Incidence of CRC Increased in Male Patients Younger Than 50 Years

Individuals who were younger than 50 years had an increased incidence of colorectal cancer (CRC) if they were a male individual, according to a study in JAMA Network Open. Advanced adenoma prevalence also increased in patients younger than 50 years.

The mortality and incidence of CRC has decreased in both the United States and in European countries in adults aged 55 years and older. Although the American Cancer Society recommends that first-time screening for CRC should start at 45 years, screening programs usually focus on patients aged 50 years and older. Adenomas can lead to CRC, with the transition rate from advanced adenomas (AA) to CRC increasing with age.

In this study, the researchers analyzed the prevalence of AAs in younger adults who didn’t have symptoms of CRC, as well as the incidence of CRC.

Aesthetic handdrawn highlighted illustration of human intestine | Image credit: mi_viri - stock.adobe.com

The Austrian quality assurance program for screening colonoscopies was used to analyze colonoscopies. This dataset was created by the Austrian Society of Gastroenterology and Hepatology and the National Cancer Aid, with all participants having to prove that they performed 200 colonoscopies and 50 polypectomies with supervision and an additional 100 unsupervised colonoscopies and 10 polypectomies each year. Although the data mostly included patients who were 50 years and older, younger adults who had a voluntary colonoscopy due to fear of cancer were also included.

Patients were excluded if they had a family history of CRC, had inflammatory bowel disease, or had cancer symptoms. Any colonoscopies done by endoscopists who had done less than 30 screening colonoscopies were excluded along with any exams that had poor bowel preparation.

There were 296,170 patients included who had had a colonoscopy between 2008 and 2018, of which 50.9% were female. The median (IQR) age of the cohort was 60 (54-68) years, with 3.8% younger than 50 years. A total of 97.1% of participants had colonoscopies that reached the cecum and the median detection rate was 21.4% (17.6%-26.1%) for adenomas and 6.6% (4.2%-9.0%) in AAs.

The incidence of CRC increased in men younger than 50 years from 1988 to 2018, from 9.1 incidences per 100,000 individuals to 10.2; incidence had briefly decreased to 8.5 incidents and 8.6 incidents in 1998 and 2008. Incidence in female participants younger than 50 years decreased from 9.7 incidents in 1988 to 7.7 incidents in 2018. Male participants who were older than 50 years had a decrease in incidents from 217 incidents in 1988 to 143 incidents in 2018. Female participants who were older than 50 years also had a decrease in incidents from 168 in 1988 to 97 in 2018.

A total of 12,271 male participants had AAs detected compared with 7798 female participants.Male participants had a higher amount compared with women in participants younger than 50 years (229 vs 160 respectively). The prevalence of AAs increased from 21 males in 2008 to 42 males in 2018 whereas it decreased from 7 women in 2008 to 2 women in 2018 in participants younger than 50 years. The prevalence of AAs increased in all participants aged 50 years and older from 888 participants in 2008 to 2578 participants in 2018; prevalence increased in both men and women.

There were some limitations to this study. Factors associated with CRC were not analyzed and comorbidities, such as smoking, diabetes, and fatty liver disease, did not have any data included. Data on serrated lesions was missing for 2008 to 2012. This study was also primarily descriptive.

Younger adults had an increased prevalence of AAs in Austria and that the incidence of CRC has increased in males who are younger than 50 years. The researchers concluded that sex should be taken into account when suggesting a screening for patients, with men likely requiring screening as early as 40 years of age.

Reference

Penz D, Waldmann E, Hackl M, et al. Colorectal cancer and precursor lesion prevalence in adults younger than 50 years without symptoms. JAMA Netw Open. 2023;6(12):e2334757. doi:10.1001/jamanetworkopen.2023.34757