ADR Meta-Analysis Supports CRC Screening at Age 45

The pooled detection rate for adenomas in patients aged 45 to 49 years with average colorectal cancer (CRC) risk was 28.2%, according to a systematic review and meta-analysis published in The American Journal of Gastroenterology.

“A recent guidance published by the American College of Physicians recently suggested to start screening at 50 years of age in average-risk asymptomatic patients...,” wrote corresponding author Aasma Shaukat, MD, MPH, of NYU Grossman School of Medicine, New York, New York, and study coauthors. “Our review, however, shows that there is a significant precancerous lesion burden in this age group, which would actually reinforce the guidance from major gastroenterological organizations to start screening at 45 years.”

The investigation included 16 moderate- to high-quality studies reporting on detection rates of adenomas and sessile serrated lesions in 45- to 49-year-olds who underwent colonoscopies for any indication. Studies were based in the United States, South Korea, China, Canada, and France.

Across the 16 studies, there were a total 150,436 colonoscopies and 41,709 detected adenomas. Researchers reported a pooled overall adenoma detection rate of 23.1%. Among 6 studies that reported on sessile serrated lesion detection, the pooled detection rate was 6.3%.

In a separate analysis that focused on people at average CRC risk undergoing screening colonoscopy, the pooled adenoma detection rate from 7 studies was 28.2%. Data was insufficient, however, to calculate the sessile serrated lesion detection rate in average-risk patients.

The authors reported considerable heterogeneity in all analyses.

“Despite… limitations, our meta-analysis provides valuable information regarding the adenoma detection rate and sessile serrated lesions detection rates in 45- to 49-year-old individuals underdoing colonoscopy,” researchers wrote. “The comparable detection rates of precancerous lesions in this age group to those 50 to 54 years old support starting CRC screening at 45 years of age.”

Reference

Abdallah M, Mohamed MFH, Abdalla AO, et al. Adenomas and sessile serrated lesions in 45- to 49-year-old individuals undergoing colonoscopy: a systematic review and meta-analysis. Am J Gastroenterol. 2024;119(8):1600-1606. doi:10.14309/ajg.0000000000002735