This review aims to examine the effectiveness of interventions in increasing faecal occult blood test (FOBT) uptake rates among older adults with an average-risk of colorectal cancer (CRC) and to identify essential components of such interventions based on current evidence.

Five databases were included in a systematic literature search for studies reporting randomized controlled trials (RCT) and interventions aimed at increasing FOBT uptake rates among average-risk individuals aged 50-75. Review Manager 5.4.1 was used for conducting meta-analyses and subgroup analyses.

A meta-analysis of the 20 included studies demonstrated that health promotion interventions led to significant increases in FOBT uptake rates (odds ratio [OR] ​= ​1.55, 95% confidence interval (CI) ​= ​1.30-1.85; I 2 ​= ​95%). Provision of information, mailing of FOBT outreach, and reminders were identified as core components of promotion interventions to increase FOBT uptake rates. Among the different significant reminder strategies, a digital message (via text) plus telephone calls (automated and navigator-initiated) had a larger effect size than a telephone call alone. In addition, there was no significant evidence that financial incentives were associated with FOBT uptake. Most studies included a diverse mixture of components, but only a few studies utilized theoretical framework-based interventions.

Future studies with rigorous methodologies are warranted to examine the effectiveness and understand the mechanisms of theoretical framework-based multi-component educational programmes aimed at increasing FOBT uptake rates.

PROSPERO CRD42024520859.

Despite extensive investigations into the microbiome and metabolome changes associated with colon polyps and colorectal cancer (CRC), the microbiome and metabolome profiles of individuals with colonic polyposis, including those with (Gene-pos) and without (Gene-neg) a known genetic driver, remain comparatively unexplored. Using colon biopsies, polyps, and stool from patients with Gene-pos adenomatous polyposis (N = 9), Gene-neg adenomatous polyposis (N = 18), and serrated polyposis syndrome (SPS, N = 11), we demonstrated through 16S rRNA sequencing that the mucosa-associated microbiota in individuals with colonic polyposis is representative of the microbiota associated with small polyps, and that both Gene-pos and SPS cohorts exhibit differential microbiota populations relative to Gene-neg polyposis cohorts. Furthermore, we used these differential microbiota taxa to perform linear discriminant analysis to differentiate Gene-neg subjects from Gene-pos and from SPS subjects with an accuracy of 89% and 93% respectively. Stool metabolites were quantified via 1H NMR, revealing an increase in alanine in SPS subjects relative to non-polyposis subjects, and Partial Least Squares Discriminant Analysis (PLS-DA) analysis indicated that the proportion of leucine to tyrosine in fecal samples may be predictive of SPS. Use of these microbial and metabolomic signatures may allow for better diagnostric and risk-stratification tools for colonic polyposis patients and their families as well as promote development of microbiome-targeted approaches for polyp prevention.

We examined the association between body mass index (BMI) and guideline-concordant colorectal cancer (CRC) screening utilization among cancer survivors while considering the role of sociodemographic characteristics using a representative sample of the United States. We conducted a cross-sectional analysis utilizing data from the 2022 and 2020 Behavioral Risk Factor Surveillance System. Our outcome of interest was guideline-concordant CRC screening utilization and our exposure of interest was BMI. We performed weighted descriptive statistics and multivariable logistic regression analysis to examine the mentioned associations. Among 44,244 eligible cancer survivors, those who were overweight (84%) had the greatest CRC screening use, followed by those who were obese (81.3%), and underweight/normal weight (79.2%; p values < 0.001). Multivariable logistic regression analysis revealed those who were overweight or obese compared to underweight/normal weight had 1.2-1.3-fold increased odds of having guideline-concordant CRC screening (overweight: OR: 1.27; 95% CI: 1.09-1.49; obese: OR: 1.18; 95% CI: 1.00-1.39). Our subpopulation analyses within the levels of BMI showed that females who were overweight (OR: 0.83; 95% CI: 0.69-1.00) and non-Hispanic other (NHO) survivors who were underweight/normal weight (OR: 0.47; 95% CI: 0.24-0.91) were 17%-53% less likely to be screened for CRC. Our findings indicate that BMI was positively associated with guideline-concordant CRC screening use among cancer survivors. However, female survivors who were obese and NHO survivors who were underweight/normal weight were less likely to be screened for CRC. Cancer survivorship care that integrates weight management and specific sociodemographic characteristics has potential for improving CRC screening adherence.

Studies aimed to evaluate the expected impact of alternative screening strategies are essential for optimizing colorectal cancer (CRC) screening offers, but such studies are lacking in Germany, where two screening colonoscopies (CS) 10 years apart are offered for men from age 50 and women from age 55. Our aim was to explore whether and to what extent the efficacy of utilizing two CS could be enhanced by alternative starting ages and screening intervals. We modeled the expected numbers of CRC cases, CRC deaths, years of potential life lost (YPLL), and disability-adjusted life years (DALYs) due to CRC in hypothetical cohorts of 100,000 men and women aged 45-85 using COSIMO, a validated Markov-based multi-state simulation model. Modeled strategies included combinations of starting ages (45/50/55/60) and CS (10/15/20 years). For men, CRC deaths could be slightly reduced by extending the interval to 15 years, with a second CS at 65. YPLL and DALYs would be reduced by decreasing starting age to 45 when combined with a 15-year screening interval. For women, use of two CS at ages 50 and 65 would reduce all CRC burden parameters compared to the current earliest-use offer at 55 and 65 years. Our results suggest that lowering the starting age of screening colonoscopy to 45 for men and 50 for women, combined with extending the CS screening interval to 15 years would have the potential to enable significant reductions in years of potential life lost, and disability-adjusted life years compared to current screening offers in Germany.

In recent years, the number of new cases of colorectal cancer in people under the age of 50 (early-onset colorectal cancer, EOCRC) has increased, and extension of colorectal cancer screening for younger age groups is currently being discussed.

To discuss whether the age for population-wide colorectal cancer screening should be lowered?

Extension of population-wide screening to younger age groups particularly to those under the age of 40 would be highly inefficient due to the low colorectal cancer incidence. Still, it could be considered for people at increased risk, including young adults with familial risk. Implementation of primary prevention measures would already be possible.

More targeted risk-adapted prevention and screening strategies are needed to reverse the rising trend of EOCRC and to detect colorectal cancer more frequently at an early stage.

With screening, colorectal cancer can be detected when treatable, or even prevented. However, approximately one in five people tend to avoid colorectal cancer information, and avoidance is associated with being less likely to have been screened for the disease. Crucial to developing strategies to reduce information avoidance, we sought a comprehensive understanding of reasons people avoid colorectal cancer information.

In a mixed methods study, we surveyed 200 participants who varied with respect to avoidance and interviewed 15 people who tended to avoid colorectal cancer information (all aged 40-75) about reasons for avoiding.

In both survey and interviews, primary reasons for information avoidance were: (1) shielding from anxiety and other aversive emotion, (2) perceived information sufficiency and (3) feelings of information overload. Trait anxiety, fear of diagnosis, anticipating negative interactions with healthcare, and negative associations with screening procedures exacerbated avoidance. Participants justified information non-relevance by attributing risk to other people's characteristics such as family history, gastrointestinal symptoms, being male, or living an unhealthy lifestyle.

Novel findings include the triggering influence of trait anxiety and financial constraints on information avoidance. Also, information overload and incorrect understanding of risk factors may exacerbate perceptions of information sufficiency and avoidance.

The multicancer early detection (MCED) test has the potential to enhance current cancer-screening methods. We evaluated a new MCED test that analyzes plasma cell-free DNA using genetic- and fragmentomics-based features from whole-genome sequencing. The present study included an internal validation cohort of 3,021 patients with cancer and 3,370 noncancer controls, and an independent cohort of 677 patients with cancer and 687 noncancer individuals. The results demonstrated an overall sensitivity of 87.4%, specificity of 97.8% and tissue-of-origin prediction accuracy of 82.4% in the independent validation cohort. Preliminary results from a prospective study of 3,724 asymptomatic participants showed a sensitivity of 53.5% (predominantly early stage cancers) and specificity of 98.1%. These findings indicate that the MCED test has strong potential to improve early cancer detection and support clinical decision-making.

Limited English proficiency may hinder completion of colorectal cancer (CRC) screening in Spanish speakers. This study evaluated CRC re-screening adherence using the multi-target stool DNA (mt-sDNA) test with Spanish language navigation, and patient characteristics associated with re-screening adherence.

Data from Exact Sciences Laboratories, LLC, (01/01/2023-12/31/2023) were used. Patients (45-75 years) with insurance who indicated Spanish as their preferred language and were shipped an mt-sDNA test during the study period and had completed mt-sDNA screening with a negative result ≥2.5 years prior were included. Re-screening adherence and mean time to test return were compared among payer types; regression models were used to determine the relationship between these outcomes and patient characteristics.

Among 8,651 patients (45-64 years: 58.9%; female: 59.0%), partial digital with SMS only (46.3%) was the most frequent outreach type. Re-screening adherence was 80.4%, with numerically highest rates in patients insured through managed care organizations (83.7%). Mean (standard deviation) overall time to test return from shipment of mt-sDNA kit to receipt of valid test was 26.6 (38.2) days (range across payer types: 26.1 [38.9]-29.8 [41.5]). Medicare patients had a 42% higher likelihood of adherence than commercially insured patients (p = 0.004); patients who received SMS and email had a 59% higher likelihood of adherence than patients with no digital outreach (p < 0.001).

Re-screening adherence of the mt-sDNA tests with Spanish language navigation was high, at 80.4%, across all payer types in patients selecting Spanish as their preferred language.

Internet-based patient engagement (PE) can empower rural individuals in essential health services. This study investigated predisposing, need, and enabling factors associated with major online PE activities in the rural populations of the United States Pacific Northwest region.

A cross-sectional survey of 250 adults aged 45 to 75 residing in rural parts of Alaska, Idaho, Oregon, and Washington was conducted. Three domains of predictors (predisposing, need, and enabling factors) were assessed. The outcomes were 3 major online PE activities (online access to care, information seeking and sharing, and self-management support).

Online health engagement was associated with multiple chronic diseases, perceived need for colorectal cancer screening, difficulty finding providers, and lower mistrust. Younger age, higher awareness of colorectal cancer risk, better health status, difficulty finding providers, frequent internet use, and misunderstanding between patients and providers were associated with increased online information seeking and sharing. Female gender, more cancer knowledge, lower income, and higher information search difficulty were associated with increased online self-management support. Health information literacy was associated with all PE activities.

Different factors influence online PE activities among rural populations. Optimizing diverse PE activities should assess different predisposing, need, and enabling factors in rural health care.

For patients with colorectal cancer liver metastasis (CRCLM), curative-intent liver therapies are associated with improved survival. However, randomized data are lacking, and individual-level retrospective data are limited by selection bias. We aimed to quantify the survival impact of these therapies by analyzing how regional variation in liver therapy rates influence survival outcomes within health service areas (HSA).

The Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2000-2020) was analyzed for patients aged 66-85 years with liver-isolated CRCLM who underwent curative-intent liver therapy (i.e., hepatectomy, ablation, or transplantation). Rates of resection within HSAs for each year were calculated. A comparison of observed versus expected survival was performed between two eras (era 1: 2002-2004; era 2: 2013-2015) to quantify the impact of changing rates of curative-intent liver therapy on HSA-level survival.

A total of 34,781 patients across 163 HSAs were included. Most patients had synchronous CRCLM (65.8%) and received chemotherapy (63.1%); a minority (10.9%) underwent curative-intent liver therapy (hepatectomy, 74.3%; ablation alone, 24.9%; transplantation 0.8%). A total of 56 (34%) HSAs had the rate of curative-intent liver therapy increase (≥ 5%) across eras, 58 (36%) HSAs had the rate remain constant, and 49 (30%) HSAs experienced a rate decrease (≥ 5%). Each 5% increase in the rate of curative-intent liver therapy was associated with a 1.2% (95% CI 0.4-2.0%) increase in the risk-adjusted survival rate (p = 0.003).

HSA variation in rates of curative-intent therapy for CRCLM was associated with population-level changes in survival. These data quantify the expected improvements associated with efforts to increase patient access to curative-intent therapies for CRCLM.

To assess awareness and willingness of average-risk adults to complete a colorectal cancer (CRC) screening blood test and evaluate test preferences for future screening.

Following approval by the United States Food and Drug Administration, a cross-sectional online survey was conducted in September 2024 of adults ages 45-75 in the United States (n = 633). An informative statement about the new test was followed by a series of questions. Logistic regression identified correlates of participants' willingness to complete a CRC screening blood test.

Only 18.2% of participants were aware of a CRC screening blood test. Most (77.9%) were willing to get the test if free or covered by health insurance, while only 19.2% were willing if it cost $895 out of pocket. Participants were more willing to complete a free CRC screening blood test if they had a high household income (odds ratio [OR] = 5.12, 95% confidence interval [CI]: 1.63-16.13), had a routine medical check-up in the last year (OR = 2.87, CI:1.44-5.71), and were more wanting to talk to a doctor at their next medical appointment about the new test (OR = 2.55, CI: 1.92-3.37). Participants' preferred CRC screening approach for the future was the blood test every three years (53.0%), an annual stool test (31.1%), and a colonoscopy every 10 years (15.8%).

The blood test has the potential to increase CRC screening, as most participants were willing to complete the test if it was free or covered by health insurance. Findings can guide the development of programs that include the CRC screening blood test as an option.

Young-onset colorectal cancer (YOCRC) refers to colorectal cancer diagnosed in individuals under the age of 50. Whilst the overall incidence of colorectal cancer is decreasing, YOCRC cases are increasing and now accounts for up to 10% of all colorectal cancers. YOCRC more frequently presents with acute symptoms, where radiologists play an important role in identifying malignancy and distinguishing it from benign colonic pathologies. Risk factors associated with YOCRC, such as inflammatory bowel disease and hereditary syndromes, may exhibit specific imaging manifestations. In addition, YOCRC is frequently associated with a mucinous histopathological subtype which may be identifiable based on the presence of specific imaging features. Given their younger age, these patients are more likely to undergo aggressive treatment and complex surgical interventions. Specific considerations such as fertility preserving surgical techniques must be factored in when managing these patients. As the incidence of YOCRC increases, guidance for colonoscopy screening protocols may need revision. This includes evaluating the role of ionising imaging techniques in both diagnosing and follow-up to balance early detection and minimising radiation exposure in this younger patient population.

Colorectal cancer (CRC) continues to impart a significant mortality burden in the United States, with a growing number of cases affecting younger individuals. In this study, we set out to characterize predictors of missed colorectal cancer screening in a general and age-stratified population. Methods: We analyzed a patient population of over 85,000 patients who presented to a large outpatient network in the Baltimore, Maryland area and were due for CRC screening. We analyzed different characteristics, including race, occupation, relationship status, tobacco smoking status, and body mass index, of patients up to date and overdue on their CRC screening. The majority (over 99%) of our patient population was insured. We performed this analysis on the patient population as a whole and as an age-stratified patient population. Results: In our overall patient population, all of the aforementioned characteristics were significantly different between patients up to date and those overdue on CRC screening. Races with the highest up-to-date CRC screening proportion were Pacific Islanders, East Asian, and White patients, while Asian Indian patients had the lowest up-to-date percentage. Non-employed patients (including patients with disabilities and students), single patients, and current or past tobacco smokers were all found to have significantly lower percentages of up-to-date patients as compared to other groups within these categories. BMI was significantly lower in up-to-date patients. In our age-stratified analysis, younger patients had a significantly lower percentage of up-to-date patients. Notably, younger patients had a significantly higher proportion of patients electing for noninvasive screening modalities. Conclusions: These disparities in CRC screening warrant targeted interventions to minimize future risk of heightened mortality in certain patient populations.

Colorectal cancer (CRC) screening disparities persist among populations with limited health care access. Although Medicaid expansion and paid sick leave could address these barriers, there is limited data on the combined impact of these policies and CRC screening.

The authors conducted a difference-in-differences analysis using 2012-2018 Behavioral Risk Factor Surveillance System data. The study population included adults 50-75 years of age meeting preventive cancer screening guidelines during the study period. States were categorized into three groups: those with Medicaid expansion and paid sick leave (ME + SL), Medicaid expansion without paid sick leave (MEnoSL), and neither policy (NoME/NoSL). The pre-policy period was 2012-2014 and the post-policy period was 2015-2018. The outcome was the percent up-to-date with CRC screening. Survey-weighted logistic regression models accounted for individual- and state-level covariates and state-clustered standard errors.

Post-policy implementation, CRC up-to-date screening was 2.9 percentage points greater in ME + SL states compared to MEnoSL states (p < .001) and 4.2 percentage points greater compared to NoME/NoSL states (p = .018). These changes correspond to an estimated 352,343 and 1,087,140 fewer missed screenings between ME + SL and MEnoSL and NoME/NoSL states, respectively. The increased percent of up-to-date CRC screenings was associated with a reduction in colorectal cancer deaths: 8456 from ME + SL versus MEnoSL and 26,091 from ME + SL versus NoME/NoSL.

Medicaid expansion combined with paid sick leave was associated with a greater likelihood of being up-to-date with CRC screening compared to Medicaid expansion alone or neither policy.

Colorectal cancer (CRC) remains a leading cause of cancer death in the United States. Since the latest USPSTF update, additional studies examining the performance of the multi-target stool DNA (mt-sDNA) and the fecal immunochemical test (FIT) have been published. This analysis builds upon the USPSTF analysis by including recent studies on test performance.

PubMed and Embase were searched for manuscripts published between December 4, 2019, and July 9, 2024, using colonoscopy as the reference standard. Double-blinded reviewers screened articles. Primary outcomes were test sensitivity and specificity for CRC, advanced neoplasia (AN), advanced precancerous lesions (APLs), and non-advanced precancerous lesions (NAPLs).

Of 4,320 citations screened, 41 new studies were identified. After combining with 14 studies from the previous USPSTF evidence review, 55 studies were analyzed. Forty-one studies reported the performance of FIT alone, ten of mt-sDNA alone, and four reported FIT and mt-sDNA. Of 14 studies evaluating mt-sDNA, two considered the next-generation mt-sDNA test's CRC sensitivity was 93.6% (95% CI:89.0-97.1) for next-generation mt-sDNA and 71.6% (95% CI:64.3-77.9) for FIT. Specificity was 91.6% (95% CI:89.2-93.7) for next-generation mt-sDNA and 96.3% (95% CI:95.4-97.0) for FIT. APL sensitivity was 22.2% (95% CI:20.6-24.0) for FIT and 45.6% (95% CI:40.8-50.4) for next-generation mt-sDNA.

This meta-analysis revealed that mt-sDNA has high sensitivity for detecting CRC and is more than twice as sensitive than FIT for detecting APL. The lifetime benefit and effectiveness of these tests should be further analyzed.

Accurate population stratification of colorectal cancer risk enables identification of individuals who would benefit from screening and risk-reducing interventions. We conducted a population-based cohort study using almost 400,000 unaffected UK Biobank participants who were aged 40-69 years at their baseline assessment and who had genetically determined UK ancestry. For women and men separately, we developed (i) a multivariable risk prediction model using family history, a polygenic risk score (PRS) and clinical risk factors, and (ii) a simple model comprising family history and a PRS. We then compared their performance to that of existing models. The models were developed using Cox regression with age as the time axis in a 70% training dataset. The performance of the 10-year risk of colorectal cancer was assessed in a 30% testing dataset using Cox regression to estimate the hazard ratio per standard deviation of risk, Harrell's C-index to assess discrimination and logistic regression to assess calibration. There were 214,183 women and 181,889 men in the dataset with 1,913 women and 2,598 men diagnosed with colorectal cancer during the follow-up period. The mean age at diagnosis was 66.4 years (standard deviation = 7.3 years) for women and 67.3 years (standard deviation = 6.7 years) for men. In the 30% testing dataset, the new multivariable models discriminated better (Harrell's C-index = 0.690, 95% CI = 0.669 to 0.712 for women; 0.699, 95% CI = 0.681 to 0.717 for men) than the new family history and PRS models (Harrell's C-index = 0.683, 95% CI = 0.663 to 0.704 for women; 0.692, 95% CI = 0.673 to 0.710 for men; change in discrimination P = 0.02 for women and P = 0.01 for men). Our models identify individuals who are at increased risk of colorectal cancer and who would benefit from personalised screening and risk-reduction options.

Multi-cancer early detection (MCED) tests are novel technologies that detect cancer signals from a broad set of cancer types using a single blood sample. The objective of this study was to estimate the effect of screening with an MCED test at different intervals on cancer stage at diagnosis and mortality endpoints.

The current model is based on a previously published state-transition model that estimated the outcomes of a screening programme using an MCED test when added to usual care for persons aged 50-79. Herein, we expand this analysis to model the time of cancer diagnosis and patient mortality with MCED screening undertaken using different screening schedules. Screening intervals between 6 months and 3 years, with emphasis on annual and biennial screening, were investigated for two sets of tumour growth rate scenarios: 'fast (dwell time=2-4 years in stage I) and 'fast aggressive' (dwell time=1-2 years in stage I), with decreasing dwell times for successive stages.

Inputs for the model include (1) published MCED performance measures from a large case-control study by cancer type and stage at diagnosis and (2) Surveillance, Epidemiology and End Results (SEER) data describing stage-specific incidence and cancer-specific survival for persons aged 50-79 in the US for all cancer incidence.

We used the following outcome measures: diagnostic yield, stage shift, and mortality.

Annual screening under the fast tumour growth scenario was associated with more favourable diagnostic yield. There were 370 more cancer signals detected/year/100,000 people screened, 49% fewer late-stage diagnoses, and 21% fewer deaths within 5 years than usual care. Biennial screening had a similar, but less substantial, impact (292 more cancer signals detected/year/100,000 people screened; 39% fewer late-stage diagnoses, and 17% fewer deaths within 5 years than usual care). Annual screening prevented more deaths within 5 years than biennial screening for the fast tumour growth scenario. However, biennial screening had a higher positive predictive value (54% vs 43%); it was also more efficient per 100,000 tests in preventing deaths within 5 years (132 vs 84), but prevented fewer deaths per year.

Adding MCED test screening to usual care at any interval could improve patient outcomes. Annual MCED test screening provided more overall benefit than biennial screening. Modelling the sensitivity of outcomes to different MCED screening intervals can inform timescales for investigation in trials.

Health literacy (HL) can impact health behaviors including colorectal cancer (CRC) screening. Prior findings using extensive measures of HL suggested that low HL is associated with lower CRC screening rates. We hypothesized that low HL, when measured using a clinically applicable three-question measure, would also be associated with low CRC screening rates.

Data collected from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) was utilized from 17 states that included a three-question HL measure. Participants ages 50-75 were included. The HL scores were categorized as adequate, marginal, or limited HL. The primary outcome was United States Preventative Services Task Force (USPSTF) recommendation-concordant CRC screening. The relationship between HL and CRC screening was examined using multivariable logistic regression.

Among 38,044 participants who met inclusion criteria, 47.2% (n = 17,950), 49.9% (n = 18,989), and 2.9% (n = 1105) had adequate, marginal, and limited HL, respectively. Lower HL levels were associated with lower adherence to USPSTF CRC screening recommendations: 73.3% for adequate, 68.0% for marginal, and 48.9% for limited HL (p < 0.01). Respondents with limited HL were 45% less likely to undergo CRC screening (OR = 0.55; 95%CI: 0.48-0.63). A significant interaction (p < 0.01) between health literacy and sex was identified. CRC screening difference among HL levels was more pronounced for male (OR = 0.48; 95% CI: 0.40-0.79) than female respondents (OR = 0.63; 95% CI: 0.52-0.76).

Limited health literacy is associated with significantly lower rates of appropriate CRC screening, particularly for males. This three-question HL measure provides a clinically applicable tool to identify people at risk for lack of CRC screening.

In 2021, the US Preventive Services Task Force (USPSTF) issued a final recommendation to lower the initial age for colorectal cancer (CRC) screening to 451. At many institutions, trainees play a critical role in the implementation of CRC screening guidelines. The aim of the current study is to assess trainee awareness of recent changes to CRC screening guidelines. Trainees in surgical and non-surgical residency and fellowship programs at a single academic medical center were surveyed, in February of 2023, regarding awareness of recent changes to CRC screening guidelines. Additional information regarding trainee recommendations for various types of screening modalities and their perceptions of patient awareness was obtained. A total of 116 trainees responded to the survey, reflecting a 39% response rate. Of trainees recommending CRC screening, 75% recommended screening to be initiated at age 45, 13% at age 50, 6% at age 40, and 2% at age greater than 50. Trainee knowledge of screening guidelines came from medical school learning (70.7%) and USPSTF guidelines (82%). The most recommended screening modalities were colonoscopy (87%), fecal immunochemical testing (FIT) (31%), and fecal occult blood testing (FOBT) (15%). In comparing trainees who perform colonoscopies versus trainees from primary care specialties, there was no statistical difference between groups regarding knowledge on current screening guideline recommendations. Most trainees recommended CRC screening during their training. Unfortunately, many trainees were unaware of recent changes to CRC screening guidelines. These results revealed an important knowledge gap to be addressed among surgical and non-surgical trainees.

Cancer screening outside of evidence-based recommendations can be considered a form of low-value care. We aimed to describe the frequency of colorectal, breast, cervical, and prostate cancer screening outside of recommended age guidelines in Switzerland.

We analysed data from the 2022 Swiss Health Survey. Of 21,930 participants aged 15 or more, 20,515 (9,555 men and 10,960 women) were included in this study. We calculated age at last screening and classified individuals as having been not screened, screened within age-specific A, B, and C recommendations from the United States Preventive Services Taskforce (USPSTF), screened within age-specific A and B recommendations, or screened outside of recommendations.

Among adults aged 75 years and above (75+), 40.2% (men: 35.1%; women: 44.5%) had undergone cancer screening outside of USPSTF A, B, and C recommendations. This proportion was 26.0% for adults aged 85+ (men: 27.8%; women: 24.6%). Cervical cancer screening was the most frequently undertaken outside of recommended ages by older adults (women aged 75+: 37.1%), followed by prostate (men aged 75+: 34.0%), breast (women aged 75+: 17.8%), and colorectal cancer screening (adults aged 75+: 1.3%). Screening outside of recommendations was also observed among middle-aged adults 40-59 at 12.3% (men: 20.8%; women 4.0%), and younger-aged women 20-39 at 9.9%. Proportions for screening outside of USPSTF A and B recommendations were high (adults 75+: 50.4%; adults 85+: 40.6%; adults 40-59: 20.9%).

Cancer screening outside of recommendations is highly prevalent, particularly among older adults. Further research is needed to better understand drivers of this form of low-value care.

Mammogram uptake and colorectal cancer (CRC) screening are influenced by racially biased healthcare experiences and presence of chronic conditions; moreover, there is racially/ethnically disparate uptake of each. The current study aimed to expand on extant literature by examining the association between racially biased healthcare experiences and chronic conditions across three racial/ethnic groups.

We conducted weighted multivariable logistic regressions to examine the interaction between chronic conditions (none, cancer, other chronic conditions) and racially biased healthcare experiences (none, better, worse, other) on mammogram and CRC screening adherence across three racial/ethnic groups (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic/non-Hispanic Other [NHO]) using 2022 Behavioral Risk Factor Surveillance System data.

Among 42,053 and 86,033 eligible respondents for mammogram and CRC screening, most respondents had an up-to-date mammogram (77.4%) or CRC test (67.0%). In adjusted analysis, Hispanic/NHO respondents with conditions other than cancer and felt they were treated worse than other races while seeking healthcare had a decreased odds of having an up-to-date mammogram (OR 0.21, 95% CI 0.09-0.46). NHW respondents with cancer who felt they were treated better than other races while seeking healthcare had increased odds of having an up-to-date mammogram (OR 1.70, 95% CI 1.11-2.60). All significant associations (i.e., p < 0.05) between chronic conditions and CRC screening were positive, regardless of treatment while seeking healthcare across racial/ethnic groups.

Culturally sensitive interventions aimed at improving patient-centered communication may improve mammogram and CRC screening adherence, particularly for racially/ethnically minoritized groups.

Background: Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer and the second leading cause of cancer-related deaths in the United States. Screening can prevent CRC by detecting advanced precancerous lesions. Adherence to screening is crucial in reducing CRC disease burden; however, there is limited research on the impact of digital outreach screening uptake and adherence. Objective: This study evaluated the impact of different digital outreach channels on patient adherence to CRC screening with a multi-target stool DNA (mt-sDNA) test in a real-world setting. Methods: Patients were individuals aged 45 to 85 years with a valid mt-sDNA test order from Exact Sciences Laboratories, LLC (Jan. 1, 2023-Sept. 23, 2023). All patients received letters and phone calls; some received short message service (SMS), email, or both. Adherence and time to test return were compared across digital outreach categories stratified by patient characteristics. Multivariable regression evaluated the association of digital outreach methods with adherence and time to test return. Results: Among 2 425 308 patients (43.5% between 50 and 64 years, 58.2% female), digital SMS only (62.7%) was the most common outreach method. Overall adherence was 70.1%, with highest adherence in the digital SMS-plus-email group (72.9%). Mean time to test return from shipment of mt-sDNA kit to receipt of valid test was 25.8 days. In adjusted analyses, patients receiving digital SMS plus email had the highest odds of test return (odds ratio, 1.75; 95% confidence interval [CI], 1.73-1.78; P<.001) and had return times 8.7% shorter than the no-digital-outreach group (95% CI, 8.2-9.2; P<.001). Discussion: Among nationally insured individuals within the recommended age range for CRC screening, overall adherence to the mt-sDNA test was in the 70s, with the highest rates in the digital (SMS and email) outreach group and the lowest in the no-digital-outreach group. Conclusions: These findings highlight the importance of multichannel navigation in facilitating completion of CRC screening with the mt-sDNA test.

Germline (likely-)pathogenic variants (PV) in CDH1 predispose carriers to hereditary diffuse gastric cancer and lobular breast cancer. Previous studies from the United States suggest CDH1 variant carriers have an increased risk for adenomas or sessile serrated lesions (SSL), yet data linking CDH1 PVs and colorectal neoplasia are scarce. We aimed to investigate colonoscopy findings in CDH1 PVs. Adults carrying a PV/LPV in CDH1 with ≥ 1 colonoscopy between 01/01/2004-12/31/2023 were included. Patients were sourced from the David G. Jagelman Inherited Colorectal Cancer Registries at Cleveland Clinic and the German Consortium for Familial Intestinal Cancer. 103 CDH1 PV carriers were included. Most were female (66%) and white (93.1%). The median age at first colonoscopy was 47 years. The adenoma detection rate (ADR) was 29.4% (95% CI:19.9-41.1%) in the German cohort and 48.6% (95% CI: 33.0-64.4%) in the Cleveland cohort (p = 0.055) and significantly correlated with age (< 45 years, 13.6% (95% CI: 6.40-26.7%); 45-49 years, 52.4% (95% CI: 32.4-71.7%); ≥50 years, 52.6% (95% CI: 37.3-67.5%); p < 0.001). The ADR in Cleveland was higher than the U.S. average ADR but the difference was not statistically significant (48.6% vs. 35.6%, p = 0.08), and the ADR in the German cohort (29.4%) was similar to the national German average risk screening cohort (31.3% in men, p = 0.84; 20.1% in women, p = 0.08). In our screening cohort with CDH1 PV carriers, we demonstrated an ADR of 13.5% in individuals under 45 years, similar to the ADR in patients aged 25-40 years with a family history of CRC. Overall, SSL detection rate was 9.7%. Colorectal cancer was diagnosed in 3 patients (3.2%), 2/3 with an early age of onset before the age of 50 years. This first international study provides preliminary evidence of a higher ADR in U.S. CDH1 PV carriers compared to the general population, with a high number of adenomas detected before the age of 50. This may indicate an increased CRC risk that should be explored in larger studies.

Geriatric patients account for nearly half of new colorectal cancer (CRC) cases. This study compares clinicopathological features, treatments, outcomes, and frailty in elderly (≥ 70) and younger (< 70) CRC patients at our center.

Patients diagnosed with non-metastatic or de novo metastatic CRC between January 2015 and April 2024 were included. Demographic, pathological, and survival data were retrospectively collected. Analyses were performed using SPSS version 25, with statistical significance set at P < 0.05.

Of the 414 non-metastatic CRC patients, 26.6% were aged ≥ 70. Elderly patients received less perioperative chemotherapy (60% vs. 81.6%, P < 0.001) and had more dose reductions (41.6% vs. 19.2%, P < 0.001). Frailty reduced perioperative chemotherapy in elderly non-metastatic patients (54.5% vs. 92.1%, P < 0.001) but did not affect dose reduction (37.9% vs. 33.3%, P = 0.764) or treatment duration (median 24 weeks for both groups, P = 0.909). In metastatic patients, frailty shortened chemotherapy duration (9.5 vs. 15.5 weeks, P = 0.129). Elderly patients had lower 5- and 8-year overall survival (OS) rates (64.7%, 60.1% vs. 83.0%, 78.8%, P = 0.004). In the de novo metastatic cohort (135 patients), age did not affect OS (19.4 vs. 17.3 months, P = 0.590) or PFS (9.8 vs. 7.5 months, P = 0.209). Rectal cancer (HR: 2.751, P = 0.005) and early chemotherapy termination (HR: 4.138, P < 0.001) worsened OS in non-metastatic CRC, while absence of RAS (HR: 2.043, P = 0.047), BRAF mutations (HR: 8.263, P = 0.010), and metastasectomy (HR: 3.650, P = 0.036) improved OS in metastatic CRC.

Age does not independently worsen CRC survival, though early chemotherapy discontinuation impacts outcomes. Reduced-dose chemotherapy or monotherapy can help minimize adverse effects in elderly patients.

Cancer is a leading cause of death in people experiencing homelessness, who are more commonly diagnosed with late-stage disease and have poorer survival after diagnosis than housed.

To characterize the incidence and timeliness of colorectal and breast cancer screening in a national sample of Veterans.

Retrospective, matched cohort study from 2011 to 2021 in a national sample of Veterans receiving care from the Veterans Health Administration (VA).

Each Veteran experiencing homelessness was matched to three housed Veterans with the same age, gender, clinic location, and month and year of outpatient clinic appointment.

We classified Veterans as homeless if they had any homeless indicator at the matched clinic visit or in the 12 months prior and all others as housed.

Our primary outcomes were being up to date on screening, receiving a biopsy following a positive screen and timeliness of biopsy. We assessed the association between housing status and our outcomes using conditional Poisson regression models with generalized estimating equations, adjusting for race, ethnicity, marital status, Charlson Comorbidity Index, smoking status, and mental health comorbidities.

Our sample included 2,580,640 Veterans, with 1,935,480 housed and 645,160 experiencing homelessness. Patients experiencing homelessness had a 16% lower adjusted incidence rate ratio (aIRR) of being up to date with colorectal cancer screening when compared to housed (aIRR 0.84, 95%CI 0.83-0.84; p<0.001) and a 13% lower aIRR for breast cancer (aIRR 0.87, 95%CI 0.86-0.88; p<0.001). Following a positive stool-based test, patients experiencing homelessness had a 12% lower aIRR of undergoing diagnostic colonoscopy compared to housed (aIRR 0.88, 95%CI 0.84-0.92; p<0.001). Time to biopsy was similar between groups for both cancer types.

Veterans experiencing homelessness were less commonly screened for cancer than a matched housed cohort. However, screening rates in this group were higher than in non-Veteran homeless populations. The VA system may offer insights into providing preventative care for this population.

The global rise in aging populations is challenging healthcare systems, especially in developed countries. Despite advancements in healthcare and living standards, the extension of lifespan has not been matched by an equivalent improvement in healthspan, leading to a higher prevalence of chronic diseases and disabilities in older adults. This review examines strategies to promote healthy aging throughout the life cycle, emphasizing the importance of a comprehensive strategy that integrates individual, healthcare, and environmental approaches. Individual strategies include lifestyle factors like diet, physical activity, and social connections. Healthcare approaches focus on improving health literacy, vaccinations, and screenings. Environmental approaches aim to mitigate climate change, reduce pollution, and design longevity-ready cities. A comprehensive strategy combining individual approaches, public health measures, innovative policies, and community support is essential for helping populations live longer, healthier, and more independent lives. Looking forward, this will be complemented by personalized approaches, focusing on individual traits and biological backgrounds. The key to this lies in geroscience, which studies the biological and molecular mechanisms of aging and how they contribute to age-related diseases and functional decline, aiming to design targeted interventions to slow aging and improve quality of life. Artificial intelligence will play a key role in analyzing these complex factors and creating innovative solutions. In conclusion, aging is shaped by various factors, requiring more than one solution. A combination of comprehensive and personalized strategies can bridge the gap between public health measures and personalized care, offering the scientific insights needed to slow aging and enhance quality of life.

This document serves to update the 2018 ACR Appropriateness Criteria® colorectal screening guidance document. In light of new recommendations from the US Preventative Services Task Force (USPSTF), an updated literature review of the imaging procedures for the screening of colorectal cancer was performed. Average-risk, elevated-risk, and high-risk individuals as well as those individuals who had an incomplete colonoscopy or were unable to tolerate colonoscopy were included. CT colonography without contrast was found to be usually appropriate for individuals at average and elevated risk between 45 to 75 years of age at initial screening. Additionally, CT colonography without contrast was found to be usually appropriate in individuals at average risk, elevated risk, and at high risk after incomplete colonoscopy or unable to tolerate colonoscopy. Other imaging procedures such as barium fluoroscopy and CT of the abdomen and pelvis were usually not appropriate. CT colonography without contrast, barium fluoroscopy, and CT of the abdomen and pelvis were usually not appropriate in high-risk individuals who can undergo a complete colonoscopy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Guidelines recommend individualized decision making for screening colonoscopy for colorectal cancer (CRC) in patients after the age of 75 years due to low additional benefits. That should be taken with a grain of salt, as these recommendations are based on expert opinion and simulation models which do not consider (1) the differences in pathogenesis and cancer biology of CRC in elderly; (2) the risks of colonoscopy in this patient population; (3) and the impact of new surgical and nonsurgical therapies for CRC. In this review, our goal is to bring a surgeon's perspective to understand the role of screening colonoscopy in patients older than 75 years.

As the incidence of colorectal cancer (CRC) in the younger population increases and women start their childbearing journey at later ages, CRC in pregnancy will become an increasingly relevant and decreasingly rare occurrence. Unfortunately, there is a dearth of data on this subject given its historical rarity. CRC is often diagnosed at a late stage in pregnancy because of the conflation of symptoms of pregnancy with symptoms of CRC. A major branch point for the diagnosis and treatment of CRC in pregnancy is whether it is diagnosed early or late in pregnancy. The workup for cancer is similar for pregnant and nonpregnant populations and includes endoscopy and staging computed tomography. Treatment is dependent on the stage of cancer and term of pregnancy. This review summarizes the current evidence for diagnosis, workup, and treatment of CRC during pregnancy and explores issues of fertility after a diagnosis of CRC.

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Most cases arise from polyps, which can be detected and removed before becoming cancerous. Computed tomography colonography (CTC), also known as virtual colonoscopy, was first introduced in 1994 as a minimally invasive method for CRC screening and diagnosis. This 2025 update on CTC will focus on (1) techniques and dose reduction strategies, (2) image display methods, (3) reporting and classification systems, (4) tumor staging capabilities, (5) integration of advanced imaging techniques, and (6) cost-effectiveness and reimbursement.

T-cell receptor (TCR) diversity 50 (D50) values could assess peripheral blood (PB) TCR diversity and immunity. This study aimed to evaluate the potential D50 value in the diagnosis and treatment evaluation of colorectal cancer (CRC) and nonsmall-cell lung cancer (NSCLC).

This prospective observational study enrolled patients with CRC, benign colorectal disease (BCD), NSCLC, or benign nodule controls (BNC) and healthy donors (HD) at Yunnan Cancer Hospital between January 2021 and June 2022. PB specimens were used for TCRβ sequencing, and D50 was calculated and compared within different groups. The area under the curve (AUC) was used to evaluate the diagnostic performance of D50 in CRC and NSCLC.

A total of 114 HD and 115 CRC, 31 BCD, 67 NSCLC, and 25 BNC patients were enrolled. Both CRC and NSCLC patients exhibited significantly lower D50 compared with HDs (p < 0.001), whereas BCD and BNC patients showed a modest decrease in TCR diversity (p < 0.05). NSCLC patients with lymph node metastases had markedly lower D50 than those without lymph node metastasis (0.05 vs. 0.11, p < 0.01). Higher D50 was found in CRC and NSCLC patients with normal carcinoembryonic antigen (CEA) levels (p < 0.05). The potential of D50 value for early detection of CRC and NSCLC was demonstrated, with an area under the receiver operating characteristic curve (AUC) of 0.736 for CRC (sensitivity: 71.30%, specificity: 68.42%) and 0.768 for NSCLC (sensitivity: 83.58%, specificity: 60.53%). Significant differences in D50 values were observed between patients with tumor regression grade (TRG) 0-1 and those with TRG 2-3 (p = 0.027), with an AUC of 0.731 (sensitivity: 68.75%, specificity: 76.92%).

These findings suggest that the PB TCR D50 values may have significant clinical value in cancer diagnosis and in evaluating the efficacy of neoadjuvant therapies.

We aimed to evaluate the association between colonoscopy and colorectal cancer (CRC) occurrence and related mortality in an older population.This retrospective, nationwide, population-based cohort study used data of adults aged ≥40 years from the Health Insurance Review and Assessment Service database. After excluding colonoscopy within 6 months of CRC diagnosis during enrollment, CRC occurrence and related mortality were compared between colonoscopy and non-colonoscopy groups using a time-dependent Cox proportional hazard model. Subgroup analysis was conducted among four age groups: young, middle-aged, old, and very old.Among 748986 individuals followed for 9.64 (SD 0.99) years, the colonoscopy group had a 65% lower CRC occurrence (adjusted hazard ratio [HRa] 0.35, 95%CI 0.32-0.38) and 76% lower CRC-related mortality (HRa 0.24, 95%CI 0.18-0.31) after 5 years compared with the non-colonoscopy group. Colonoscopy was associated with the most significant reduction in CRC occurrence in the middle-aged group (HRa 0.32, 95%CI 0.29-0.35) and in CRC-related mortality in the young group (HRa 0.04, 95%CI 0.01-0.33); the very old group had the least reduction in both CRC occurrence and CRC-related mortality (HRa 0.44, 95%CI 0.33-0.59 and HRa 0.28, 95%CI 0.15-0.53, respectively).We found a significant association between colonoscopy and reduction in CRC occurrence and CRC-related mortality in adults aged ≥40 years after 5 years of follow-up; however, these associations were weaker in the very old group. More research is needed on the association between colonoscopy and older age.

Timely follow-up after an abnormal cancer screening test result is needed to maximize the benefits of screening, but is frequently not achieved. Little is known about patient experiences with the process of following up abnormal screening results.

Assess patient experiences and perceptions regarding the process of a diagnostic workup following abnormal breast, cervical, or colorectal cancer screening results.

Survey of participating patients between April 2021 and June 2022 after reaching the primary outcome time point in a randomized controlled trial to improve follow-up of overdue abnormal screening results.

Patients from 44 participating practices in three primary care practice networks.

Self-reported ease of scheduling follow-up, perceived barriers or concerns, provider trust, and satisfaction with communication and care received for the follow-up of abnormal screening results.

Overall, 241 (25.0%) patients completed the survey including 66 (32.8%) with breast, 79 (25.3%) with cervical, and 96 (21.3%) with colorectal screening test; median age 55 years, 79.7% women, 80.5% non-Hispanic white, and 51.0% did not complete recommended follow-up. Most patients were worried that the test would find cancer (63.1%), but fewer worried about discomfort or side effects (34.4%), and neither were associated with completing follow-up. However, 17% of patients did not think they needed follow-up tests or appointments and were less likely to complete follow-up (10.5% vs. 24.0%, respectively, p-value 0.009). Most patients were very satisfied with their overall care (71.0%), but only 50.2% strongly agreed that they trusted their provider to put their medical needs above all else when making recommendations.

Patients with overdue abnormal breast, cervical, and colorectal cancer screening test results reported important deficiencies in the management of recommended follow-up. Addressing patient concerns about fear of cancer and effectively communicating the need for follow-up procedures may improve timely follow-up after an abnormal cancer screening result.

ClinicalTrials.gov NCT03979495.

PurposeTo evaluate how CRC screening practices differ between e-cigarette users and non-users.DesignCross-sectional study design.SettingNational Cancer Institute's Health Information National Trends Survey (HINTS 5).SubjectsRespondents aged 45 to 75 years.MeasuresDemographics, CRC screening, e-cigarette use, cancer history, presence of comorbidities, and access to a primary care provider.AnalysisThe demographic characteristics of the study participants were evaluated by their e-cigarette smoking status using chi-squared tests. The differences in CRC screening between e-cigarette users and non-users were evaluated using a multivariate logistic regression model.ResultsWe identified a total of 6963 participants, of which 181 (2.6%) were e-cigarette users. The prevalence of e-cigarette use was inversely related to age. A significant portion were uninsured (10.7% vs 5.9% of non-users), and almost half (49.9%) were current tobacco smokers. E-cigarette users were as likely to undergo CRC screening compared to non-users [OR 1.40; 95% CI (0.74, 2.66)]. Increasing age, educational level, health insurance, comorbidity, access to a primary care provider, personal history of cancer, and presence of a comorbidity were associated with increased participation in CRC screening. However, e-cigarette use was not associated with increased screening.ConclusionOur study found no significant difference in CRC screening rates between e-cigarette users and non-users. While screening behaviors appear unaffected for now, ongoing surveillance is important as more users reach screening age given the uncertainties surrounding the long-term effects of e-cigarette use.

The aim of the study was to evaluate the association of frequency of polyp diagnosis in relatives with the risk of overall and early-onset colorectal cancer (CRC).

Data from nationwide Swedish family cancer datasets (1964-2018) were leveraged to calculate standardized incidence ratios for individuals with a family history of polyp by frequency of polyp diagnosis in family members.

A total of 11,676,043 individuals were followed for up to 54 years. Compared with the risk in individuals without a family history of colorectal tumor (n = 142,234), the risk of overall CRC was 1.4-fold in those with 1 first-degree relative (FDR) with 1-time polyp diagnosis (95% CI, 1.3-1.4; n = 11,035; early-onset standardized incidence ratio [SIR], 1.4; 95% CI, 1.3-1.5; n = 742). The risk was significantly higher in individuals with 1 FDR with 2 or more (frequent) polyp diagnoses (overall CRC: SIR, 1.8; 95% CI, 1.8-1.9; early-onset CRC: SIR, 2.3; 95% CI, 2.0-2.6). A rather similar risk was observed for individuals with ≥2 FDRs with 1-time polyp diagnosis (overall CRC: SIR, 1.9; 95% CI, 1.7-2.1; early-onset CRC: SIR, 2.2; 95% CI, 1.5-2.9). Individuals with ≥2 FDRs with frequent polyp diagnoses had a 2.4-fold overall risk (95% CI, 2.2-2.7) and a 3.9-fold early-onset risk (95% CI, 2.8-5.3). Younger age at polyp diagnosis in FDRs was associated with an increased risk of CRC. A family history of polyp in second-degree relatives was important only when there were frequent diagnoses of polyp.

A higher frequency of colorectal polyp diagnosis in relatives is associated with a greater risk of CRC, especially early-onset CRC. This risk is independent of number of affected relatives or youngest age at polyp diagnosis. These findings underscore the need for more personalized CRC screening strategies that are tailored to individuals with a family history of polyp.

The lifetime risk of aging-related diseases among survivors of childhood cancer, accelerated by cancer treatment exposures, is unknown. Understanding this risk can provide a more comprehensive assessment of long-term health across the lifespan of survivors and guide adult care.

To estimate the lifetime risks of 8 treatment-related cancers and cardiovascular conditions among childhood cancer survivors and compare them with the general population.

Using data from the Childhood Cancer Survivor Study and national databases, this simulation modeling study projected long-term outcomes for 5-year survivors diagnosed between 1970 and 1999 based on treatment exposures and age-related risks. The general population comparator was simulated using age-, sex-, and calendar year-matched individuals who faced only age-related risks.

Treatment era (1970s, 1980s, 1990s), original cancer diagnosis, radiation treatment for primary diagnosis (any, none).

Estimated lifetime risks of 8 health conditions (breast cancer, colorectal cancer, glial tumors, sarcomas, heart failure, coronary heart disease/myocardial infarction, stroke, and valvular disease). Risks were projected and compared with the general population, stratified by radiation exposure.

In the general population, 20% developed at least 1 health condition by age 65.0 years; in 5-year survivors this threshold was reached at age 47.3 years, representing a 17.7-year (95% uncertainty interval [UI], 14.0-21.0) acceleration in disease onset. By age 65 years, 55% of survivors were projected to develop at least 1 condition, indicating a 2.7-fold (95% UI, 2.2-3.5) higher relative risk and 34.2% (95% UI, 28.3-42.5) absolute excess risk compared with the general population. Risks were higher among those treated with radiation therapy for childhood cancer (22.0 years earlier onset [95% UI, 18.0-25.0]; 37.3% excess risk [95% UI, 31.6%-44.7%]) but still elevated for those without radiation exposure (13.5 years earlier onset [95% UI, 10.0-16.0]; 31.0% excess risk [95% UI, 23.9%-40.3%]). Reaching middle age was still associated with increased health risks. Compared with the general population, survivors who reached age 40 years had a 6.2-fold higher risk (95% UI, 4.8-9.4) of developing a new condition within 10 years.

This study found that survivors of childhood cancer experience accelerated onset of aging-related diseases, regardless of prior radiation exposure. These findings underscore the importance of prioritizing cancer and cardiovascular disease prevention among survivors decades earlier than for the general population.