Colorectal Cancer Screening with Fecal Immunochemical Test (FIT) in Adults Aged 45 to 49 Years Old

Aims Addressing the rising incidence of colorectal cancer (CRC) in patients under 50 years, the U.S. Preventive Services Task Force (USPSTF) issued a statement in May 2021 recommending expanding the ages for colorectal cancer screening to 45 to 75 years. However, this recommendation has not been validated worldwide.

This study aims to investigate the trend of colorectal cancer (CRC) screening through fecal immunochemical test (FIT) in adults aged 45 to 49, following the aforementioned USPSTF recommendation.

Methods An observational, retrospective cohort study was conducted in a tertiary care center in Mexico. Patients aged 45-49 with average risk who underwent screening with FIT test between June 2021 and May 2023 were included and compared with those who underwent screening from June 2019 to May 2021. Positive FIT tests were defined as>20 ug Hb/g. Patients for whom the indication for FIT test was not average-risk CRC screening were excluded.

Results In the period from 2019 to 2021, only 157 FIT tests were requested for individuals aged 45-49 (2.3% of total FIT requests), compared to 484 tests in the two years following the guideline modification (4% of total FIT requests) (p>0.0001).

Of the 484 patients, 100 were excluded due to incomplete medical records or an indication for FIT test different to CRC screening. Of 384 patients, the mean age was 47.5±1.2 years, with 72% being women. The FIT test positivity rate was lower compared to those over 50 (3.1 vs. 5%, p=0.09). Twelve FIT tests (3.1%) were positive. Among the positive cases, nine underwent colonoscopy, and four showed abnormal findings. Two cases revealed advanced adenomas (both tubulovillous adenomas>10mm), which were treated with endoscopic mucosal resection (EMR). No cases of cancer were detected. [1] [2] [3]

Conclusions Following the USPSTF's extension of CRC screening, we observed a substantial increase in FIT test requests among individuals aged 45-49. Although the positivity rate of FIT tests in this age range was low, it often led to the detection of early neoplastic lesions, underscoring the relevance of extended screening. The utilization of CRC screening in individuals under 50 is on the rise, but further studies are warranted to assess its impact.

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024

• References

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• 2 Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM. et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. Vol. 325, JAMA – Journal of the American Medical Association. American Medical Association 2021; 1965-77
• 3 Araghi M, Soerjomataram I, Bardot A, Ferlay J, Cabasag CJ, Morrison DS. et al. Changes in colorectal cancer incidence in seven high-income countries: a population-based study. Lancet Gastroenterol Hepatol 2019; 4 (07) 511-8