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Huang L, Hu Y, Liu S, Jin B, Lu B. The analysis of multilevel factors affecting adenoma detection rates for colonoscopies: a large-scale retrospective study. BMC Gastroenterol 2021; 21:403. [PMID: 34696715 PMCID: PMC8546946 DOI: 10.1186/s12876-021-01983-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 10/07/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Adenoma detection rate (ADR) is a validated primary quality indicator for colonoscopy procedures. However, there is growing concern over the variability associated with ADR indicators. Currently, the factors that influence ADRs are not well understood. AIMS In this large-scale retrospective study, the impact of multilevel factors on the quality of ADR-based colonoscopy was assessed. METHODS A total of 10,788 patients, who underwent colonoscopies performed by 21 endoscopists between January 2019 and December 2019, were retrospectively enrolled in this study. Multilevel factors, including patient-, procedure-, and endoscopist-level characteristics were analyzed to determine their relationship with ADR. RESULTS The overall ADR was 20.21% and ranged from 11.4 to 32.8%. Multivariate regression analysis revealed that higher ADRs were strongly correlated with the following multilevel factors: patient age per stage (OR 1.645; 95% CI 1.577-1.717), male gender (OR 1.959; 95% CI 1.772-2.166), sedation (OR 1.402; 95% CI 1.246-1.578), single examiner colonoscopy (OR 1.330; 95% CI 1.194-1.482) and senior level endoscopists (OR 1.609; 95% CI 1.449-1.787). CONCLUSION The ADR is positively correlated with senior level endoscopists and single examiner colonoscopies in patients under sedation. As such, these procedure- and endoscopist-level characteristics are important considerations to improve the colonoscopy quality.
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Affiliation(s)
- Liang Huang
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang, Chinese Medical University, 54 Youdian Road, Hangzhou, Zhejiang, China
| | - Yue Hu
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang, Chinese Medical University, 54 Youdian Road, Hangzhou, Zhejiang, China
- Key Laboratory of Digestive Pathophysiology of Zhejiang Province, First Affiliated Hospital of Zhejiang, Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Shan Liu
- Center of Clinical Evaluation, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Hangzhou, Zhejiang, China
| | - Bo Jin
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang, Chinese Medical University, 54 Youdian Road, Hangzhou, Zhejiang, China
| | - Bin Lu
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang, Chinese Medical University, 54 Youdian Road, Hangzhou, Zhejiang, China.
- Key Laboratory of Digestive Pathophysiology of Zhejiang Province, First Affiliated Hospital of Zhejiang, Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China.
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Dairi O, Anderson JC, Butterly LF. Why is colorectal cancer increasing in younger age groups in the United States? Expert Rev Gastroenterol Hepatol 2021; 15:623-632. [PMID: 33480301 DOI: 10.1080/17474124.2021.1876561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: While colorectal cancer (CRC) incidence and mortality have decreased for older adults, the rates are increasing in adults younger than 50 years of age in the United States as well as globally. In response to strong epidemiologic evidence as well as sophisticated models, the American Cancer Society (ACS) has recommended screening adults for CRC starting at age 45. Understanding the factors associated with the rise of incidence in adults younger than age 50 may help to identify those adults who may be at greatest risk.Areas covered: In this review, we provide an overview of the recent literature and discuss possible explanations for the increase in CRC in young adults including obesity and other recognized CRC risk factors, delay in diagnosis of symptomatic patients (<50 years of age), and review perspectives on the current and future status of the field.Expert opinion: Currently there are little data regarding risk factors for CRC in average risk young adults who are asymptomatic. With potential endorsement of screening at 45 years of age by US Preventive Services Task Force, more data regarding clinical and molecular risk factors associated with CRC in young adults will be available.
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Affiliation(s)
- Obaida Dairi
- Department of Veterans Affairs Medical Center, White River Junction, VT and the Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, VT and the Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, CT, USA.,New Hampshire Colonoscopy Registry, Lebanon, NH, USA
| | - Lynn F Butterly
- New Hampshire Colonoscopy Registry, Lebanon, NH, USA.,Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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3
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Colorectal cancer risk factors in asymptomatic Chilean population: a survey of international collaboration between Japan and Chile. Eur J Cancer Prev 2019; 29:127-133. [PMID: 31436751 DOI: 10.1097/cej.0000000000000531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In Chile, the mortality from colorectal cancer has been on the rise. A national screening program based on a fecal immunochemical test was started in 2012 as an international collaboration with Japan. This case-control study was designed to identify the risk factors for colorectal cancer, with a goal of increasing the participation rate for colorectal cancer screening. In accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we conducted a case-control study from 2012 to 2017; 23 845 asymptomatic participants were enrolled in the study. Participants who were fecal immunochemical test-positive or had a family history of colorectal cancer underwent a colonoscopy. We analyzed the odds ratio of the risk factors for colorectal cancer, including sex, age, family history, BMI, hypertension, diabetes, regular use of nonsteroidal anti-inflammatory drugs, alcohol consumption, smoking, physical activity, and daily intake of certain food items. For the screening program, 202 cases of colorectal cancer were detected, and 195 of them were evaluated pathologically after resection. Of these, 173 cases (88.7%) had colorectal cancer stage 0/1, 151 (77.4%) of which were treated with endoscopic resection. In the multivariate analysis, male sex, family history of colorectal cancer, and low intake of cereals or fibers were closely related to a high colorectal cancer incidence. Moreover, participants in their 60s and 70s had a higher incidence of colorectal cancer than those in their 50s. These results suggest that intensive screening of the high-risk population can help in improving the detection of colorectal cancer, whereas higher consumption of cereals or fibers can be effective in preventing its onset.
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Wine consumption and colorectal cancer risk: a meta-analysis of observational studies. Eur J Cancer Prev 2019; 28:151-158. [PMID: 30247171 DOI: 10.1097/cej.0000000000000444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
There were inconsistent results with respect to the correlation between consumption of wine and the development of colorectal cancer (CRC). We carried out a meta-analysis to investigate this issue. We included observational studies on the aforementioned relationship according to a literature search of Embase and Pubmed from inception till 28 February 2017. The summary relative risk (SRR) and 95% confidence intervals (CI) were calculated using a random-effects model. A total of eight case-control and nine cohort studies were identified, involving 12 110 CRC cases. The study showed that wine drinking was not associated with any greater risk for CRC (SRR=0.99, 95% CI: 0.89-1.10; Pheterogeneity<0.001) compared with nondrinkers. The subgroup analyses indicated that null associations were observed in men and women for colon and rectal cancer. Neither light to moderate (<2 drinks/day; SRR=0.93, 95% CI: 0.80-1.08, I= 69.2%) nor heavy (≥2 drinks/day; SRR=1.00, 95% CI: 0.86-1.16, I= 39.9%) consumption of wine was associated statistically with CRC risk. This meta-analysis suggests that any wine consumption was not associated with the risk of CRC. Null associations were shown in men and women for colon and rectal cancer.
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Common habitual behaviors and synchronous colorectal cancer risk: a retrospective case-control study. Int J Colorectal Dis 2019; 34:1421-1430. [PMID: 31278528 DOI: 10.1007/s00384-019-03326-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE The association of habitual behaviors with the prevalence of synchronous colorectal cancer (sCRC) is unknown. Here, we investigated whether these behaviors, which are known risk factors for colorectal polyps, may be related to sCRC risk. METHODS We enrolled 17,093 patients who underwent cancer treatment between January 1995 and December 2016 and examined the association of age, sex, familial history of hereditary colorectal cancer (CRC), and status of three common habitual behaviors (smoking and alcohol and coffee consumption) with the prevalence of sCRC. RESULTS Of the enrolled patients, 960 (5.6%) patients had sCRC. The independent risk factors for sCRC prevalence included advanced age, male sex, hereditary CRC, smoking, and daily alcohol consumption of more than one bottle (> 600 mL). Contrary to these factors, daily coffee consumption of more than one cup seemed to provide a protection from sCRC. In the Kaplan-Meier test, the significantly worse 5-year overall survival (OS) was noted in smokers with stage 0-III CRC. The effect of alcohol consumption on 5-year OS was significant in stages II and III. Compared with those without daily coffee consumption, patients with daily coffee consumption had significantly higher 5-year OS in stages I (93.0% vs. 86.4%), II (87.1% vs. 77.2%), III (71.5% vs. 61.9%), and IV (18.0% vs. 13.0%). CONCLUSIONS sCRC prevalence was significantly associated with habitual behaviors. Patients with smoking or with daily alcohol consumption of one bottle had higher sCRC prevalence than did those without these habits. Coffee consumption could be a protective factor for lowering sCRC risk.
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Smoking and the Increased Risk for Serrated Polyps: Implications for Screening and Surveillance. J Clin Gastroenterol 2019; 53:319-321. [PMID: 30920422 DOI: 10.1097/mcg.0000000000001207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Anderson JC, Calderwood AH, Christensen BC, Robinson CM, Amos CI, Butterly L. Smoking and Other Risk Factors in Individuals With Synchronous Conventional High-Risk Adenomas and Clinically Significant Serrated Polyps. Am J Gastroenterol 2018; 113:1828-1835. [PMID: 30385834 PMCID: PMC6768665 DOI: 10.1038/s41395-018-0393-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Serrated polyps (SPs) and conventional high-risk adenomas (HRAs) derive from two distinct biological pathways but can also occur synchronously. Adults with synchronous SPs and adenomas have been shown to be a high-risk group and may have a unique risk factor profile that differs from adults with conventional HRAs alone. We used the population-based New Hampshire Colonoscopy Registry (NHCR) to examine the risk profile of individuals with synchronous conventional HRAs and SPs. METHODS Our study population included 20,281 first time screening colonoscopies from asymptomatic NHCR participants 40 years or older between 2004-15. Exams were categorized by findings: (1) normal, (2) HRA only (adenomas ≥ 1 cm, villous, high grade dysplasia, multiple adenomas ( > 2) and adenocarcinoma), (3) clinically significant SP (CSSP) only (any hyperplastic polyp ≥ 1 cm, sessile serrated adenomas/polyps or traditional serrated adenomas), and (4) synchronous HRA + CSSP. Risk factors examined included exposure of interest, smoking (never, past, and current/pack years), as well as age, sex, alcohol, education, and family history of colorectal cancer (CRC). Multivariable unconditional logistic regression tested the relation of risk factors with having synchronous HRA + CSSP versus having a normal exam or HRA alone. RESULTS Among NHCR participants with 18,354 screening colonoscopies (with complete smoking, sex, bowel preparation data, and adequate preparation) there were 16,495 normal; 1309 HRA alone; 461 CSSP alone, and 89 synchronous HRA + CSSP. Current smoking was associated with an almost threefold increased risk for HRA or CSSP, and an eightfold risk for synchronous HRA + CSSP (aOR = 8.66; 95% CI: 4.73-15.86) compared to normal exams. Adults with synchronous HRA + CSSP were threefold more likely to be current smokers than those with HRA alone (aOR = 3.27; 95% CI:1.74-6.16). CONCLUSIONS Our data suggest that current smokers may be at a higher risk for synchronous CSSP + HRA even when compared to having HRA alone.
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Affiliation(s)
- Joseph C. Anderson
- 1Department of Veterans Affairs Medical Center, White River Junction, Hartford, VT, USA.,2The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Audrey H. Calderwood
- 2The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,3Section of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Brock C. Christensen
- 4Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Christopher I. Amos
- 4Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,5Baylor College of Medicine, Houston, TX, USA. Lynn Butterly is the senior author on the paper and the Director of the New Hampshire Colonoscopy Registry
| | - Lynn Butterly
- 2The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,3Section of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Gonzales M, Qeadan F, Mishra SI, Rajput A, Hoffman RM. Racial-Ethnic Disparities in Late-Stage Colorectal Cancer Among Hispanics and Non-Hispanic Whites of New Mexico. HISPANIC HEALTH CARE INTERNATIONAL 2018; 15:180-188. [PMID: 29237342 DOI: 10.1177/1540415317746317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Hispanics in New Mexico are diagnosed with more later-stage colorectal cancer (CRC) than non-Hispanic Whites (NHW). Our study evaluated the interaction of race/ethnicity and risk factors for later-stage III and IV CRC among patients in New Mexico. METHOD CRC patients ages 30 to 75 years ( n = 163, 46% Hispanic) completed a survey on key explanatory clinical, lifestyle, preventive health, and demographic variables for CRC risk. Adjusted logistic regression models examined whether these variables differentially contributed to later-stage CRC among NHW versus Hispanics. RESULTS Compared with NHW, Hispanics had a higher prevalence of later-stage CRC ( p = .007), diabetes ( p = .006), high alcohol consumption ( p = .002), low education ( p = .003), and CRC diagnosis due to symptoms ( p = .06). Compared with NHW, Hispanics reporting high alcohol consumption (odds ratio [OR] = 7.59; 95% confidence interval [CI] = 1.31-43.92), lower education (OR = 3.5; 95% CI = 1.28-9.65), being nondiabetic (OR = 3.23; 95% CI = 1.46-7.15), or ever smokers (OR = 2.4; 95% CI = 1.03-5.89) were at higher risk for late-stage CRC. Adjusting for CRC screening did not change the direction or intensity of the odds ratios. CONCLUSION The ethnicity-risk factor interactions, identified for late-stage CRC, highlight significant factors for targeted intervention strategies aimed at reducing the burden of later-stage CRC among Hispanics in New Mexico with broad applicability to other Hispanic populations.
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Affiliation(s)
| | - Fares Qeadan
- 1 University of New Mexico, Albuquerque, NM, USA
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Jepsen P, Lash TL, Vilstrup H. The clinical course of alcoholic cirrhosis: development of comorbid diseases. A Danish nationwide cohort study. Liver Int 2016; 36:1696-1703. [PMID: 27124269 DOI: 10.1111/liv.13151] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/19/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS We aimed to determine associations between alcoholic cirrhosis and incidence of comorbidity, and to describe the clinical course of alcoholic cirrhosis in terms of comorbidity development. The comorbid diseases we studied were acute myocardial infarction, heart failure, peripheral arterial disease, chronic obstructive pulmonary disease, chronic kidney disease, epilepsy, diabetes and cancer. METHODS This was a registry-based nationwide historical cohort study. We included 10 650 Danish citizens diagnosed with alcoholic cirrhosis at age 45-69 years in 1994-2014 and 43 150 age- and gender-matched persons. None of them had the comorbid diseases we studied at inclusion. We compared rates and cumulative risks of comorbidity development between patients and controls. RESULTS Patients with alcoholic cirrhosis had a higher rate of comorbidity (hazard ratio for any comorbidity = 3.74, 95% CI 3.56-3.94), including all the non-cancer comorbidities (hazard ratio for any non-cancer comorbidity = 4.33, 95% CI 4.06-4.62) except acute myocardial infarction. They also had a higher rate of developing cancer (hazard ratio = 2.94, 95% CI 2.70-3.19). Still, relatively few patients actually lived to experience development of non-cancer (10-year risk: 21.4% vs. 13.2% for controls) or cancer comorbidity (10-year risk: 10.9% vs. 10.0%) because they died before they developed any comorbid disease. Hepatocellular carcinoma and oropharyngeal cancer were the only two comorbidities that were much more likely to develop in patients than in controls. CONCLUSIONS Alcoholic cirrhosis promotes development of several comorbid diseases, but only few patients with alcoholic cirrhosis live long enough to actually develop them.
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Affiliation(s)
- Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark. .,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Timothy L Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Hendrik Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
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Li W, Zhang L, Hao J, Wu Y, Lu D, Zhao H, Wang Z, Xu T, Yang H, Qian J, Li J. Validity of APCS score as a risk prediction score for advanced colorectal neoplasia in Chinese asymptomatic subjects: A prospective colonoscopy study. Medicine (Baltimore) 2016; 95:e5123. [PMID: 27741134 PMCID: PMC5072961 DOI: 10.1097/md.0000000000005123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Asia-Pacific Colorectal Screening (APCS) score is a risk-stratification tool that helps predict the risk for advanced colorectal neoplasia (ACN) in asymptomatic Asian populations, but has not yet been assessed for its validity of use in Mainland China.The aim of the study was to assess the validity of APCS score in asymptomatic Chinese population, and to identify other risk factors associated with ACN.Asymptomatic subjects (N = 1010) who underwent colonoscopy screening between 2012 and 2014 in Beijing were enrolled. APCS scores based on questionnaires were used to stratify subjects into high, moderate, and average-risk tiers. Cochran-Armitage test for trend was used to assess the association between ACN and risk tiers. Univariate and multivariate logistic regression was performed with ACN as the outcome, adjusting for APCS score, body mass index, alcohol consumption, self-reported diabetes, and use of nonsteroidal anti-inflammatory drugs as independent variables.The average age was 53.5 (standard deviation 8.4) years. The prevalence of ACN was 4.1% overall, and in the high, moderate, and average-risk tiers, the prevalence was 8.8%, 2.83%, and 1.55%, respectively (P < 0.001). High-risk tier had 3.3 and 6.1-fold increased risk of ACN as compared with those in the moderate and average-risk tiers, respectively. In univariate analysis, high-risk tier, obesity, diabetes, and alcohol consumption were associated with ACN. In multivariate analysis, only high-risk tier was an independent predictor of ACN.The APCS score can effectively identify a subset of asymptomatic Chinese population at high risk for ACN. Further studies are required to identify other risk factors, and the acceptability of the score to the general population will need to be further examined.
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Affiliation(s)
| | | | - Jianyu Hao
- Department of Gastroenterology, Beijing Chao-Yang Hospital
| | - Yongdong Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing, China
| | - Di Lu
- Department of Gastroenterology, Beijing Chao-Yang Hospital
| | - Haiying Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Beijing, China
| | - Zhenjie Wang
- Department of Physical Examination Center, Peking Union Medical College Hospital
| | | | | | | | - Jingnan Li
- Department of Gastroenterology
- Correspondence: Jingnan Li, Department of Gastroenterology, Peking Union Medical College Hospital, No. 1, Shuaifuyuan, Dongcheng district, Beijing 100730, China. (e-mail: )
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Tominaga K, Doyama H, Nakanishi H, Yoshida N, Takeda Y, Ota R, Tsuji K, Matsunaga K, Tsuji S, Takemura K, Yamada S, Katayanagi K, Kurumaya H. Importance of colonoscopy in patients undergoing endoscopic resection for superficial esophageal squamous cell carcinoma. Ann Gastroenterol 2016; 29:318-24. [PMID: 27366032 PMCID: PMC4923817 DOI: 10.20524/aog.2016.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/09/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aim of the study was to clarify the frequency of colorectal neoplasm (CRN) complicating superficial esophageal squamous cell carcinoma (ESCC) and the need for colonoscopy. METHODS We retrospectively reviewed 101 patients who had undergone initial endoscopic resection (ER) for superficial ESCC. Control group participants were age- and sex-matched asymptomatic subjects screened at our hospital over the same period of time. Advanced adenoma was defined as an adenoma ≥10 mm, with villous features, or high-grade dysplasia. Advanced CRN referred to advanced adenoma or cancer. We measured the incidence of advanced CRN in superficial ESCC and controls, and we compared the characteristics of superficial ESCC patients with and without advanced CRN. RESULTS In the superficial ESCC group, advanced CRNs were found in 17 patients (16.8%). A history of smoking alone was found to be a significant risk factor of advanced CRN [odds ratio 6.02 (95% CI 1.30-27.8), P=0.005]. CONCLUSION The frequency of synchronous advanced CRN is high in superficial ESCC patients subjected to ER. Colonoscopy should be highly considered for most patients who undergo ER for superficial ESCC with a history of smoking, and is recommended even in superficial ESCC patients.
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Affiliation(s)
- Kei Tominaga
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Hisashi Doyama
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Hiroyoshi Nakanishi
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Naohiro Yoshida
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Yasuhito Takeda
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Ryosuke Ota
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Kunihiro Tsuji
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Kazuhiro Matsunaga
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Shigetsugu Tsuji
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Kenichi Takemura
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Shinya Yamada
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology (Kazuyoshi Katayanagi, Hiroshi Kurumaya), Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroshi Kurumaya
- Department of Diagnostic Pathology (Kazuyoshi Katayanagi, Hiroshi Kurumaya), Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Giordano ME, Ingrosso I, Schettino T, Caricato R, Giovinazzo G, Lionetto MG. Intracellular Antioxidant Activity of Grape Skin Polyphenolic Extracts in Rat Superficial Colonocytes: In situ Detection by Confocal Fluorescence Microscopy. Front Physiol 2016; 7:177. [PMID: 27303304 PMCID: PMC4882411 DOI: 10.3389/fphys.2016.00177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/04/2016] [Indexed: 12/31/2022] Open
Abstract
Colon is exposed to a number of prooxidant conditions and several colon diseases are associated with increased levels of reactive species. Polyphenols are the most abundant antioxidants in the diet, but to date no information is available about their absorption and potential intracellular antioxidant activity on colon epithelial cells. The work was addressed to study the intracellular antioxidant activity of red grape polyphenolic extracts on rat colon epithelium experimentally exposed to prooxidant conditions. The experimental model chosen was represented by freshly isolated colon explants, which closely resemble the functional, and morphological characteristics of the epithelium in vivo. The study was carried out by in situ confocal microscopy observation on CM-H2DCFDA charged explants exposed to H2O2 (5, 10, and 15 min). The qualitative and quantitative polyphenolic composition of the extracts as well as their in vitro oxygen radical absorbing capacity (ORAC) was determined. The incubation of the explants with the polyphenolic extracts for 1 h produced a significant decrease of the H2O2 induced fluorescence. This effect was more pronounced following 15 min H2O2 exposure with respect to 5 min and it was also more evident for extracts obtained from mature grapes, which showed an increased ORAC value and qualitative peculiarities in the polyphenolic composition. The results demonstrated the ability of red grape polyphenols to cross the plasma membrane and exert a direct intracellular antioxidant activity in surface colonocytes, inducing a protection against pro-oxidant conditions. The changes in the polyphenol composition due to ripening process was reflected in a more effective antioxidant protection.
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Affiliation(s)
- M Elena Giordano
- Department of Biological and Environmental Sciences and Technologies, University of Salento Lecce, Italy
| | - Ilaria Ingrosso
- Institute of Science of Food Production, Unit of Lecce, National Research Council of Italy Lecce, Italy
| | - Trifone Schettino
- Department of Biological and Environmental Sciences and Technologies, University of Salento Lecce, Italy
| | - Roberto Caricato
- Department of Biological and Environmental Sciences and Technologies, University of Salento Lecce, Italy
| | - Giovanna Giovinazzo
- Institute of Science of Food Production, Unit of Lecce, National Research Council of Italy Lecce, Italy
| | - M Giulia Lionetto
- Department of Biological and Environmental Sciences and Technologies, University of Salento Lecce, Italy
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Schroy PC, Wong JB, O’Brien MJ, Chen CA, Griffith JL. A Risk Prediction Index for Advanced Colorectal Neoplasia at Screening Colonoscopy. Am J Gastroenterol 2015; 110:1062-71. [PMID: 26010311 PMCID: PMC4705553 DOI: 10.1038/ajg.2015.146] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/03/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Eliciting patient preferences within the context of shared decision making has been advocated for colorectal cancer screening. Risk stratification for advanced colorectal neoplasia (ACN) might facilitate more effective shared decision making when selecting an appropriate screening option. Our objective was to develop and validate a clinical index for estimating the probability of ACN at screening colonoscopy. METHODS We conducted a cross-sectional analysis of 3,543 asymptomatic, mostly average-risk patients 50-79 years of age undergoing screening colonoscopy at two urban safety net hospitals. Predictors of ACN were identified using multiple logistic regression. Model performance was internally validated using bootstrapping methods. RESULTS The final index consisted of five independent predictors of risk (age, smoking, alcohol intake, height, and a combined sex/race/ethnicity variable). Smoking was the strongest predictor (net reclassification improvement (NRI), 8.4%) and height the weakest (NRI, 1.5%). Using a simplified weighted scoring system based on 0.5 increments of the adjusted odds ratio, the risk of ACN ranged from 3.2% (95% confidence interval (CI), 2.6-3.9) for the low-risk group (score ≤2) to 8.6% (95% CI, 7.4-9.7) for the intermediate/high-risk group (score 3-11). The model had moderate to good overall discrimination (C-statistic, 0.69; 95% CI, 0.66-0.72) and good calibration (P=0.73-0.93). CONCLUSIONS A simple 5-item risk index based on readily available clinical data accurately stratifies average-risk patients into low- and intermediate/high-risk categories for ACN at screening colonoscopy. Uptake into clinical practice could facilitate more effective shared decision-making for CRC screening, particularly in situations where patient and provider test preferences differ.
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Affiliation(s)
- Paul C. Schroy
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - John B. Wong
- Department of Medicine, Tufts Medical Center, Boston, MA
| | - Michael J. O’Brien
- Department of Pathology, Boston University School of Medicine, Boston, MA
| | - Clara A. Chen
- Data Coordinating Center, Boston University School of Public Health, Boston, MA
| | - John L. Griffith
- Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA
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Baeg MK, Choi MG, Jung YD, Ko SH, Lim CH, Kim HH, Kim JS, Cho YK, Park JM, Lee IS, Kim SW. Esophageal Squamous Cell Carcinoma Patients Have an Increased Risk of Coexisting Colorectal Neoplasms. Gut Liver 2015; 10:76-82. [PMID: 25963088 PMCID: PMC4694738 DOI: 10.5009/gnl14381] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background/Aims Esophageal squamous cell carcinoma (ESCC) and colorectal neoplasms (CRNs) share risk factors. We aimed to investigate whether the CRN risk is increased in ESCC patients. Methods ESCC patients who underwent a colonoscopy within 1 year of diagnosis were retrospectively analyzed. Patients were matched 1:3 by age, gender, and body mass index to asymptomatic controls. CRN was defined as the histological confirmation of adenoma or adenocarcinoma. Advanced CRN was defined as any of the following: ≥3 adenomas, high-grade dysplasia, villous features, tumor ≥1 cm, or adenocarcinoma. The risk factors for both CRN and advanced CRN were evaluated by univariate and multivariate analyses. Results Sixty ESCC patients were compared with 180 controls. The ESCC group had significantly higher numbers of CRNs (odds ratio [OR], 2.311; 95% confidence interval [CI], 1.265 to 4.220; p=0.006) and advanced CRNs (OR, 2.317; 95% CI, 1.185 to 4.530; p=0.013). Significant risk factors for both CRN and advanced CRN by multivariate analysis included ESCC (OR, 2.157, 95% CI, 1.106 to 4.070, p=0.024; and OR, 2.157, 95% CI, 1.045 to 4.454, p=0.038, respectively) and older age (OR, 1.068, 95% CI, 1.032 to 1.106, p<0.001; and OR, 1.065, 95% CI, 1.024 to 1.109, p=0.002, respectively). Conclusions The rates of CRN and advanced CRN are significantly increased in ESCC. Colonos-copy should be considered at ESCC diagnosis.
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Affiliation(s)
- Myong Ki Baeg
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yun Duk Jung
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sun-Hye Ko
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chul-Hyun Lim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyung Hun Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Su Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yu Kyung Cho
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Myung Park
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - In Seok Lee
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang-Woo Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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15
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Wong MCS, Ching JYL, Chan VCW, Lam TYT, Luk AKC, Ng SSM, Sung JJY. Factors associated with false-positive and false-negative fecal immunochemical test results for colorectal cancer screening. Gastrointest Endosc 2015; 81:596-607. [PMID: 25293827 DOI: 10.1016/j.gie.2014.08.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/04/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Certain subgroups have higher rates of false fecal immunochemical test (FIT) results, yet few studies have addressed this topic. OBJECTIVE To identify demographic factors associated with false-positive and false-negative FIT results in colorectal cancer screening. DESIGN Retrospective database review of prospectively collected data. SETTING A bowel cancer screening center in Hong Kong invited participants for colorectal cancer screening (2008-2012). PATIENTS Study participants who underwent both FIT and colonoscopy in the first year (n = 4482) and underwent colonoscopy after negative FIT results for 3 consecutive years (n = 857). MAIN OUTCOME MEASUREMENTS The diagnostic accuracy and predictive values of FIT according to participant characteristics. RESULTS The sensitivity, specificity, positive predictive values, and negative predictive values for advanced neoplasia were 33.1%, 91.9%, 19.0%, and 96.0%, respectively. Participants 66 to 70 years of age had higher sensitivity, whereas older age, smoking, and use of aspirin/nonsteroidal anti-inflammatory drugs were associated with lower specificity. The rates of false-positive and false-negative results were 8.1% and 66.9%, respectively. Older age (66-70 years; adjusted odds ratio [AOR] 1.95; 95% confidence interval [CI], 1.35-2.81; P < .001), smoking (AOR 1.68; 95% CI, 1.08-2.61; P = .020), and the presence of polypoid adenoma (AOR 1.71; 95% CI, 1.14-2.57; P = .009) were associated with false-positive results. Younger participants (AOR for elderly participants 0.31) and the use of aspirin/nonsteroidal anti-inflammatory drugs (AOR 4.44) in participants with 1 FIT with negative results and the absence of high-grade dysplasia (AOR for presence 0.41) were associated with false-negative results. LIMITATIONS Self-referred participants who received one type of qualitative FIT. CONCLUSION These findings could be used to target screening more toward those with a higher risk of false-negative results and those with a lower risk of false-positive results for earlier colonoscopy.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China; School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Jessica Y L Ching
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Victor C W Chan
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Arthur K C Luk
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Simon S M Ng
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, Chinese University of Hong Kong, Shatin, Hong Kong, HKSAR, China
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Bortniker E, Anderson JC. Do recent epidemiologic observations impact who and how we should screen for CRC? Dig Dis Sci 2015; 60:781-94. [PMID: 25492505 DOI: 10.1007/s10620-014-3467-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/26/2014] [Indexed: 12/18/2022]
Abstract
Colorectal cancer (CRC) screening is recommended to begin at age 50 for those patients with no significant family history of CRC. However, even within this group of average-risk patients, there is data to suggest that there may be variation in CRC risk. These observations suggest that perhaps CRC screening should be tailored to target those patients at higher risk for earlier or more invasive screening as compared to those individuals at lower risk. The strategy of how to identify those higher-risk patients may not be straightforward. One method might be to use single risk factors such as smoking or elevated BMI as has been suggested in the recent American College of Gastroenterology CRC screening guidelines. Another paradigm involves the use of models which incorporate several risk factors to stratify patients by risk. This article will highlight recent large studies that examine recognized CRC risk factors as well as review recently developed CRC risk models. There will also be a discussion of the application of these factors and models in an effort to make CRC screening more efficient.
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Affiliation(s)
- Ethan Bortniker
- Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
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17
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Consumption of beer and colorectal cancer incidence: a meta-analysis of observational studies. Cancer Causes Control 2015; 26:549-60. [DOI: 10.1007/s10552-015-0532-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/05/2015] [Indexed: 12/11/2022]
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18
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Klare P, Ascher S, Hapfelmeier A, Wolf P, Beitz A, Schmid RM, von Delius S. Patient age and duration of colonoscopy are predictors for adenoma detection in both proximal and distal colon. World J Gastroenterol 2015; 21:525-532. [PMID: 25593468 PMCID: PMC4292284 DOI: 10.3748/wjg.v21.i2.525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/01/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the relation of patient characteristics and procedural parameters to the endoscopic detection rate of colonic adenomas. Further to study, which factors may be capable to predict the localization of adenomatous lesions.
METHODS: We used the data base of a prospective randomized colonoscopy study (The ColoCap trial) to identify patients being diagnosed with colon adenoma. Logistic regression analysis was conducted to reveal predictors for adenoma detection in the entire colon and also with respect to the proximal and distal part. Covariates including age, gender, duration of colonoscopy and comorbidities were defined to determine association between predictors and adenoma detection.
RESULTS: Equal numbers of adenomas were detected in the proximal and distal side of the splenic flexure [126 (57%) vs 94 (43%), P = 0.104]. Simultaneous occurrence of adenomas in both sides of the colon was rare. The appearance of both proximal and distal adenoma was associated with increasing age (P = 0.008 and P = 0.024) and increasing duration of colonoscopy (P < 0.001 and P = 0.001). Male gender was a predictor for adenoma detection in the proximal colon (P = 0.008) but statistical significance was slightly missed with respect to the distal colon (P = 0.089). Alcohol abuse was found to be a predictor for the detection of distal adenoma (P = 0.041).
CONCLUSION: Increasing age and longer duration of colonoscopy are factors with a strong impact on adenoma detection both in the proximal and distal colon. Since proximal adenomas occurred in absence of distal adenomas, complete colonoscopy should be performed for screening.
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Artero A, Artero A, Tarín JJ, Cano A. The impact of moderate wine consumption on health. Maturitas 2014; 80:3-13. [PMID: 25449821 DOI: 10.1016/j.maturitas.2014.09.007] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 09/20/2014] [Indexed: 12/29/2022]
Abstract
Wine is a traditional beverage that has been associated with both healthy and harmful effects. Conceptions like the so-called "French paradox" or the beneficial impact of the Mediterranean diet suggest benefit. Wine has a complex composition, which is affected by whether it is red or white or by other variables, like the variety of grapes or others. Alcohol and phenolic compounds have been attributed a participation in the benefits ascribed to wine. The case of alcohol has been extensively studied, but the key question is whether wine offers additional benefits. Resveratrol, a non-flavonoid compound, and quercetin, a flavonol, have received particular attention. There is much experimental work confirming a beneficial balance for both substances, particularly resveratrol, in various organs and systems. The pharmacological dosages used in many of those experiments have shed doubt, however, on the clinical translation of those findings. Clinical studies are limited by their observational nature as well as for the difficulties to abstract the benefits of wine from other confounders. Notwithstanding the doubts, there is reasonable unanimity in beneficial effects of moderate wine consumption in cardiovascular disease, diabetes, osteoporosis, maybe neurological diseases, and longevity. Observations are less enthusiastic in what refers to cancer. While considering these limitations, clinicians may spread the message that the balance of moderate wine consumption seems beneficial.
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Affiliation(s)
- Ana Artero
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario, Av Blasco Ibáñez 17, 46010 Valencia, Spain.
| | - Arturo Artero
- Department of Internal Medicine, Hospital Univesitario Dr. Peset, Av Gaspar Aguilar 90, 46017 Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Av Blasco Ibáñez 15, 46010 Valencia, Spain.
| | - Juan J Tarín
- Department of Functional Biology and Physical Anthropology, School of Biological Sciences, Burjasot Campus, University of Valencia, Valencia, Spain.
| | - Antonio Cano
- Service of Obstetrics and Gynecology, Clínico University Hospital, Av Blasco Ibáñez 17, 46010 Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Av Blasco Ibáñez 15, 46010 Valencia, Spain.
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20
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Lin XF, Shi KQ, You J, Liu WY, Luo YW, Wu FL, Chen YP, Wong DKH, Yuen MF, Zheng MH. Increased risk of colorectal malignant neoplasm in patients with nonalcoholic fatty liver disease: a large study. Mol Biol Rep 2014; 41:2989-2997. [PMID: 24449368 DOI: 10.1007/s11033-014-3157-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 01/13/2014] [Indexed: 12/12/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) has been suggested to be a strong risk factor of colorectal benign adenomas and advanced neoplasms. The aim of this large cohort study was to further investigate the prevalence of colorectal malignant neoplasm (CRMN) in patients with NAFLD and determine whether association between NAFLD and CRMN exists. 2,315 community subjects (1,370 males and 945 females) who underwent a routine colonoscopy according to international colorectal cancer screening guideline were recruited. Nature of colorectal lesions determined by biopsy and NAFLD was diagnosed by ultrasound. Binary logistic regression analysis was applied to explore the related associations. Prevalence of CRMN was 29.3% (77/263) in patients with NAFLD, which was significantly higher than 18.0% (369/2,052) in the control group (P<0.05). In addition, malignant neoplasm in NAFLD group occurred more frequently at sigmoid colon than in control group (14.3 vs. 11.9%). The incidence of highly-differentiated colorectal adenocarcinoma in NAFLD group was significantly higher than control group (62.3 vs. 9.8%). Univariate analysis showed that NAFLD had strong association with CRMN (OR 2.043; 95% CI 1.512-2.761; P<0.05). After adjusting for metabolic and other confounding factors, NAFLD remained as an independent risk factor for CRMN (OR 1.868; 95% CI 1.360-2.567; P<0.05). NAFLD was an independent risk factor for CRMN. Sigmoid carcinoma and highly differentiated colorectal adenocarcinoma were more commonly found in NAFLD. (ClinicalTrials.gov number, NCT01657773, website: http://clinicaltrials.gov/ct2/show/NCT01657773?term=zheng+minghua&rank=1 ).
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Affiliation(s)
- Xian-Feng Lin
- Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, 325000, China
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21
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Wong MCS, Lam TYT, Tsoi KKF, Chan VCW, Hirai HW, Ching JYL, Sung JJY. Predictors of advanced colorectal neoplasia for colorectal cancer screening. Am J Prev Med 2014; 46:433-9. [PMID: 24745632 DOI: 10.1016/j.amepre.2013.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 12/05/2013] [Accepted: 12/13/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Asia-Pacific Colorectal Screening (APCS) score based on age, gender, family history, and smoking is useful to predict advanced colorectal neoplasia (ACN) in asymptomatic Asian subjects. PURPOSE To evaluate the factors in addition to those of APCS associated with ACN colonoscopic findings. METHODS Data from 5,220 asymptomatic subjects aged between 50 and 70 years who underwent screening colonoscopy in a community center between 2008 and 2012 were analyzed. One binary logistic regression analysis was conducted in 2013 with the presence of ACN or cancer as the outcome, controlling for APCS score, alcohol consumption, BMI, hypertension, and other chronic diseases as independent variables. RESULTS The average participant age was 57.7 years (SD=4.9) and 47.5% were men. Advanced neoplasms or cancers were identified at colonoscopy in 5.6% of all screening participants. From multivariate regression analysis, APCS score≥4 (adjusted OR [AOR]=1.74, 95% CI=1.34, 2.25, p<0.001); overweight (BMI=23-24.9, AOR=1.52, 95% CI=1.12, 2.07, p=0.007); obesity (BMI≥25, AOR=1.56, 95% CI=1.15, 2.10, p=0.004); hypertension (AOR=1.58, 95% CI=1.21, 2.06, p=0.001); and alcohol consumption (AOR=1.47, 95% CI=1.05, 2.06, p=0.025) were associated with ACN. The c-statistic of APCS score alone was 0.560 (95% CI=0.524, 0.595, p=0.001) and that of APCS score plus BMI, hypertension, and alcohol consumption was 0.613 (95% CI=0.578, 0.648, p<0.001). CONCLUSIONS Alcohol consumption, hypertension, and BMI are independent predictors of ACN, which could be incorporated into the APCS for prioritizing Asian asymptomatic subjects for colorectal cancer screening.
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Affiliation(s)
- Martin C S Wong
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong; School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Thomas Y T Lam
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Kelvin K F Tsoi
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Victor C W Chan
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Hoyee W Hirai
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Jessica Y L Ching
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong
| | - Joseph J Y Sung
- Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong.
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Stegeman I, de Wijkerslooth TR, Stoop EM, van Leerdam ME, Dekker E, van Ballegooijen M, Kuipers EJ, Fockens P, Kraaijenhagen RA, Bossuyt PM. Combining risk factors with faecal immunochemical test outcome for selecting CRC screenees for colonoscopy. Gut 2014; 63:466-71. [PMID: 23964098 DOI: 10.1136/gutjnl-2013-305013] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Faecal immunochemical testing (FIT) is increasingly used in colorectal cancer (CRC) screening but has a less than perfect sensitivity. Combining risk stratification, based on established risk factors for advanced neoplasia, with the FIT result for allocating screenees to colonoscopy could increase the sensitivity and diagnostic yield of FIT-based screening. We explored the use of a risk prediction model in CRC screening. DESIGN We collected data in the colonoscopy arm of the Colonoscopy or Colonography for Screening study, a multicentre screening trial. For this study 6600 randomly selected, asymptomatic men and women between 50 years and 75 years of age were invited to undergo colonoscopy. Screening participants were asked for one sample FIT (OC-sensor) and to complete a risk questionnaire prior to colonoscopy. Based on the questionnaire data and the FIT results, we developed a multivariable risk model with the following factors: total calcium intake, family history, age and FIT result. We evaluated goodness-of-fit, calibration and discrimination, and compared it with a model based on primary screening with FIT only. RESULTS Of the 1426 screening participants, 1112 (78%) completed the questionnaire and FIT. Of these, 101 (9.1%) had advanced neoplasia. The risk based model significantly increased the goodness-of-fit compared with a model based on FIT only (p<0.001). Discrimination improved significantly with the risk-based model (area under the receiver operating characteristic (ROC) curve: from 0.69 to 0.76, (p=0.02)). Calibration was good (Hosmer-Lemeshow test; p=0.94). By offering colonoscopy to the 102 patients at highest risk, rather than to the 102 cases with a FIT result >50 ng/mL, 5 more cases of advanced neoplasia would be detected (net reclassification improvement 0.054, p=0.073). CONCLUSIONS Adding risk based stratification increases the accuracy FIT-based CRC screening and could be used in preselection for colonoscopy in CRC screening programmes.
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Affiliation(s)
- Inge Stegeman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, , Amsterdam, The Netherlands
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23
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Stegeman I, de Wijkerslooth TR, Stoop EM, van Leerdam M, van Ballegooijen M, Kraaijenhagen RA, Fockens P, Kuipers EJ, Dekker E, Bossuyt PM. Risk factors for false positive and for false negative test results in screening with fecal occult blood testing. Int J Cancer 2013; 133:2408-14. [PMID: 23649826 DOI: 10.1002/ijc.28242] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/09/2013] [Indexed: 12/27/2022]
Abstract
Differences in the risk of a false negative or a false positive fecal immunochemical test (FIT) across subgroups may affect optimal screening strategies. We evaluate whether subgroups are at increased risk of a false positive or a false negative FIT result, whether such variability in risk is related to differences in FIT sensitivity and specificity or to differences in prior CRC risk. Randomly selected, asymptomatic individuals were invited to undergo colonoscopy. Participants were asked to undergo one sample FIT and to complete a risk questionnaire. We identified patient characteristics associated with a false negative and false positive FIT results using logistic regression. We focused on statistically significant differences as well as on variables influencing the false positive or negative risk for which the odds ratio exceeded 1.25. Of the 1,426 screening participants, 1,112 (78%) completed FIT and the questionnaire; 101 (9.1%) had advanced neoplasia. 102 Individuals were FIT positive, 65 (64%) had a false negative FIT result and 66 (65%) a false positive FIT result. Participants at higher age and smokers had a significantly higher risk of a false negative FIT result. Males were at increased risk of a false positive result, so were smokers and regular NSAID users. FIT sensitivity was lower in females. Specificity was lower for males, smokers and regular NSAID users. FIT sensitivity was lower in women. FIT specificity was lower in males, smokers and regular NSAID users. Our results can be used for further evidence based individualization of screening strategies.
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Affiliation(s)
- Inge Stegeman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academical Medical Center, Amsterdam, The Netherlands; Department of research and development, NDDO Institute for Prevention and Early Diagnostic, Amsterdam, The Netherlands
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Anderson JC. Smoking-associated colorectal cancer risk: do micronutrients help or hurt? Clin Gastroenterol Hepatol 2013; 11:416-8. [PMID: 23333702 DOI: 10.1016/j.cgh.2012.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 12/16/2012] [Accepted: 12/17/2012] [Indexed: 02/07/2023]
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Stegeman I, de Wijkerslooth TR, Stoop EM, van Leerdam ME, Dekker E, van Ballegooijen M, Kuipers EJ, Fockens P, Kraaijenhagen RA, Bossuyt PM. Colorectal cancer risk factors in the detection of advanced adenoma and colorectal cancer. Cancer Epidemiol 2013; 37:278-83. [PMID: 23491770 DOI: 10.1016/j.canep.2013.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/06/2013] [Accepted: 02/13/2013] [Indexed: 12/18/2022]
Abstract
Several risk factors for colorectal cancer (CRC) have been identified. If individuals with risk factors are more likely to harbor cancer or it precursors screening programs should be targeted toward this population. We evaluated the predictive value of colorectal cancer risk factors for the detection of advanced colorectal adenoma in a population based CRC colonoscopy screening program. Data were collected in a multicenter trial conducted in the Netherlands, in which 6600 asymptomatic men and women between 50 and 75 years were randomly selected from a population registry. They were invited to undergo a screening colonoscopy. Based on a review of the literature CRC risk factors were selected. Information on risk factors was obtained from screening attendees through a questionnaire. For each CRC risk factor, we estimated its odds ratio (OR) relative to the presence of advanced neoplasia as detected at colonoscopy. Of the 1426 screening participants who underwent a colonoscopy, 1236 (86%) completed the risk questionnaire. 110 participants (8.9%) had advanced neoplasia. The following risk factors were significantly associated with advanced neoplasia detected by colonoscopy: age (OR: 1.06 per year; 95% CI: 1.03-1.10), calcium intake (OR: 0.99 per mg; 95% CI: 0.99-1.00), positive CRC family history (OR: 1.55 per first degree family member; 95%CI: 1.11-2.16) and smoking (OR: 1.75; 95%CI: 1.09-2.82). Elderly screening participants, participants with lower calcium intake, a CRC family history, and smokers are at increased risk of harboring detectable advanced colorectal neoplasia at screening colonoscopy.
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Affiliation(s)
- Inge Stegeman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
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Pyo JH, Kim ES, Chun HJ, Keum B, Jeen YT, Lee HS, Kim CD, Ryu HS, Kim YH, Lee JE. Fasting blood sugar and serum triglyceride as the risk factors of colorectal adenoma in korean population receiving screening colonoscopy. Clin Nutr Res 2013; 2:34-41. [PMID: 23429421 PMCID: PMC3572815 DOI: 10.7762/cnr.2013.2.1.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 01/07/2013] [Accepted: 01/14/2013] [Indexed: 01/28/2023] Open
Abstract
In several previously reported studies, metabolic syndrome (MS) was found to be associated with colorectal adenomas. While the incidence of colorectal adenoma is growing in Korean population, there are only few studies that examined the association between MS and colorectal adenoma in Korea. The aim of this study was to investigate relationships between prevalence of colorectal adenoma and MS components. We conducted a cross sectional study using data from individuals who had undergone complete colonoscopy for health examinations at the Health Promotion Center of Korea University Medical Center from July 1, 2004 to July 31, 2010. A total of 7481 subjects (4459 males and 3022 females) were included; 1733 subjects with pathologically proven adenoma were assigned to the case group, and other 5748 subjects were assigned to the non-case group. All the participants underwent colonoscopy and received blood biochemical tests (fasting blood sugar [FBS], insulin, lipid profile, hemoglobin, blood urea nitrogen [BUN], creatinine). Univariate analysis showed that the prevalence of colorectal adenoma was higher in individuals with higher blood pressure, body mass index (BMI), total cholesterol (TC), triglyceride (TG), FBS and lower high-density lipoprotein cholesterols (HDL-C) levels, compared to those with low levels. Multiple logistic regression analysis revealed that high levels of BMI (OR 1.17, 95% CI 1.01-1.34, P trend = 0.01), TG (OR 1.27, 95% CI 1.07-1.51, P trend = 0.006), and FBS (OR 1.19 95% CI 1.01-1.40, P trend = 0.05) were significantly associated with prevalence of colorectal adenoma. Subjects with high levels of BMI, TG and FBS have increased prevalence of developing colorectal adenoma in Korea.
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Affiliation(s)
- Jeung Hui Pyo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, Korea
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Abstract
BACKGROUND Alcohol is considered to be a cocarcinogen or a tumor promoter, and various studies have shown a linear dose-dependent association between alcohol consumption and colorectal cancer. However, a few studies suggest that moderate alcohol consumption may have a protective effect, similar to that in cardiovascular disease. OBJECTIVE The aim of this study was to evaluate the relationship of colorectal cancer to quantity and type of alcohol consumed. DESIGN This was case-control study. SETTINGS The study was conducted in the area of Attica, Greece. PARTICIPANTS A total of 250 consecutive patients with a first diagnosis of colorectal cancer were matched for age group and sex with 250 controls recruited from the community. The mean age was 63 (SD, 12) years for the patient group (147 men, 59%; 103 women, 41%) and 55 (SD, 13) years for the control group (112 men; 44.8%; 138 women, 55.2%). MAIN OUTCOME MEASURES Questionnaires were administered by trained interviewers to assess sociodemographic, clinical, and lifestyle characteristics, in addition to dietary habits and quantity and type of alcoholic beverages usually consumed during the preceding year. Adherence to the Mediterranean diet was evaluated with the MedDietScore (theoretical range, 0-55). RESULTS With intake of less than 12 g of alcohol per day as the reference, moderate alcohol intake (12-35 g/day) was associated with a significantly decreased likelihood of colorectal cancer in men (OR, 0.35; 95% CI, 0.16-0.74) and in women (OR, 0.40; 95% CI, 0.18-0.91). High alcohol intake (more than 48 g/day) was associated with an increased likelihood, which was significant in men (OR, 3.45; 95% CI, 1.35-8.83) but not in women (OR, 3.40; 95% CI, 0.50-22.92). Drinking red wine was associated with reduced odds of colorectal cancer, significant in men (OR, 0.47; 95% CI, 0.23-0.96) but not in women (OR, 0.54; 95% CI, 0.23-1.30). None of the associations between other beverage types and colorectal cancer were significant. Adherence to the Mediterranean diet was independently associated with lower odds of colorectal cancer overall (p < 0.001), in men (OR, 0.90; 95% CI, 0.83-0.97), and in women (OR, 0.87; 95% CI, 0.80-0.94). LIMITATIONS The major limitations of this study included the inability of a case-control design to determine causation and the potential for recall bias. CONCLUSIONS The association between quantity of alcohol consumed and the presence of colorectal cancer followed a J-shaped curve. While demonstrating the detrimental effect of consuming large amounts of alcohol, the results of this study suggest that moderate alcohol consumption exerts a protective effect on colorectal cancer in both men and women, possibly related to the effects of red wine.
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Anderson JC, Swede H, Rustagi T, Protiva P, Pleau D, Brenner BM, Rajan TV, Heinen CD, Levine JB, Rosenberg DW. Aberrant crypt foci as predictors of colorectal neoplasia on repeat colonoscopy. Cancer Causes Control 2011; 23:355-61. [PMID: 22187142 DOI: 10.1007/s10552-011-9884-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 12/07/2011] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To estimate the risk for colorectal neoplasia detected on repeat colonoscopy in relation to aberrant crypt foci (ACF) frequency reported during the previous baseline examination. METHODS From July 2003 until December 2008, patients had a colonoscopy with an ACF study using a magnifying colonoscope. The distal 20 cm section of colon was sprayed with Methylene Blue to ascertain the ACF frequency, the independent variable. Patients were categorized into low and high ACF count using the median as the cut point. Data collected from consenting patients included age, gender, height, weight, ethnicity, smoking history, family history of colorectal cancer (CRC), and personal history of colorectal neoplasia. A follow-up colonoscopy was performed at an interval as dictated by clinical surveillance guidelines. The main outcome was surveillance detected advanced colorectal neoplasia (SDAN) detected on repeat colonoscopy. Logistic Regression was used to calculate risk of SDAN on repeat colonoscopy in relation to baseline ACF count. RESULTS 74 patients had a baseline ACF exam and a repeat surveillance colonoscopy. The median ACF was six and thus a high ACF count was >6 ACF and a low ACF count was ≤6 ACF. Patients diagnosed with SDAN were more likely to have had a high ACF number at baseline compared to patients without these lesions at follow-up (adjusted odds ratio = 12.27; 95% confidence interval: 2.00-75.25) controlling for age, sex, smoking, history of prior adenoma, family history of colon cancer, obesity, and time interval to surveillance exam. A sub analysis of our results demonstrated that this relationship was observed in 48 patients who were undergoing a surveillance colonoscopy for a previous adenoma and not those receiving surveillance for a family history of neoplasia. CONCLUSIONS Increased number of ACF in the distal colorectum was independently associated with substantial risk for future advanced neoplasia. This relationship was observed in patients undergoing surveillance for previous adenomas. Thus, ACF may serve as potential biomarkers in patients with adenomas to help identify patients who may need additional surveillance.
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Affiliation(s)
- Joseph C Anderson
- Carole and Ray Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT 06030-1845, USA.
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Kim MC, Kim CS, Chung TH, Park HO, Yoo CI. Metabolic syndrome, lifestyle risk factors, and distal colon adenoma: A retrospective cohort study. World J Gastroenterol 2011; 17:4031-7. [PMID: 22046093 PMCID: PMC3199563 DOI: 10.3748/wjg.v17.i35.4031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 05/19/2011] [Accepted: 05/26/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate relationships between colorectal adenoma incidence, metabolic syndrome (MS) components and lifestyle factors.
METHODS: We conducted a retrospective cohort study using data from individuals who had multiple sigmoidoscopies for colon cancer at the Health Promotion Center of Ulsan University Hospital in Korea from 1998 to 2007.
RESULTS: By multivariate analysis, the incidence of distal colon adenoma was increased by more than 1.76 times in individuals with at least one component of MS compared to those without a component of MS. After adjustment for age, gender, smoking, drinking, and physical exercise, only high body mass index (BMI) was significantly associated with the incidence of distal colon adenoma (Hazard ratio 1.66, 95% confidence interval 1.05-2.62).
CONCLUSION: Our results suggest that high BMI may increase the risk of colorectal adenoma in Korean adults.
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Shin A, Hong CW, Sohn DK, Chang Kim B, Han KS, Chang HJ, Kim J, Oh JH. Associations of cigarette smoking and alcohol consumption with advanced or multiple colorectal adenoma risks: a colonoscopy-based case-control study in Korea. Am J Epidemiol 2011; 174:552-62. [PMID: 21791710 DOI: 10.1093/aje/kwr098] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The associations between alcohol consumption and cigarette smoking habits and the risk for colorectal adenomatous polyps according to the detailed clinical information about polyps were assessed in a large colonoscopy-based study. The study enrolled participants who visited the National Cancer Center of the Republic of Korea for cancer screening between April 2007 and April 2009. In 1,242 newly diagnosed colorectal adenoma patients and 3,019 polyp-free controls, past smokers (odds ratio (OR) = 1.31, 95% confidence interval (CI): 1.04, 1.65) and current smokers (OR = 1.70, 95% CI: 1.37, 2.11) had increased risks for adenomas compared with nonsmokers. Cigarette smoking conferred an even higher risk for advanced adenomas and 3 or more adenomas than for low-risk adenomas or a single adenoma. Dose-response relations were observed among the daily number of cigarettes smoked, the duration of smoking, the pack-years of smoking, and the risk for adenomas. A longer duration of alcohol consumption was associated with a higher risk for advanced adenomas (for >28 years of consumption: OR = 2.0, 95% CI: 1.10, 3.64) and 3 or more adenomas (OR = 2.19, 95% CI: 1.27, 3.76). In conclusion, cigarette smoking and alcohol consumption play roles in colorectal carcinogenesis, and the association differs by the clinical features of the adenomas.
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Affiliation(s)
- Aesun Shin
- Colorectal Cancer Branch, National Cancer Center Hospital, 323 Ilsanro Ilsandong-gu, Goyang-si, Geyonggi-do 410-769, Republic of Korea
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Forester SC, Oteiza P, Waterhouse AL. Identification and Cancer Therapeutic Properties of Microfloral Anthocyanin Metabolites. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/09571264.2011.603249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
In addition to histology, size and location, a morphologic description can be ascribed to polyps and adenomas. Traditionally, adenomas have been described as sessile and pedunculated, but it is now accepted that they can also present as flat or even depressed. Although first recognized in 1985, flat adenomas have become more common in Western published literature and in endoscopic reports. The Japanese Research Society Classification describes flat adenomas as lesions with a height that is less than one half of the diameter, while the Paris classification divides polyps into protruding and nonprotruding. The clinical significance of flat adenomas includes their potential malignancy, difficulty in detection and possible role in interval cancers. Serrated polyps represent a subset of polyps that have all the features that make flat lesions clinically important. Due to the relatively recent recognition of these lesions, as well as the technology required to detect them, the prevalence and malignant potential of these lesions in Western patients are still unknown. Finally, the best techniques and equipment for detecting flat polyps are also not established. In this article, we examine the issue of flat polyps and their significance in colorectal cancer screening with regard to prevalence, risk factors and methods for detecting flat polyps.
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Affiliation(s)
- Joseph C Anderson
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1845, USA.
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Abstract
BACKGROUND Awareness of risk factors for colorectal neoplasia could address risk reduction strategies in asymptomatic subjects. METHODS This is a post hoc analysis of a prospective, cross-sectional study of 1321 asymptomatic adults. All the subjects underwent same-day CT colonography and colonoscopy to determine the prevalence of colorectal neoplasia. The variables examined included body mass index, smoking, alcohol consumption, age, and gender. Univariate and logistic regression analyses were performed for detection of colorectal neoplasia and hyperplastic polyps. Odds ratios with 95% confidence intervals were calculated. RESULTS Colorectal adenomas and hyperplastic polyps were detected in 378 (28.6%) and 157 (11.9%) participants, respectively. In both univariate and multivariate analysis, increasing age, male gender, and body mass index > or =25 were significantly associated with the detection of colorectal adenomas, with an odds ratio of 1.22 (95% CI,1.09-1.36), 1.28 (95% CI, 1.06-1.45), and 1.34 (95% CI, 1.02-1.77), respectively. A history of smoking was the only identifiable risk factor for hyperplastic polyps (odds ratio, 1.98; 95% CI, 1.41-2.78). CONCLUSIONS Body mass index > or =25, increasing age, and male gender were all associated with an increased likelihood of colorectal adenomas at screening, whereas smoking was strongly associated with hyperplastic polyps.
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Regula J, Kaminski MF. Targeting risk groups for screening. Best Pract Res Clin Gastroenterol 2010; 24:407-16. [PMID: 20833345 DOI: 10.1016/j.bpg.2010.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 02/06/2023]
Abstract
Currently colorectal cancer (CRC) screening guidelines are based on age and to some extent on family history of screenees only. Potentially CRC screening could be also customised according to gender, race, ethnicity, smoking habits, presence of obesity, diabetes and metabolic syndrome. The factors that could be individually modified are: choice of screening test, age of initiation of screening and screening intervals. Gender is probably the easiest factor to be included. One of the professional societies has already included the race into guidelines in order to lower the age of starting screening in African-Americans. Targeting persons at higher than average-risk aims at optimising the use of available resources. However, an important drawback of such approach exists; it is the risk of making guidelines too complex and incomprehensible for both eligible screenees and physicians.
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Affiliation(s)
- Jaroslaw Regula
- Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw, Poland.
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35
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Anderson JC, Pleau DC, Rajan TV, Protiva P, Swede H, Brenner B, Heinen CD, Lambrecht RW, Rosenberg DW. Increased frequency of serrated aberrant crypt foci among smokers. Am J Gastroenterol 2010; 105:1648-54. [PMID: 20234347 DOI: 10.1038/ajg.2010.109] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The American College of Gastroenterology has published guidelines recently that suggest that smokers with a history of >20 pack years may need screening for colorectal cancer (CRC) at an earlier age than non-smokers. Aberrant crypt foci (ACF) may represent important precursors for colorectal neoplasms and potential surrogate biomarkers. Clarifying the role of ACF in relation to known CRC risk factors such as smoking may have important implications for screening as well as our understanding of tobacco use and colorectal carcinogenesis. Our goal was to examine whether smoking at least 20 pack years was associated with an increased frequency of ACF. METHODS We gathered detailed smoking history, personal and family history of CRC, and other epidemiologic data (age, gender, height, weight, ethnicity, and medication use) from 125 patients undergoing routine screening or surveillance colonoscopy. We used a magnifying colonoscope (Olympus Close Focus Colonoscope XCF-Q160ALE, Olympus Corporation, Tokyo, Japan) and examined the distal 20 cm section of colon after staining with 0.5% methylene blue. ACF were counted and characterized histologically. Hyperplastic ACF were further characterized as either serrated or non-serrated. RESULTS Smoking at least 20 pack years was associated with an increased likelihood (adjusted odds ratio (OR)=3.45; 95% confidence interval (CI)=1.93-6.18) of having more than the median number of ACF (> or = 15) compared with non-smokers. Similarly, patients with a personal history of advanced neoplasia were more likely (adjusted OR=3.42; 95% CI=1.01-11.67) to have a greater than median number of ACF compared with patients without this diagnosis. Smokers were more likely than non-smokers to have serrated ACF (P=0.002). CONCLUSIONS Smoking at least 20 pack years seems to be associated with increased number of ACF in the rectum and distal sigmoid, especially those with serrated histology. Our data support ACG guidelines for earlier screening for CRC among smokers and add to our understanding of how colorectal carcinogenesis is related to tobacco use.
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Affiliation(s)
- Joseph C Anderson
- Colon Cancer Prevention Program, Neag Comprehensive Cancer Center, University of Connecticut Health Center, Farmington, CT 06030-1845, USA.
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Forester SC, Waterhouse AL. Gut metabolites of anthocyanins, gallic acid, 3-O-methylgallic acid, and 2,4,6-trihydroxybenzaldehyde, inhibit cell proliferation of Caco-2 cells. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2010; 58:5320-5327. [PMID: 20373763 DOI: 10.1021/jf9040172] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Gut microflora metabolize anthocyanins to phenolic acids and aldehydes. These metabolites may explain the relationship between anthocyanin consumption and reduced incidence of colon cancer. Here, all six major metabolites, along with a Cabernet Sauvignon anthocyanin extract, were incubated with Caco-2 cells at concentrations of 0-1000 microM over 72 h to determine effects on cell proliferation and for 24 h to assess cytotoxicity effects and at 140 microM for 24 h to measure induction of apoptosis. These measurements were based on colorimetric methods. Gallic acid and 3-O-methylgallic acid inhibited cell proliferation and lacked cytotoxicity at low concentrations. The aldehyde metabolite and anthocyanin extract also inhibited cell proliferation at low concentrations and had low cytotoxicity at a wide range of concentrations. Of the four substances that effectively reduced cell proliferation, the aldehyde was the best inducer of apoptosis. In addition, these same four treatments degraded quickly in growth media, suggesting the involvement of subsequent oxidation products in the reduction of cell viability. These results indicate that the anthocyanin microfloral metabolites gallic acid, 3-O-methylgallic acid, and 2,4,6-trihydroxybenzaldehyde reduce cell proliferation in Caco-2 cells more effectively than anthocyanins and may offer protection against colon cancer after their formation in the gut.
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Affiliation(s)
- Sarah C Forester
- Department of Viticulture and Enology, University of California, Davis, California 95616, USA
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Park JY, Mitrou PN, Dahm CC, Luben RN, Wareham NJ, Khaw KT, Rodwell SA. Baseline alcohol consumption, type of alcoholic beverage and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition-Norfolk study. Cancer Epidemiol 2009; 33:347-54. [DOI: 10.1016/j.canep.2009.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 10/27/2009] [Accepted: 10/30/2009] [Indexed: 10/20/2022]
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Forester SC, Waterhouse AL. Metabolites are key to understanding health effects of wine polyphenolics. J Nutr 2009; 139:1824S-31S. [PMID: 19640966 DOI: 10.3945/jn.109.107664] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Phenolic compounds in grapes and wine are grouped within the following major classes: stilbenes, phenolic acids, ellagitannins, flavan-3-ols, anthocyanins, flavonols, and proanthocyanidins. Consumption of foods containing phenolic substances has been linked to beneficial effects toward chronic diseases such as coronary heart disease and colorectal cancer. However, such correlations need to be supported by in vivo testing and bioavailability studies are the first step in establishing cause and effect. Class members from all phenolic groups can be glucuronidated, sulfated, and/or methylated and detected at low concentrations in the bloodstream and in urine. But the majority of phenolic compounds from grapes and wine are metabolized in the gastrointestinal tract, where they are broken down by gut microflora. This typically involves deglycosylation, followed by breakdown of ring structures to produce phenolic acids and aldehydes. These metabolites can be detected in bloodstream, urine, and fecal samples by using sophisticated instrumentation methods for quantitation and identification at low concentrations. The health effects related to grape and wine consumption may well be due to these poorly understood phenolic acid metabolites. This review discusses the known metabolism of each major class of wine and grape phenolics, the means to measure them, and ideas for future investigations.
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Affiliation(s)
- Sarah C Forester
- Department of Viticulture and Enology, University of California, Davis, CA 95616, USA
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Hirano T, Sakai A, Ootsuyama Y, Kasai H. Chronic alcohol consumption prevents 8-hydroxyguanine accumulation in 3'-methyl-4-dimethylaminoazobenzene-treated mouse liver. Biochem Biophys Res Commun 2009; 387:316-20. [PMID: 19596271 DOI: 10.1016/j.bbrc.2009.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/03/2009] [Indexed: 10/20/2022]
Abstract
Alcohol consumption is known to have opposing effects on carcinogenesis: promotion and prevention. In this study, we examined the effects of 12% ethanol on oxidative DNA damage accumulation and its repair in mouse livers treated with 3'-methyl-4-dimethylaminoazobenzene (3'-MeDAB), a well-known hepatic carcinogen. We previously reported that 3'-MeDAB increased 8-hydroxyguanine (8-OH-Gua) accumulation and its repair activity, accompanied by the fragmentation of 8-oxoguanine DNA glycosylase 1 (OGG1), the main repair enzyme of 8-OH-Gua. The present results showed that 12% ethanol intake attenuated the 8-OH-Gua accumulation, but not the fragmentation of OGG1 induced by 3'-MeDAB. Additionally, no significant changes in oxidative status, as monitored by lipid peroxidation (LPO), were observed among the 3'-MeDAB-treated mouse livers with/without alcohol administration. These findings suggested that 12% ethanol consumption may reduce the risk of 3'-MeDAB-induced carcinogenesis by decreasing 8-OH-Gua accumulation.
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Affiliation(s)
- Takeshi Hirano
- Department of Life and Environment Engineering, Faculty of Environmental Engineering, The University of Kitakyushu, Kitakyushu, Fukuoka 808-0135, Japan.
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Figueiredo P, Donato M, Urbano M, Goulão H, Gouveia H, Sofia C, Leitão M, Freitas D. Aberrant crypt foci: endoscopic assessment and cell kinetics characterization. Int J Colorectal Dis 2009; 24:441-50. [PMID: 18769883 DOI: 10.1007/s00384-008-0576-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Aberrant crypt foci (ACF) are preneoplastic lesions in animal models of colorectal cancer. The aim of the study is to investigate if ACF are involved in human colorectal carcinogenic process and if they can be helpful in predicting the presence of a colorectal neoplasia. METHODS The study included, between 2003 and 2005, 182 patients, 62 with adenoma, 55 with colorectal carcinoma, 53 without colorectal lesions, and 12 with nonneoplastic mucosal polyps. The number of rectal ACF was determined by colonoscopy. Proliferation and apoptosis indexes were evaluated by immunohistochemistry in rectal ACF, in normal rectal mucosa, and in carcinomatous tissue. RESULTS The mean number of rectal ACF in patients with rectal neoplasia was 12.64, significantly higher than in patients with neoplastic lesions elsewhere in the colon (p=0.01). The apoptosis index in ACF of patients with colorectal carcinoma or adenoma aged 50 years or older was significantly lower than in younger patients (1.3% vs 2.7%, p=0.01) and, in patients with carcinoma, lower than in normal mucosa (1.1% vs 2.1%, p=0.002). The proliferation index was significantly higher in ACF of patients with colorectal neoplasia aged less than 50 years than in normal mucosa (10.9% vs 7.7%, p=0.02). The apoptosis index in ACF foci of patients with carcinoma (1.1%) was significantly lower than in patients without lesions (2.2%) and than in normal mucosa (2%). The mean number of ACF is significantly higher in patients with polyps larger than 1 cm (11.28 vs 6.27, p=0.02). CONCLUSION Aberrant crypt foci probably precede the appearance of neoplasia and may be helpful in predicting the presence of a colorectal neoplastic lesion.
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Affiliation(s)
- Pedro Figueiredo
- Department of Gastroenterology, Hospitais da Universidade de Coimbra, Avenida Bissaya Barreto, 3000-075 Coimbra, Portugal.
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Abstract
Colorectal cancer affects over 150,000 individuals yearly, and accounts for over 50,000 deaths. Much of the benefit of colorectal cancer screening has been attributed to detection and removal of adenomatous polyps, highlighting the importance of colorectal polyps as targets for intervention and as biomarkers for colorectal cancer risk. This review details the epidemiology of sporadic colorectal polyps, rationale behind use of polyps as an important surrogate for colorectal cancer risk, the benefits and limitations of secondary prevention of colorectal polyps through chemopreventive and dietary interventions, as well as colon surveillance.
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Forester SC, Waterhouse AL. Identification of Cabernet Sauvignon anthocyanin gut microflora metabolites. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2008; 56:9299-9304. [PMID: 18767860 DOI: 10.1021/jf801309n] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Anthocyanins are polyphenol antioxidants that have been shown to prevent many chronic diseases, including colon cancer. The compounds are largely metabolized by various enzymes and bacteria in the large intestine, and the health benefits of consuming foods rich in anthocyanins could be due mostly to the effects of these metabolites. In this study, the contents of the large intestine of pigs were used to model anthocyanin metabolism because pig and human intestinal microflora are similar. An anthocyanin extract from Cabernet Sauvignon grapes that contained delphinidin-3-glucoside, petunidin-3-glucoside, peonidin-3-glucoside, and malvidin-3-glucoside was employed. The extract was incubated anaerobically in the contents of the large intestine of freshly slaughtered pigs for 0, 0.5, and 6 h (final concentrations of 20.9, 28.2, 61.4, and 298.0 microM of the above anthocyanin compounds, respectively, at t = 0 h). Anthocyanins and their metabolites were measured by LC-ESI-MS. After 6 h, anthocyanins were no longer detected, and three metabolites were identified as 3-O-methylgallic acid, syringic acid, and 2,4,6-trihydroxybenzaldehyde. Results from this study suggest that consumption of Cabernet Sauvignon grape anthocyanins could lead to the formation of specific metabolites in the human gut, and it is possible that these metabolites offer the protective effect against colon cancer attributed to anthocyanin consumption.
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Affiliation(s)
- Sarah C Forester
- Department of Viticulture and Enology, University of California, One Shields Avenue, Davis, California 95616, USA
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Toriola AT, Kurl S, Laukanen JA, Mazengo C, Kauhanen J. Alcohol consumption and risk of colorectal cancer: the Findrink study. Eur J Epidemiol 2008; 23:395-401. [DOI: 10.1007/s10654-008-9244-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 03/23/2008] [Indexed: 10/22/2022]
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Austin GL, Galanko JA, Martin CF, Sandler RS. Moderate alcohol consumption protects against colorectal adenomas in smokers. Dig Dis Sci 2008; 53:116-22. [PMID: 17510802 PMCID: PMC2664311 DOI: 10.1007/s10620-007-9831-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 03/21/2007] [Indexed: 12/09/2022]
Abstract
BACKGROUND Although some studies have shown an association between alcohol consumption and colorectal adenomas, the effect of moderate alcohol consumption is not well defined, nor is the interaction between alcohol and smoking. AIM To investigate the relationship between different levels of alcohol consumption and colorectal adenomas and to determine whether smoking modifies this relationship. METHODS Eligible patients who underwent a complete colonoscopy were included (179 cases and 466 controls). Alcohol consumption was obtained from a lifestyle questionnaire. Patients were divided into three groups: (1) Abstainers: 0 drinks/week; (2) Moderate drinkers: > 0 to <7 drinks/week; (3) Heavy drinkers: > or = 7 drinks/week. Odds ratios (OR) were calculated using logistic regression, controlling for gender, age, body mass index, use of non-steroidal anti-inflammatory medications. Results were stratified by the number of years smoked. RESULTS The proportion of patients with adenomas was 29.6% in abstainers, 22.1% in moderate drinkers, and 36.7% in heavy drinkers. The relationship between alcohol consumption and colorectal adenomas varied significantly by smoking history. For individuals who had never smoked, heavy drinkers were at significantly increased odds of having an adenoma compared to moderate drinkers (OR 3.08; 95% CI: 1.50-6.32), while no difference was seen for abstainers (OR 0.99; 95% CI: 0.52-1.89). Similarly, among individuals who had smoked 1-14 years, heavy drinkers were at increased odds of having an adenoma compared to moderate drinkers (OR 2.61; 95% CI: 1.04-6.51), and no difference was seen for abstainers (OR 1.02; 95% CI: 0.33-3.10). Somewhat unexpectedly, among individuals who had smoked for 15 or more years, abstainers were at increased odds of having an adenoma compared to moderate drinkers (OR 2.04; 95% CI: 0.91-4.59), while heavy drinkers were not at increased odds of having an adenoma (OR 0.73; 95% CI: 0.27-1.97). CONCLUSIONS Consumption of less than seven alcohol drinks per week does not increase the risk of having a colorectal adenoma. We found evidence in this study that moderate alcohol consumption among long-term smokers may potentially decrease the risk of an adenoma compared to abstainers.
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Affiliation(s)
- Gregory L Austin
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC 27599-7080, USA.
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Steinmetz J, Spyckerelle Y, Guéguen R, Dupré C. Le tabac et l'alcool augmentent le risque d'adénomes et de cancers colorectaux. Presse Med 2007; 36:1174-82. [PMID: 17350789 DOI: 10.1016/j.lpm.2007.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 11/23/2006] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the associations between lifestyle factors and colorectal adenomas or cancers in a population 50-74 years old. METHOD The study population underwent colonoscopy after positive fecal occult blood test in Health examination centers of the French general health insurance. The two sets of cases (n= 674 cancers, n=2618 adenomas) were compared with controls (n=5456). Associations between risk of colorectal disease and health data (mainly tobacco and alcohol consumption, physical activity, obesity, and laboratory test results) were analyzed with logistic regression models to estimate odds ratios. RESULTS The probability of colorectal cancer or adenoma was statistically associated with age (60 years or older in men and women). A significant relation between these diseases was observed with smoking (in both smokers and ex-smokers) and with alcohol consumption, with odds ratios above 1.30. The other risk factors studied were not significantly associated with these colorectal diseases. CONCLUSION This result provides still more evidence of the need for actions against these risk behaviors.
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Affiliation(s)
- Josiane Steinmetz
- Centre technique d'appui et de formation des centres d'examens de santé, Saint-Etienne.
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Stang A, Stabenow R, Stegmaier C, Eisinger B, Bischof-Hammes E, Jöckel KH. Unexplained inversion of the incidence ratio of colon and rectal cancer among men in East Germany. A time trend analysis including 147,790 cases. Eur J Epidemiol 2007; 22:245-55. [PMID: 17364131 DOI: 10.1007/s10654-007-9114-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 01/15/2007] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The incidence rate ratio of colon to rectal cancer is usually about 2:1. It has been observed for a while that the incidence of colon cancer among men (as opposed to women) in the Former German Democratic Republic (GDR) is lower than the rate of rectal cancer. Detailed analyses of this phenomenon have not been done so far. The aim was to give insights in this observation by detailed incidence and mortality analyses and to explore the worldwide ratio of colon and rectal cancers based on population-based cancer registry data. METHODS We analyzed age-standardized incidence and mortality data of colorectal cancers in East Germany (1961-1989 and 1996-2002; mortality 1980-2002), West Germany, Saarland (1970-2002) and all over the world (1978-82 up to 1993-97). RESULTS With the incidence increase of colorectal cancers in the GDR, the ratio of colon to rectal cancer incidence became larger and surpassed the reference value (ratio = 1) during the time of the reunification. Also the mortality data revealed a similar pattern. Estimated annual percentage increases of colon subsite incidences tended to be higher within the distal colon as compared to the proximal colon CONCLUSIONS Our analyses of international cancer registries over a period of 20 years show that the colon-rectum cancer ratio is positively associated with the overall incidence of colorectal cancer with a stronger association among women than men. Non-causal factors such as underdetection or registration artefacts are unlikely to explain the unusual colon/rectal rate ratio among men. A gradual decrease of the job-related physical activity among men may have contributed to the findings.
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Affiliation(s)
- Andreas Stang
- Clinical Epidemiology Unit, Institute of Medical Epidemiology, Biometry and Informatics, Medical Faculty, Martin-Luther-University of Halle-Wittenberg, Magdeburger Str. 27, 06097, Halle, Germany.
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Abstract
Screening and surveillance substantially reduce both the incidence and mortality of colorectal cancer. Screening of normal-risk individuals may be accomplished by several methods, including fecal occult blood testing, fiberoptic sigmoidoscopy, double contrast barium enema, and colonoscopy. New technologies for screening are being developed, such as fecal immunochemical testing for blood,fecal DNA testing, and virtual colonoscopy. Patients at increased risk for colorectal cancer, such as those with a positive family history, previous adenomatous polyps or cancer, and inflammatory bowel disease, should be offered more intensive evaluation and surveillance.
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Affiliation(s)
- William V Harford
- Veterans Administation Medical Center, Gastro 111B1, DVAMC, 4500 South Lancaster Road, Dallas, TX 75216, USA.
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