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(Reuters Health) – Average-risk individuals who undergo screening colonoscopy at ages 45 to 49 have a risk of early-age onset colorectal neoplasia that is similar to people in the 50-59 age group and warrants screening at younger ages, a systematic review and meta-analysis suggests.

Researchers examined data from 17 studies with a total of 51,811 average-risk individuals who underwent screening colonoscopy. The main focus of the study was on early-age onset of colorectal neoplasia, which researchers defined as cases before age 50.

Overall, the pooled rate of early-age onset colorectal neoplasia was 13.7% and the pooled rate of early-age onset advanced colorectal neoplasia was 2.2%.

“The rates of colorectal cancer have been increasing in individuals under age 50 for the last several decades, thus, breastfeeding augmentin we are not surprised to learn that advanced colorectal neoplasia rates in 45-49 year olds are similar to those observed in 50-59 year olds,” said senior study author Dr. Swati Patel of the University of Colorado Anschutz Medical Center, in Aurora, and the Rocky Mountain Regional Veterans Affairs Medical Center.

“For those without symptoms or family history, our data show that expanding screening to those ages 45-49 will have similar yield as current screening in those ages 50-59,” Dr. Patel said by email.

It would take six individuals aged 45 to 49 undergoing a screening colonoscopy to detect one case of colorectal neoplasia and 28 individuals this age to detect one case of advanced colorectal neoplasia, the researchers calculated.

By comparison, it would take four individuals aged 50 to 59 undergoing screening colonoscopy to detect one case of colorectal neoplasia and 24 individuals to detect one case of advanced colorectal neoplasia, according to the report in Gastroenterology.

One limitation of the study is that the results may not be generalizable to the average-risk population due to selection criteria for the individual studies included in the analysis, the authors note. The researchers were also unable to determine risk based on factors such as race, ethnicity, smoking status and obesity.

The results, however, are in line with qualified guidelines issued in 2018 by the American Cancer Society to start colorectal cancer screening at age 45, as well as a more recent and similarly qualified recommendation from the U.S. Preventive Services Task Force, said Ann Graham Zauber, an attending biostatistician at Memorial Sloan Kettering Cancer Center in New York City who wasn’t involved in the study.

“However, when American Cancer Society suggested the qualified guideline to start screening at age 45, multiple authors thought there was insignificant clinical evidence that starting screening at age 45 was prudent,” Zauber said by email.

Among other concerns, there were questions about whether younger people would have an adenoma burden similar to individuals over 50 as well as questions about whether screening at younger ages might create fewer screening spots for older individuals, Zauber said.

The study results do suggest that screening at 45 has merit, Zauber added.

“However the issue of getting adults ages 45-49 in for screening needs to be worked out,” Zauber said.

SOURCE: Gastroenterology, online June 9, 2021.

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