Abstract
BackgroundThe role of colonoscopy in the screening of colorectal cancer (CRC) has been unequivocally established. In Germany, screening colonoscopy with full insurance reimbursement is available for individuals aged 55 and above, and/or for persons with well-known risk factors for CRC. However, advanced CRC is not uncommon in individuals below 55 years. This study was designed to investigate the incidence of advanced CRC in patients < 55 years.MethodsA retrospective analysis of data from a prospectively maintained CRC database of a university hospital in Germany was performed. Using the recommended age for screening colonoscopy as cutoff, the study population was divided into two groups: < 55 years (study group) and ≥ 55 years (control group). Both groups were compared with regard to the extent of CRC using the UICC stages. Only surgically managed patients were included for analysis. Advanced CRC was defined as UICC stage III or IV.ResultsComplete follow-up data was available for 609 patients treated between 2009 and 2013. The study group included 83 patients, 42 females and 41 males with a median age of 48.0 ± 10 years, while the control group was made up of 526 patients, 230 females and 296 males with a median age of 75.5 ± 8.3 years. Both groups were comparable with regard to gender distribution, p = 0.24. Significantly more patients from the study group were diagnosed with advanced CRC in comparison to the control group, 56.6 vs. 43.9%, p = 0.03. There was no statistically significant difference amongst both groups with respect to cancer-related mortality, 10.8 vs. 12.5%, p = 0.66.ConclusionPatients below the recommended age for screening colonoscopy might be at increased risk for advanced CRC. There is need to decrease the recommended age for screening colonoscopy to prevent CRC or enable an early diagnosis in patients below 55 years.
Highlights
The role of colonoscopy in the screening of colorectal cancer (CRC) has been unequivocally established
Using the cutoff age for full insurance reimbursement for screening colonoscopy in Germany (55 years), the study population was divided into two age-dependent groups: < 55 years and ≥ 55 years, Fig. 1
The current German guidelines recommend screening for CRC in asymptomatic individuals beginning at the age of 50 years, full insurance reimbursement for screening colonoscopy is only offered to average-risk individuals aged ≥ 55 years [11]
Summary
The role of colonoscopy in the screening of colorectal cancer (CRC) has been unequivocally established. Advanced CRC is not uncommon in individuals below 55 years. This study was designed to investigate the incidence of advanced CRC in patients < 55 years. Colorectal cancer (CRC) is one of the most common solid malignancies in western nations [1, 2]. CRC arises from a sequence of events that have been described as adenoma-carcinoma sequence [3]. This sequence can be effectively disrupted via screening. The currently recommended CRC screening tests can be divided into two groups [2, 4, 5]. The first group of tests depends primarily on the detection of
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