SLIDE 6 9/13/2019 6
Age USPSTF Recommendations Grade 76‐85 The decision…should be an individual one, taking into account the patient’s
- verall health and prior screening history.
- Adults who have never been screened are more likely to benefit.
- Adults who 1) are healthy enough to undergo treatment if CRC is detected
and 2) do not have comorbid conditions that would significantly limit their life expectancy C
When To Stop CRC Screening
USPSTF recommendations on screening for colorectal cancer. JAMA. 2016;315(23):2564‐2575; Qaseem A, et al. Ann Intern Med. 2012;156(5):378‐386.
American College of Physicians ‐ Stop CRC screening in adults > age 75 years OR if life expectancy < 10 years ** No recommendations on when to stop colonoscopy in patients with a h/o adenomatous or sessile serrated polyps – e.g. surveillance colonoscopy ** Age
Sex
Race
Risk Factors for CRC
Colorectal Cancer Facts and Figures 2017‐2019, American Cancer Society
Hereditary/Medical History Relative Risk FH CRC one first degree relative 2.2 More than one relative 4 Relative with CRC < age 45 3.9 Inflammatory bowel disease 1.7 Diabetes 1.3 Behavioral Factors ETOH 2‐3 drinks/day 1.2 ETOH > 3 drinks/day 1.4 Obesity BMI >30 1.3 Red meat consumption (100 gm/d) 1.2 Processed meat consumption (50 gm/d) 1.2 Smoking 1.2
Incidence of CRC Gen X and Millennials
JNCI 2017:109(8); ruesch.georgetown.edu/youngadultcrc
Is the biology of CRC different in younger adults?
- distinct pathological/molecular features
- more advanced at Dx
- aggressive CA
- poorer prognosis
~35‐40% FH CRC or genetic mutation 60% are sporadic
Possible risk factors: obesity, type 2 diabetes,
sedentary lifestyle, red meat/processed meat/fat/processed food consumption , microbiome (societal overuse of antibiotics), smoking, alcohol, other?
Lieberman D. Clin Gastroenterol and Hepatol. Nov 2018; 16(11):1705‐1707
Obesity Metabolic Syndrome Foods, Additives, Preservatives Antibiotics Microbiome Inflammation
CRC in Age <50 yo ‐ Causes Not Fully Understood
