Background and Aims

Recent guidelines on colorectal cancer (CRC) screening recommend starting screening earlier than before. We performed a simulation study to examine and compare the optimal ages to have once-only screening colonoscopy and repeated colonoscopies.

Methods

A Markov model was set up using data from the German national screening colonoscopy registry to simulate the natural history of the adenoma-carcinoma process. CRC deaths and years of potential life lost (YPLL) for a hypothetical unscreened 50-year-old German population were estimated for a single screening colonoscopy or 2 or 3 screening colonoscopies with 10-year intervals at various ages.

Results

One single screening colonoscopy performed between 50 and 65 years of age was expected to reduce CRC death by 49% to 69% and YPLL by 51% to 68%. An inverted U-shaped association was found between screening age and proportion of CRC deaths or YPLL prevented. The optimal age for once-only colonoscopy that yielded the highest reductions in YPLL was around 54 years for men and 56 years for women. Estimates were approximately 6 to 8 years higher when proportions of CRC deaths prevented were examined. For 2 or 3 screening colonoscopies, the optimal starting age fell to around 50 years or even younger for both genders.

Conclusions

Based on the YPLL estimates, in a high CRC incidence and high life expectancy country like Germany, the optimal age for once-only screening colonoscopy is around 55 years and possibly slightly younger for men than for women. When 2 or more screening colonoscopies are offered with 10-year intervals, screening should start at age 50 at the latest or possibly even younger for both genders.

中文翻译：

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结肠镜检查的最佳年龄：模型研究

背景和目标

关于大肠癌（CRC）筛查的最新指南建议比以前更早开始筛查。我们进行了一项模拟研究，以检查和比较仅进行一次结肠镜检查和重复结肠镜检查的最佳年龄。

方法

使用德国国家筛查结肠镜检查登记处的数据建立马尔可夫模型，以模拟腺瘤-癌过程的自然史。假设未筛查的50岁德国人群的CRC死亡和可能的寿命损失年限（YPLL）估计为一次筛查结肠镜检查或2或3次筛查结肠镜检查，间隔10年，不同年龄。

结果

在50至65岁之间进行的一次单次结肠镜检查有望将CRC死亡减少49％至69％，将YPLL减少51％至68％。在筛查年龄与CRC死亡比例或预防的YPLL之间发现了倒U型关联。导致Y​​PLL降低最大的仅一次结肠镜检查的最佳年龄是男性约54岁，女性约56岁。当检查预防的CRC死亡比例时，估计值大约高6至8年。对于2或3次筛查结肠镜检查，男女的最佳起始年龄均降至50岁左右或更年轻。

结论

根据YPLL的估算，在像德国这样的高CRC发生率和高预期寿命的国家中，仅进行一次结肠镜检查的最佳年龄大约为55岁，男性可能比女性年轻。如果每隔10年进行两次或两次以上结肠镜检查，则筛查应最迟在50岁开始，甚至可能更年轻。