Long-Term Effectiveness Associated With Fecal Immunochemical Testing for Early-Age Screening

Area of Science:

• Oncology
• Preventive Medicine
• Public Health

Background:

• Rising incidence of young-onset colorectal cancer (CRC) necessitates re-evaluation of current screening guidelines.
• Limited population-based evidence exists for the long-term effectiveness of early-age CRC screening.
• Current recommended age for CRC screening initiation is 50 years.

Purpose of the Study:

• To evaluate the impact of initiating fecal immunochemical test (FIT) screening at ages 40-49 versus age 50 on CRC incidence and mortality.
• To provide evidence for potential adjustments in CRC screening age recommendations.

Main Methods:

• Community-based cohort study of Taiwanese residents aged 40-49.
• Comparison of CRC incidence and mortality between groups screened early (40-49) and those screened later (50+).
• Propensity score matching and extended nonadherence adjustment to mitigate bias.

Main Results:

• Early FIT screening (ages 40-49) was associated with significantly lower CRC incidence and mortality rates compared to screening at age 50.
• Propensity score matching showed a reduced CRC incidence (aRR, 0.79) and mortality (aRR, 0.61) with early screening.
• Extended nonadherence adjustment confirmed substantial reductions: 25% in incidence (aRR, 0.75) and 34% in mortality (aRR, 0.66).

Conclusions:

• Initiating FIT screening for colorectal cancer between ages 40-49 years is associated with reduced incidence and mortality.
• These findings provide strong empirical support for lowering the recommended age for CRC screening.
• Lowering the screening age has significant implications for public health strategies in CRC prevention.