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Background

The troubling rise in incidence of early age-onset colorectal cancer (CRC) has highlighted the need to optimize screening for both average-risk and higher-risk individuals with a family history of CRC.

Methods

Data from the statewide Ohio Colorectal Cancer Prevention Initiative was examined to determine what proportion of newly diagnosed early age-onset CRC cases from a prospectively accrued, population-based registry could have been potentially prevented if existing high-risk screening guidelines were followed and average-risk screening was initiated at age 45.

Results

Of 566 (79.4%) patients with sporadic early age-onset CRC diagnosed at a median age of 44 (range 17-49), an estimated 234 (41.3%) would have been diagnosed earlier with screening initiated at age 45.

In addition, there were 97 (13.6%) patients with a family history whose median diagnosis age was 45. The median recommended age for colonoscopy initiation was 7 years before diagnosis.The data support early initiation of screening in high-risk persons independent of the age of first-degree relatives with CRC, since roughly 50% more cases would have been diagnosed earlier or potentially prevented than if previous age restrictions were in place.

Conclusion

Encouraging stricter adherence to early CRC screening in this population is fertile territory for reduction of early age-onset CRC.

You can read an interview with the lead study author here, and about the clinical implications of the study here.