Women May Be Able to Postpone First Colonoscopy

A new study suggests that the common recommendation for screening colonoscopy to begin at age 50 for both men and women should be reconsidered, since adenomas develop later in women.

Researchers at the Medical University of Vienna (Austria) conducted a cohort study involving 44,350 participants of a national screening colonoscopy program in Austria between 2007 and 2010 to determine and compare the prevalence and number needed to screen (NNS) for adenomas, advanced adenomas (AAs), and colorectal carcinomas (CRCs) for different age groups in men and women; The median ages were 60.7 years for women and 60.6 years for men, and the sex ratio was nearly identical (51% versus 49%). The main outcome measures were prevalence and need to screen of adenomas, AAs, and CRCs in different age groups for men and women.

The results showed that adenomas were found in 19.7% of individuals screened, AAs in 6.3% and CRCs in 1.1%; NNS were 5.1, 15.9, and 90.9, respectively. Male sex was significantly associated with a higher prevalence of adenomas and CRCs. The prevalence of AAs in 50- to 54-year-old individuals was 5% in men but only 2.9% in women; the NNS in men was 20 versus 34 in women. There was no statistical significance between the prevalence and NNS of AAs in men aged 45-49 years compared with women aged 55-59 years. The study was published in the September 28, 2011, issue of the Journal of the American Medical Association (JAMA).

“The findings of earlier adenoma development in men should be considered as suggesting that male sex constitutes an independent risk factor for colorectal carcinoma, and indicating new sex-specific age recommendations for screening colonoscopy,” concluded lead author Monika Ferlitsch, MD, and colleagues.

Although some studies have shown that men are at greater age-specific risk for advanced colorectal neoplasia than women are, the age for referring patients to screening colonoscopy is independent of sex and usually recommended to be 50 years.

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Medical University of Vienna