age of 50 A new situation with a significant upward trend [4], the National Cancer Center China Colorectal Cancer Screening and Early Diagnosis and Treatment Guidelines Development Expert Group updated the "China Colorectal Cancer Screening and Early Diagnosis and Early Treatment Guidelines" in January this year [5] It is proposed that from the age of 40, the general population should be assessed for colorectal cancer risk
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The starting age of the population for colorectal cancer screening should be determined according to the risk after assessment: For high-risk populations, colorectal cancer screening should be accepted from 40-75 years old (strong recommendation, GRADE evidence grade: medium) People at risk are screened for colorectal cancer at the age of 50-75 (strong recommendation, GRADE evidence grade: medium).
However, even if the individual is at low risk, such as 1 or more first-degree relatives suffering from colorectal cancer, it is recommended to receive colorectal cancer The starting age for cancer screening is 40 years old or 10 years earlier than the youngest patient among first-degree relatives (weak recommendation, GRADE evidence grade: medium)
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In addition, taking into account the benefits of screening and life expectancy, this update of the "Guidelines for Screening and Early Diagnosis and Treatment of Colorectal Cancer in China" does not recommend screening for people over 75 years of age
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The screening cycle of colorectal cancer is also different according to the different screening tools.
The update of the "Guidelines for Screening and Early Diagnosis and Treatment of Colorectal Cancer in China" believes that high-quality colonoscopy is recommended every 5-10 years.
Once (strong recommendation, GRADE evidence classification: high) For FIT examination, it is recommended to perform once a year (strong recommendation, GRADE evidence classification: medium) For sigmoidoscopy, it is recommended to perform once every 3-5 years (weak recommendation, GRADE evidence classification: Medium) For colonic CT imaging technology examination, it is recommended to perform once every 5 years (weak recommendation, GRADE evidence grade: low) For multi-target stool FIT-DNA testing, it is recommended to perform once every 3 years (weak recommendation, GRADE evidence grade: low) )▌ Foreign guidelines: New guidelines issued within 3 years will lower the screening age to 45 years.
In 2018, the American Cancer Society lowered the screening start age for general risk populations to 45 years [6]
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Subsequently, in March this year, the American College of Gastroenterology (ACG) also stated that based on the new 45-49-year-old young people’s rising risk of colorectal cancer, it is recommended that individuals with general risks start at the age of 45.
CRC screening (before this was 50 years old) [7]
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In addition, the initial screening ages recommended by other institutions are varied, such as: Colorectal cancer screening announced by the United States Colorectal Cancer Multi-Society Working Group (USMSTF) and Canadian Task Forceon Preventive Health Care (Canadian Task Forceon Preventive Health Care) and other groups The guidelines all use 50-74 years as the screening age for the general risk population (the guidelines were issued in 2017 and 2001 respectively) [8,9] The best age range recommended by the EU colorectal cancer screening guidelines in 2010 should be 55 years old To 64 years of age, and should stop after 74 years of age [10] The 2015 Asia Pacific Colorectal Cancer Screening Consensus recommends that general risk populations should be screened for colorectal cancer at the age of 50-75 [11] but will start from above Compared with the guidelines that adjusted the screening age to 45 years old, these guidelines have been released for a long time and have not been updated for a long time.
Some guidelines were even issued more than ten years ago.
Therefore, it is likely that they are no longer applicable to the current situation
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Summary: Colorectal cancer in China is one of the main cancers that threaten the lives and health of Chinese residents.
Colorectal cancer patients in China account for 31% of colorectal cancer patients in the world
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Research and practice have shown that colorectal cancer screening and early diagnosis and treatment can effectively reduce its mortality
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Looking at home and abroad, it is a common trend to lower the starting age for colorectal cancer screening.
The "Guidelines for Colorectal Cancer Screening and Early Diagnosis and Treatment in China" is a guide based on evidence-based medicine, and its recommendations are based on the risk of colorectal cancer in the population.
Screening is carried out by stratification, and the starting age of screening for high-risk groups should even be advanced to 40 years old
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