Should colorectal cancer screening guidelines account for gender and race/ethnicity?

Abstract

1022 Objectives: The recommended age to begin colorectal screening is 50 for all Americans at “average” risk, regardless of gender or race/ethnicity. However, the natural history of colorectal cancer differs between men and women and across major racial/ethnic groups. Therefore the optimum starting age for colorectal screening may depend upon gender and race/ethnicity. We compare the total cost-effectiveness of different starting ages for colorectal screening by gender and race/ethnicity to address this issue. Methods: We determined age-specific colorectal cancer incidence rates, the proportion of left-sided cancers, and the proportion of localized cancers in Asian, Black, Latino, and White men and women using the California Cancer Registry. We incorporated these data and available data for life expectancy and colorectal cancer survival to model the cost-effectiveness of two 35-year colorectal cancer-screening interventions. Results: Age-specific colorectal cancer incidence rates were highest in Black men and lowest in Latino women. Screening beginning at age 50 was most cost-effective in Black men and least cost-effective in Latino women (measured as dollars spent per year of life saved) using annual fecal occult blood testing combined with flexible sigmoidoscopy every 5 years and using colonoscopy every 10 years. The cost-effectiveness of a 35-year screening program in Black men beginning at age 45 was similar to the cost-effectiveness of screening White men and Black women beginning at age 50 and more cost-effective than screening non-Black women as well as Asian and Latino men beginning at age 50. Conclusions: Screening is most cost-effective in Black men because of high age-specific colorectal cancer incidence rates. Initiation of colorectal cancer screening in this group prior to age 50 should be strongly considered, and could mimic prostate cancer screening recommendations in this high-risk group. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Pfizer