Colorectal Neoplasia Screening Before Age 50? Current Epidemiologic Trends in the United States

PURPOSE: Colorectal cancer screening has decreased mortality through early disease detection. In 1995, the United States Preventative Services Task Force recommended commencing screening at age 50 for average-risk people. We assessed trends in colorectal resection for neoplasia in the interval following these recommendations. METHODS: The Nationwide Inpatient Sample was queried to identify patient discharges for colorectal resection of neoplastic disease, 1998-2005. Univariate analyses were performed using Rao-Scott chi-squared tests and survey-weighted analysis of variance. Trends were analyzed by the Mantel-Haenszel chi-squared test. RESULTS: There were 212,389 patient discharges following resection for colorectal neoplasia. The number of resections for each age group were as follows: less than 50 years ranged from 11.8 to 13.3 percent, around 12.5 percent for ages 50 to 70 years, and 13.5 to 11.6 percent for ages greater than 70, with overall P < 0.0001. In-hospital mortality was 0.6 percent for patients aged less than 50 years, 1.5 percent for those aged 50 to 70 years, and 4.6 percent for those aged greater than 70 years. Right colectomy was the most common procedure among all age groups (42.5 percent). CONCLUSIONS: Although the national incidence of colorectal cancer has been fairly stable, the increase in colorectal resection for neoplasia in patients less than age 50, combined with their low in-hospital mortality rate, strengthens the argument for screening before age 50. The predominance of right-sided procedures supports the use of full colonoscopy as the primary screening method.