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July
22
- Earlier Colon
Screenings May Identify Cancer Sooner
New findings suggest that beginning colon cancer screening
at an earlier age may help clinicians track adenomas, precancerous growths,
more effectively. Currently, standard protocol recommends screening
patients over age 50 for colon cancer based on the increasing incidence
of colon cancer at that age. Because observational studies have shown
that it takes a decade for adenomas to develop and progress to cancer,
the increase in colon cancer prevalence in the over-50 age group, in
fact, may be the result of undetected adenomas that were present in
the individuals in their 40s, according to a study published in the
current issue of Gastroenterology.
"Our results support the theory that adenomas, which later may
lead to cancer, form at an age earlier than we screen for today,"
says Alfred I. Neugut, MD, PhD, a professor of epidemiology at the Mailman
School of Public Health and professor of medicine at Columbia University
College of Physicians and Surgeons and head of cancer prevention and
control for the Herbert Irving Comprehensive Cancer Center at Columbia
University Medical Center and New York-Presbyterian Hospital. "With
this information in hand, it is logical to think that if we were to
recommend screening for colon cancer at age 40, we may be able to decrease
its prevalence even further and save more people from having to battle
the disease."
The prevalence of adenomas in the colon is the same for average-risk
patients who are 40 to 49 years of age and those who are 50 to 59 years
of age. In comparing colonoscopy results by age group, the team of scientists
found that in the 40 to 49 age group, 79 patients, or 14%, had one or
more adenoma. Similarly, the 50 to 59 age group had 56 patients, or
16%, with one or more adenoma. Only one prior study has investigated
the prevalence of colorectal adenomas in average-risk individuals aged
40 to 49 years in the U.S., and it reported similar findings: an adenoma
prevalence of 11% in the age group.
Data from a centralized digital medical record system were analyzed
by a team of researchers led by Neugut and Andrew Rundle, PhD, an assistant
professor of epidemiology at the Mailman School of Public Health. The
researchers reviewed 553 screening colonoscopies for patients aged 40
to 49 and 352 screening colonoscopies for patients aged 50 to 59. Individuals
who could be deemed "high-risk" because of a family history
of colon cancer, a personal history of inflammatory bowel disease, or
any malignancy other than skin cancer were excluded from the sample.
Though the number of adenomas was relatively similar in the two age
groups, there was a doubling in the prevalence of abnormal cell growth,
or advanced neoplasia, in the 50 to 59 age group versus the 40 to 49
age group. While not statistically significant, 11 patients in the 40
to 49 age group, or 2%, had an advanced neoplasm, and 13 patients in
the 50 to 59 age group, 4%, had an advanced neoplasm.
"What this implies is that while the number of precancerous growths
is very similar in both age groups, there is a progression toward cancer
in older patients," notes Rundle. "Abnormal cell growth is
a warning sign of cancer, so the fact that there's an increase in advanced
neoplasia in the older age group is in line with the increased colon
cancer incidence we see in individuals over the age of 50. Detecting
adenomas when patients are in their 40s could mean that we are able
to drastically lower the prevalence of colorectal cancer. Additional
studies need to be done to look specifically at this possibility and
the cost-benefit of beginning screening at an earlier age."
Source: Columbia University
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