What Age Is the Best “FIT” for Colorectal Cancer Screening?
Menée auprès de 263 125 participants (55,8 % de femmes), cette étude évalue l'effet, sur l'incidence du cancer colorectal et la mortalité, d'un dépistage du cancer colorectal par test FIT en fonction de l'âge d'inclusion (entre 40 et 49 ans ou à partir de 50 ans)
Early-onset colorectal cancer (eoCRC), defined as colorectal cancer (CRC) diagnosed in individuals younger than 50 years, is one of the most rapidly increasing malignancies among young adults globally. The highest incidence rates of eoCRC have been reported in Australia, with an age-standardized rate (ASR) of 16.5 per 100 000 population (95% CI, 16.1-16.9), followed by New Zealand (ASR, 14.8; 95% CI, 14.0-15.6), the US (ASR, 14.8; 95% CI, 14.7-14.9), and South Korea (ASR, 14.3; 95% CI, 14.0-14.5). While the overall incidence of CRC in the US has declined by approximately 1.3% to 4.2% annually since the mid-1990s, the incidence of eoCRC has increased by about 2% per year during this timeframe. In parallel, CRC-related mortality among individuals younger than 50 years has also risen by approximately 1% per year between 2011 and 2020, with CRC now being the leading cause of cancer-related death in men aged 20 to 49 years in the US and the second leading cause in women of the same age group. The alarming rise of eoCRC prompted the US Preventive Services Task Force to lower the recommended starting age for CRC screening in average-risk individuals from age 50 to 45 years in 2021. However, most screening programs in other countries initiate screening at age 50 years. Furthermore, unlike the US, which largely relies on colonoscopy as the primary screening modality, most other countries rely on less resource-intensive, noninvasive stool-based tests such as the fecal immunochemical test (FIT) and fecal occult blood test. Thus, as the burden of eoCRC continues to grow around the world, there is an urgent need to better understand the effectiveness of these noninvasive tools in younger populations.
JAMA Oncology , éditorial, 2025