Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related death worldwide. A recent meta-analysis estimated a pooled CRC age-standardized incidence rate of 5.25 per 100,000, though suggested this to be an under-estimate of the true rate. Due to the heterogeneity of dietary and lifestyle practices throughout the continent, our work sought to define risk factors for the development of CRC in Africa. Methods: We systematically searched PubMed, Embase, Global Health, CINAHL, Cochrane CENTRAL, and African Index Medicus for studies written in English, examining risk factors of CRC in Africa. Metaanalysis was performed to compare different risk factors in constituent studies. Jamovi software was used for statistical analysis utilizing a random-effects model. Analysis of CRC studies was supplemented by estimated relative risk (RR) comparing various risk factors. Results: Of 2479 studies screened, 149 were included for the quantitative analysis (n593707). Family history of CRC was associated with a RR of 2.14 and 95% RR CI [1.68-2.72], n5340. Individuals with diets based on high calcium, or vegetable consumption had 45% and 8% lower chances of having CRC, with respective RR of 0.55 [0.44-0.69] and 0.92 [0.84-0.99]. Diets based on carbohydrate, dairy, sugary food/ drinks, or meat consumption indicated 14, 31, 43, or 45% higher chances of CRC, and 1.
Conclusion:In summary, this small study of 12 patients with BE and EV suggests that endoscopic surveillance may not be prioritized in the setting of varices. As a subset of these patients may still develop dysplasia and even adenocarcinoma, decision-making in this setting should weigh the relative risks of surveillance endoscopy and biopsies versus a more conservative approach. Two of these patients without adequate surveillance developed advanced pathology. This study highlights the importance and difficulty in providing adequate endoscopic surveillance in patients with BE and EV.
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