Work is set to begin on a three-year, $900,000 study to develop a model to predict the risk for colon cancer in people under 50 with no family history of the disease. Thomas Imperiale, a clinician-researcher with the VA and Regenstrief Institute in Indianapolis, will lead the study, which is being funded by the U.S. Department of Veterans Affairs.
Imperiale says the study will look beyond age and family history as a means of screening for colon cancer. He says researchers will identify demographic, physical and clinical factors and people younger than 50 with colon cancer compared to those without it. He says those factors make the patients more comparable to those 50 and over.
"There have been calls to lower the age for routine colon cancer screening below age 50, but doing that doesn’t make sense at this point," said Imperiale. "It would simply be a reactive response that would likely result in net harm because we would be screening so many people unnecessarily and placing those with small adenomas into surveillance programs younger so they would have more lifetime colonoscopies – nearly all of them unnecessary. At this point, lowering the screening age would be time consuming and expensive and not necessarily good medicine."
The retrospective study will use de-identified information from VA medical records. The study will also look at potential clinical risk factors, such as body mass index, cholesterol and triglyceride levels, blood pressure and medical history, as well as lifestyle factors, including smoking, alcohol consumption, exercise and occupation.
"The VA is one of very few healthcare systems where this work could be done," said Imperiale. "The VA’s electronic medical record systems are so broad and deep we should able to discover candidate factors that will allow us to identify a subgroup of people under age 50 whose risk is comparable to older adults. For this group we could recommend some type of "early" screening — not necessarily colonoscopy — but perhaps blood stool test or another less invasive test before age 50."