Abstract

BACKGROUND: All major U.S. guidelines now endorse average-risk colorectal cancer (CRC) screening at ages 45-49. Concerns exist that endoscopic capacity may be strained, that low-risk persons may self-select for screening, and that calculations of the adenoma detection rate (ADR) may be diluted. We analyzed age-specific screening colonoscopy volumes and lesion detection rates before vs. after the endorsement of CRC screening at ages 45-49.METHODS: We compared colonoscopy volumes and lesion detection rates in our healthcare system during Period I (October 2017-December 2018), before the first change in guidelines, vs. Period II (January 2019-August 2021), the era of new guidelines.RESULTS: The proportion of first-time screening colonoscopies performed in 45-49 year-olds increased from 3.5% to 11.6% (RR 3.36 [95% CI, 2.45-4.61]). The Period II detection rates for adenoma, advanced adenoma, sessile serrated lesion (SSL), advanced SSL, adenomas per colonoscopy (APC), and lesions per colonoscopy (LPC) were very similar for 45-49 year-olds (34.3%, 6.3%, 8.6%, 2.9%, 0.58, and 0.69) and 50-54 year-olds (38.2%, 5.8%, 9.4%, 3.0%, 0.63, and 0.76) at first-time screening, and for 60-64 year-olds at re-screening (33.4%, 6.1%, 7.2%, 2.3%, 0.61, and 0.70). All detection rates, APC and LPC increased from Period I to Period II (e.g. overall ADR 35.1% to 42.6%, p<0.0001), without any decreases among 45-49 year-olds.CONCLUSIONS: In our healthcare system, a lower CRC screening initiation age has modestly affected colonoscopy volume by age without compromising screening yield. Lesion detection rates, including for advanced adenomas, in average-risk 45-49 year-olds approximate those in 50-54 year-olds at first-time screening, and 60-64 year-olds at re-screening. National monitoring is needed to assess fully the impact of lowering the CRC screening initiation age.

View details for DOI 10.1016/j.cgh.2022.04.037

View details for PubMedID 35580769