ASPO Abstracts
Changes in Incident Colonoscopy Use Among Young Adults in the United States
Category: Early Detection & Risk Prediction
Conference Year: 2019
Abstract Body:
Abstract Purpose of the Study: The American Cancer Society (ACS) recently lowered the recommended age to begin colorectal cancer (CRC) screening for average-risk adults from 50 to 45 years because of escalating CRC incidence in generations born since the 1950s. Although debate remains about whether this rise is a result of increased detection because of more colonoscopy use, population-based screening trends in individuals younger than 50 are unknown. Herein, we examined temporal trends in recent colonoscopy use among a nationally representative sample of adults aged 40-54 years. Methods: Recent colonoscopy prevalence was computed among 53,175 respondents aged 40-54 years in National Health Interview Survey (NHIS) data from 2000 through 2015. Unadjusted and adjusted rates of past year colonoscopy, accounting for sociodemographic factors, insurance and CRC risk factors (smoking, alcohol, excess body weight, and family history of CRC), were estimated overall and by 5-year age group. Factors related to past-year colonoscopy were examined with adjusted rate ratios (aRR) and 95% confidence intervals (CI). Results: Among respondents aged 40-44 years, unadjusted past-year colonoscopy rates did not change during 2000 to 2015 and ranged from 2.3% to 3.5% (p-value=0.771). In contrast, past-year colonoscopy rates in ages 45-49 and 50-54 increased between 2000 and 2008 (from 2.5% to 5.7% in 45-49 years and 5.0% to 15.0% in 50-54 years, respectively) but remained stable during 2008 to 2015. Adjusted rates were similar. People with a family history of CRC (40-44 years: aRR=3.90 95%CI 2.63-5.78; 45-49 years aRR=3.17, 95%CI 2.18-4.62; 50-54 years aRR=1.36, 95%CI 1.04-1.77) were three to four times as likely to have a past-year colonoscopy.Conclusions and Relevance: During 2000 to 2015, past-year colonoscopy use in the United States was low among people in their 40s and increases were confined to ages 45-54 from 2000 to 2008. These trends do not fully explain the steady rise in young onset colorectal cancer during the corresponding time period. Further studies are needed to identify reasons for the rising CRC rates in young adults.
Keywords: colorectal cancer; screening;