Gut Liver.  2018 Nov;12(6):655-663. 10.5009/gnl17514.

Optimal Starting Age for Colorectal Cancer Screening in an Era of Increased Metabolic Unhealthiness: A Nationwide Korean Cross-Sectional Study

• Choi YJ
• Lee DH
• Han KD
• Kim HS
• Yoon H
• Shin CM
• Park YS
• Kim N

• KMID: 2427456
• DOI: http://doi.org/10.5009/gnl17514

Abstract

BACKGROUND/AIMS
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 CRC screening in Korea requires modification when considering increased metabolic syndrome.
METHODS
We analyzed data from the National Health Insurance Corporation database, which covers ~97% of the population in Korea. CRC risk was evaluated with stratification based on age and the presence/absence of relevant metabolic syndrome components (diabetes, dyslipidemia, and hypertension).
RESULTS
A total of 51,612,316 subjects enrolled during 2014 to 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 cutoff age for detecting CRC, based on the highest Youden index, was 45 years among individuals without diabetes, dyslipidemia, and hypertension. Individuals with at least one of these components of metabolic syndrome had the highest Youden index at 62 years old, but the value was only 0.2. Resetting the cutoff age from 50 years to 45 years achieved a 6% increase in sensitivity for CRC detection among the total population.
CONCLUSIONS
Starting CRC screening earlier, namely, at 45 rather than at 50 years of age, may improve secondary prevention of CRC in Korea.

Keyword

Colonic neoplasms; Screening; Youden index; Metabolic syndrome; Diabetes mellitus

MeSH Terms

Colonic Neoplasms
Colorectal Neoplasms*
Cross-Sectional Studies*
Diabetes Mellitus
Dyslipidemias
Humans
Hypertension
Incidence
Korea
Mass Screening*
National Health Programs
Secondary Prevention