Screening people in their 40s for colorectal cancer significantly lowers incidence and mortality rates compared with starting screenings at 50, a National Taiwan University Hospital (NTUH) study has shown.
Taiwan has a high colorectal cancer incidence rate, with the rate among people aged 40 to 49 ranking among the top three globally, NTUH Health Management Center director Chiu Han-mo (邱瀚模) told a news conference on Thursday.
Colorectal cancer was the second-most common cancer in Taiwan in 2022, with 17,643 cases reported that year, behind lung cancer with 17,982 cases, Health Promotion Administration data showed.
Photo: Chiu Chih-jou, Taipei Times
“A few years ago, many people said we should wait to see what Western countries would do [to address the high incidence rate of colorectal cancer] before making our own decisions,” said Chiu, who is also an NTU College of Medicine clinical professor.
“But we believe Taiwan faces unique challenges [due to its relatively high rate of colorectal cancer among 40-to-49-year-olds] that must be addressed domestically. That is why we sought an evidence-based foundation to advance [the screening] policy,” he added.
Chiu’s team analyzed 17 years of data from community-based screening programs, tracking more than 500,000 people in Keelung and Tainan.
Some of the study participants started receiving fecal immunochemical test (FIT) screenings between the ages of 40 and 49 through local government-funded programs, while others started at 50 under a central government scheme.
After two years studying and developing models based on those data, Chiu’s team found that participants who started FIT screening in the 40-to-49 age group had a 21 to 25 percent lower risk of developing colorectal cancer and a 34 to 39 percent reduction in related deaths compared with those who started screenings at 50.
The study also found that for every 1,548 people screened before the age of 50, one case of colorectal cancer could be prevented — a significant improvement over the 2,079 needed when screening begins at age 50.
Screening helps detect precancerous lesions so they can be treated before developing into cancer, and also catches cancer early before it progresses to a late stage and leads to death, Chiu said.
Published on June 12 in JAMA Oncology, a peer-reviewed journal of the American Medical Association, the study is the world’s first to provide real-world evidence of the benefits of early colorectal cancer screening.
It was accompanied in the journal by an editorial from three Harvard Medical School researchers highlighting the significance of the findings.
One of the Harvard researchers, Andrew Chan, said that in the US, data on earlier screening — such as beginning at age 40 — and on the use of FIT have been “lacking,” and Chiu’s study is significant because it helps “address this important evidence gap.”
The study could be used to “support FIT screening in lower-resource settings where colonoscopy screening was not an option and provide additional evidence for us to potentially lower our screening age even further,” said Chan, who joined the news conference via videoconference.
Since Jan. 1, Taiwan has expanded eligibility for biennial government-subsidized FITs to include individuals aged 45 to 49, lowering the previous age range of 50 to 74.
People aged 40 to 44 with a family history of colorectal cancer are now eligible for the tests following the expansion.
Chiu welcomed the change, calling it highly cost-effective, as people aged 45 to 49 are a vital part of the workforce.
“If we can reduce their risk of developing colorectal cancer, the impact on the country would be tremendous,” he said.
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