BMI Proves a Strong Predictor in Deciding Age for CRC Screening

Colorectal cancer (CRC) screening was found to be cost-effective for overweight adults, as well as financially beneficial for adults in normal weight range who opt for the screening at an earlier age, researchers found in a new study. The findings are published in Clinical Gastroenterology and Hepatology.

Three investigators compared the results obtained from CRC screenings done at the age of 40 or 45 instead of 50. They also estimated numbers from results by shortening the screening intervals for adults with varying body mass index (BMI) ranging from normal to grade III obesity. The team deployed strategies such as colonoscopy every 10 (Colo10) or 5 years (Colo5), or annual fecal immunochemical test (FIT) to draw conclusions about the age of screening and cost-effectiveness.

The study found that in absence of screening, the CRC-related deaths among sex-specific overweight or obesity I, II, and III adults were similar. The researchers concluded that as BMI increased, the CRC risk increased too, in turn lowering life expectancy.

“For all BMI/sex groups, Colo10 starting at 45 or FIT starting at 40 were cost-effective at a threshold of $100,000/quality-adjusted life year (QALY) gained. Colo10 starting at 40 was cost-effective only for men with obesity II-III, at $93,300 and $80,400/QALY gained, respectively. Shifting Colo10 to earlier starting ages was always preferred over Colo5 starting at later ages,” the authors stated.

The study pointed out that adults who were overweight or obese were at a higher risk of CRC, increased health care spending and increased risk of mortality. Lowering the age of initial CRC screening to 45 with colonoscopy and 40 with FIT appeared to reap financial benefits for adults across all ranges of BMI. For men with obesity II and III, starting colonoscopy at age 40 was most beneficial financially.

However, “it remains to be decided whether BMI should be used as a single predictor or incorporated into a multivariable tool to tailor CRC screening,” the authors advised.

—Priyam Vora

Reference:
Yeoh A, Mannalithara A, Ladabaum U. Cost-effectiveness of earlier or more intensive colorectal cancer screening in overweight and obese patients. Clin Gastroenterol Hepatol. Published Online: August 4, 2022. DOI: https://doi.org/10.1016/j.cgh.2022.07.028