Colorectal Cancer Screening Completion and Yield in Patients Aged 45 to 50 Years : An Observational Study.

IF 19.6 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

Annals of Internal Medicine Pub Date : 2024-10-22 DOI:10.7326/M24-0743

Theodore R Levin, Christopher D Jensen, Natalia Udaltsova, Andrea A Burnett-Hartman, Aruna Kamineni, Chun R Chao, Joanne E Schottinger, Nirupa R Ghai, Gaia Pocobelli, Larissa L White, Malia Oliver, Hina Chowdhry, Brian P Hixon, Jessica M Badalov, Shauna R Goldberg, Susan C Bradford, Charles P Quesenberry, Jeffrey K Lee

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引用次数: 0

Abstract

Background: Guidelines now recommend initiating colorectal cancer (CRC) screening at age 45 years rather than 50 years, but little is known about screening completion and yield among people aged 45 to 49 years.

Objective: To evaluate fecal immunochemical test (FIT) completion and yield in patients aged 45 to 49 versus 50 years.

Design: Retrospective cohort study.

Setting: Kaiser Permanente Northern California, Washington, and Colorado.

Patients: Those distributed a FIT kit during January to September 2022.

Measurements: FIT completion within 3 months, FIT positivity, receipt of colonoscopy within 3 months after a positive FIT result, and colonoscopy yield.

Results: A total of 267 732 FIT kits were distributed: 213 928 (79.9%) to patients aged 45 to 49 years, and 53 804 (20.1%) to those aged 50 years. Overall, FIT completion was slightly higher in patients aged 45 to 49 years (38.9% vs. 37.5%; adjusted risk ratio [aRR], 1.05 [95% CI, 1.04 to 1.06]), although at Colorado, those aged 45 to 49 years were substantially less likely to complete a FIT (30.7% vs. 40.2%; aRR, 0.77 [CI, 0.73 to 0.80]). Overall, FIT positivity was lower in patients aged 45 to 49 years (3.6% vs. 4.0%; aRR, 0.91 [CI, 0.84 to 0.98]), and receipt of colonoscopy after a positive FIT result was similar between groups (64.9% vs. 67.4%; aRR, 1.00 [CI, 0.94 to 1.05]). Adenoma detection was lower in the younger group (58.8% vs. 67.7%; aRR, 0.88 [CI, 0.83 to 0.95]). Yields were similar for adenoma with advanced histology (13.2% vs. 15.9%; aRR, 0.86 [CI, 0.69 to 1.07]), polyp with high-grade dysplasia (3.4% vs. 5.1%; aRR, 0.68 [CI, 0.44 to 1.04]), sessile serrated lesion (10.3% vs. 11.7%; aRR, 0.92 [CI, 0.71 to 1.21]), and CRC (2.8% vs. 2.7%; aRR, 1.10 [CI, 0.62 to 1.96]).

Limitation: The small number of neoplasia events contributed to wide CIs.

Conclusion: Similar FIT completion and yield rates in people aged 45 to 50 years support initiation of CRC screening at age 45 years.

Primary funding source: Kaiser Permanente Sidney R. Garfield Memorial Fund.

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45 至 50 岁患者的结直肠癌筛查完成率和收益率：一项观察性研究。

背景：现在的指南建议在 45 岁而不是 50 岁开始进行结直肠癌（CRC）筛查，但人们对 45 至 49 岁人群的筛查完成度和筛查率知之甚少：评估 45 至 49 岁与 50 岁患者的粪便免疫化学检验（FIT）完成率和筛查率：设计：回顾性队列研究：地点：北加州、华盛顿州和科罗拉多州的凯撒医疗机构：患者：2022 年 1 月至 9 月期间获得 FIT 套件的患者：测量指标：3 个月内完成 FIT、FIT 阳性、FIT 阳性后 3 个月内接受结肠镜检查和结肠镜检查率：共发放了 267 732 套 FIT 套件：其中 213 928 套（79.9%）发放给 45 至 49 岁的患者，53 804 套（20.1%）发放给 50 岁的患者。总体而言，45 至 49 岁患者的 FIT 完成率略高（38.9% 对 37.5%；调整风险比 [aRR]，1.05 [95% CI，1.04 至 1.06]），但在科罗拉多，45 至 49 岁患者完成 FIT 的可能性要低得多（30.7% 对 40.2%；aRR，0.77 [CI，0.73 至 0.80]）。总体而言，45 至 49 岁患者的 FIT 阳性率较低（3.6% 对 4.0%；aRR，0.91 [CI，0.84 至 0.98]），两组患者在 FIT 阳性后接受结肠镜检查的比例相似（64.9% 对 67.4%；aRR，1.00 [CI，0.94 至 1.05]）。年轻组的腺瘤检出率较低（58.8% 对 67.7%；aRR，0.88 [CI，0.83 对 0.95]）。晚期组织学腺瘤（13.2% 对 15.9%；aRR，0.86 [CI，0.69 至 1.07]）、高级别发育不良息肉（3.4% 对 5.1%；aRR，0.68[CI，0.44至1.04]）、无柄锯齿状病变（10.3% vs. 11.7%；aRR，0.92[CI，0.71至1.21]）和CRC（2.8% vs. 2.7%；aRR，1.10[CI，0.62至1.96]）：局限性：肿瘤事件的数量较少导致CI值较宽：结论：45 岁至 50 岁人群中相似的 FIT 完成率和收益率支持在 45 岁开始进行 CRC 筛查：主要资金来源：Kaiser Permanente Sidney R. Garfield Memorial Fund。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Internal Medicine 医学-医学：内科

CiteScore

23.90

自引率

1.80%

发文量

1136

审稿时长

3-8 weeks

期刊介绍： Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.