Detection of Colorectal Neoplasia by Colonoscopy in Average-Risk Patients Age 40–49 Versus 50–59 Years

Thoma, Matthew N.; Castro, Fernando; Golawala, Mushfeka; Ren, Chao

doi:10.1007/s10620-011-1565-6

Cited by 21 publications

(19 citation statements)

References 23 publications

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“…Our study also showed that the prevalence of either neoplasia (overall) or advanced adenoma was more prevalent among men in different ages; but they were not significant (Table 5), which is comparable with previous reports (Lieberman et al, 2000;Bafandeh et al, 2005;Boursi et al, 2009;Ferlay et al, 2010;Ferlitsch et al, 2011;Thoma et al, 2011). Furthermore, adenoma in the proximal colon was detected more among males, although it was not significant.…”

Section: Discussionsupporting

confidence: 89%

“…Moreover, our findings shows that a noticeable number of colorectal neoplasia (11.7%) has been detected among the younger participants (40-49 years old). Although this result is lower than Thoma, Rundel and Chung's studies (Rundle et al, 2008;Chung et al, 2010;Thoma et al, 2011); when considering other factors such as the young population and westernization of the younger generation's lifestyle, it is suspected that we would be faced with a population holding a higher risk of colorectal adenoma in the future.…”

Section: Discussionmentioning

confidence: 62%

“…The beginning of screening for colorectal lesions for the average-risk population is recommended at age 50 by many gastrointestinal professionals societies (Ness et al, 2000;Thoma et al, 2011). Studies regarding the effectiveness of CRC screening program support the benefit of screening programs as a means of decreasing morbidity and mortality of CRC (Winawer et al, 1993;Levin et al, 2008;Rex et al, 2009;Morois et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Colorectal Polyps in a Group of Subjects at Average-risk of Colorectal Cancer Undergoing Colonoscopic Screening in Tehran, Iran between 2008 and 2013

Sohrabi¹,

Zamani²,

Ajdarkosh³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Colorectal cancer (CRC) is one of the prime causes of mortality around the globe, with a significantly rising incidence in the Middle East region in recent decades. Since detection of CRC in the early stages is an important issue, and also since to date there are no comprehensive epidemiologic studies depicting the Middle East region with special attention to the average risk group, further investigation is of significant necessity in this regard. Aim: Our aim was to investigate the prevalence of preneoplastic and neoplastic lesions of the colon in an average risk population. Materials and Methods: A total of 1,208 eligible asymptomatic, average-risk adults older than 40 years of age, referred to Firuzgar Hospotal in the years 2008-2012, were enrolled. They underwent colonoscopy screening and all polypoid lesions were removed and examined by an expert gastrointestinal pathologist. The lesions were classified by size, location, numbers and pathologic findings. Size of lesions was measured objectively by endoscopists. Results: The mean age of participants was 56.5 ± 9.59 and 51.6% were male. The overall polyp detection rate was 199/1208 (16.5 %), 26 subjects having non-neoplastic polyps, including hyperplastic lesions, and 173/1208 (14.3%) having neoplastic polyps, of which 26 (2.15%) were advanced neoplasms .The prevalence of colorectal neoplasia was more common among the 50-59 age group. Advanced adenoma was more frequent among the 60-69 age group. The majority of adenomas were detected in the distal colon, but a quarter of advanced adenomas were found in the proximal colon; advance age and male gender was associated with the presence of adenoma. Conclusions: It seems that CRC screening among average-risk population might be recommended in countries such as Iran. However, sigmioidoscopy alone would miss many colorectal adenomas. Furthermore, the 50-59 age group could be considered as an appropriate target population for this purpose in Iran.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

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Prevalence of Colorectal Polyps in a Group of Subjects at Average-risk of Colorectal Cancer Undergoing Colonoscopic Screening in Tehran, Iran between 2008 and 2013

Sohrabi¹,

Zamani²,

Ajdarkosh³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…One piece of information required for the models is the prevalence of clinically-important neoplasia (i.e., adenocarcinoma and advanced adenomatous polyps). What does the literature tell us about this prevalence?In this issue, Thoma and colleagues [7] report on neoplastic findings in 247 persons aged 40-49 years as compared with those of 747 persons aged 50-59. All subjects underwent first-time colonoscopy to the cecum.…”

mentioning

confidence: 99%

“…In this issue, Thoma and colleagues [7] report on neoplastic findings in 247 persons aged 40-49 years as compared with those of 747 persons aged 50-59. All subjects underwent first-time colonoscopy to the cecum.…”

mentioning

confidence: 99%

The Average-Risk Age Threshold for Colorectal Cancer Screening: Should It Be Lowered?

Imperiale

2011

Dig Dis Sci

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Screening for colorectal cancer (CRC) among average-risk adults is recommended by several guidelines organizations beginning at age 50. This age threshold was established in part because of a dramatic increase in CRC incidence during the sixth decade of life [1]. CRC screening is considered to be both effective and cost-effective in persons 50 years or older. The most recent epidemiologic data from SEER indicate that CRC incidence has continued to fall in this age group, and screening undoubtedly accounts for part of the decline.In contrast, the CRC picture for persons younger than age 50 is not as good: CRC incidence in this age group has risen. In particular, CRC incidence has increased among persons ages 40-45 from 12 per 100,000 in 1987 to 18 per 100,000 in 2006-a 50% increase over 20 years [2]. Persons younger than age 50 account for 7-9% of CRC diagnoses, tend to present with more advanced disease, and have a less favorable prognosis [3][4][5]. There are no published data on the effectiveness of CRC screening for persons younger than 50, and the only published model that considered this age group showed that one-time colonoscopy was not costeffective [6]. Nonetheless, other screening modalities such as fecal immunochemical testing might be useful. In light of the rising incidence and poorer prognosis of CRC in persons under age 50, should the average-risk screening age threshold be lowered to 40 years?Obtaining the answer to this complex question requires quantifying and weighing the benefits, risks, and costs of various screening modalities in persons aged 40-49 years, as compared with beginning CRC screening at age 50. Simulation models would be most appropriate for addressing this issue. One piece of information required for the models is the prevalence of clinically-important neoplasia (i.e., adenocarcinoma and advanced adenomatous polyps). What does the literature tell us about this prevalence?In this issue, Thoma and colleagues [7] report on neoplastic findings in 247 persons aged 40-49 years as compared with those of 747 persons aged 50-59. All subjects underwent first-time colonoscopy to the cecum. In addition to reporting age-related prevalence of neoplasia, the investigators report prevalence by gender, ethnicity, and body mass index (BMI). Other than the difference in age, the two groups differed in gender distribution (the proportion of women was greater in the 40-49 group) and colonoscopy indication (the proportion of screening colonoscopies was greater in the 50-59 group)-factors that would tend to have opposing effects on neoplasia prevalence.Not surprisingly, the study found that neoplasia prevalence was higher in the older age group: 22.6% versus 12.1% for any neoplasia, and 4.95% versus 2.02% for advanced adenomas. The protective effect of younger age on neoplasia prevalence persisted after adjustment for gender, race, and BMI. As in previous studies, men were more likely to have adenomas. Of some interest was the finding that higher BMI was associated with increased risk of neoplasia ind...

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Advanced Colorectal Adenomas in Patients Under 45 Years of Age Are Mostly Sporadic

et al. 2014

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Background The presence of advanced adenomas in younger individuals is a criterion for Lynch syndrome (LS). However, the utility of screening advanced adenomas for loss of mismatch repair (MMR) protein expression to identify suspected LS remains unclear. Aims Determine the prevalence of MMR defects to understand whether these patients harbor a defined genetic risk for CRC. Methods The study cohort included adult patients ≤45 years of age with advanced adenomas (villous histology, ≥1 cm in diameter, ≥3 polyps of any size) endoscopically removed between 2001 and 2011. Clinical records were reviewed along with detailed pathological review and immunohistochemical MMR analysis. Results A total of 76 (40.1 % male, age 40.6 ± 5.4 years) patients met inclusion and exclusion criteria. Indications for colonoscopy were gastrointestinal (GI) bleeding 39 (51.3 %), CRC in a first-degree relative 17 (22.4 %) and somatic GI symptoms 20 (26.3 %). Index colonoscopy revealed a median of 1 adenoma (range 1–4), mean diameter of 12.9 ±7.1 mm, 40 (52.6 %) with villous histology. The mean follow-up duration was 3.3 ± 2 years. Recurrent adenomas developed in 24 (31.6 %), of which 8 (10.5 %) were advanced adenomas; none of these patients developed CRC. One of 66 (1.5 %) adenomas available for immunohistochemical (IHC) testing revealed loss of MLH1 and PMS2. Conclusions IHC screening of advanced adenomas from patients younger than 45 years of age identified potential LS in one of 64 patients. The low yield of IHC screening in this population suggests that universal IHC screening of advanced adenomas from patients younger than 45 years of age for MMR defects is not an efficient strategy for identifying LS subjects.

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Detection of Colorectal Neoplasia by Colonoscopy in Average-Risk Patients Age 40–49 Versus 50–59 Years

Cited by 21 publications

References 23 publications

Prevalence of Colorectal Polyps in a Group of Subjects at Average-risk of Colorectal Cancer Undergoing Colonoscopic Screening in Tehran, Iran between 2008 and 2013

Prevalence of Colorectal Polyps in a Group of Subjects at Average-risk of Colorectal Cancer Undergoing Colonoscopic Screening in Tehran, Iran between 2008 and 2013

The Average-Risk Age Threshold for Colorectal Cancer Screening: Should It Be Lowered?

Advanced Colorectal Adenomas in Patients Under 45 Years of Age Are Mostly Sporadic

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