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03-10-2011 | Surgery | Article

Effective CRC screening age younger in men than women


Free abstract

MedWire News: Study results indicate that the efficacy of colonoscopy-based colorectal cancer (CRC) screening may be increased if performed at a younger age in men than in women.

The majority of national guidelines recommend CRC screening in men and women aged 50 years or over, because the risk for this condition is believed to increase markedly around the age of 60 years, say Monika Ferlitsch (Medical University of Vienna, Austria) and team.

However, findings from the current study show that a marked increase in colorectal adenoma prevalence occurs among women aged 60-64 years, whereas in men, the increase occurs 15 years earlier, at the age of 45-49 years.

The findings also show that the rates of adenoma, CRC, and advanced adenoma (AA) are significantly higher in men than women, irrespective of age. Indeed, male gender was associated with a 1.9-, 1.8-, and 2.1-fold higher risk for adenoma, CRC, and AA, respectively.

In the study, the 4-year rates of adenoma, CRC, and AA development were monitored among 44,350 Austrian individuals who took part in a colonoscopy screening program.

In all, 22,598 of the participants were women (mean age 60.7 years) and 21,572 were men (mean age 60.6 years). Over the 4-year study period, adenomas occurred in 19.7% of participants, CRCs in 1.1%, and AAs in 6.3%.

The authors highlight that the mean number needed to screen (NNS) to detect one adenoma was 5.1 among the overall cohort. However, when gender-specific NNSs were calculated, women had a significantly higher NNS than men, at 6.7 and 4.0, respectively.

Furthermore, the NNS among men aged 45-49 years was similar to that for women aged 60-64 years, at 5.9 and 6.0, respectively.

A similar trend was seen for the NNSs for CRC and AA.

Ferlitsch and team say that their study has many strengths, such as the large cohort size and the similar proportion of men and women enrolled. These study features, remark the authors, add further validity to the findings.

The study, which is published in JAMA, suggests that "male gender constitutes an independent risk factor for colorectal carcinoma and indicating new gender-specific age recommendations for screening colonoscopy," say Ferlitsch et al.

They conclude: "Deciding whether to adjust the age at which screening begins also requires considering whether the recommended age for women should be older or the recommended age for men younger."

By Lauretta Ihonor

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