Does metabolic health status affect the optimal starting age for colorectal cancer screening? A Korean nationwide cross-sectional study.

Abstract

573 Background: The association between metabolic syndrome and colorectal cancer (CRC) has been suggested as one of causes for the increasing incidence of CRC, particularly in younger age groups. The present study examined whether the current age threshold (50 years) for colorectal cancer (CRC) screening in Korea requires modification when considering metabolic syndrome. Methods: We examined data from the National Health Insurance Corporation database, which covers ~97% of the population in Korea. CRC risk was analyzed with stratification based on age and the presence/absence of relevant metabolic syndrome components (diabetes, dyslipidemia, and hypertension). The incidence of CRC was determined for four, 2-year time periods. Results: A total of 51,612,316 subjects enrolled during 2014-2015 were analyzed. Among them, 19.3% had diabetes, hypertension, dyslipidemia, or some combination thereof. This population had a higher incidence of CRC than did those without these conditions and this was more prominent in subjects < 40 years of age. The optimal cut-off age for detecting CRC, based on the highest Youden index, was 45 years among individuals without diabetes, dyslipidemia, and hypertension, and 62 years among individuals with at least one of these components of metabolic syndrome. Resetting the cut-off age from 50 years to 45 years achieved a 6% increment in sensitivity for CRC detection among the total population. Conclusions: An earlier start of CRC screening, namely at 45 rather than at 50 years of age, may improve secondary prevention of CRC in Korea.