Disparate age and sex distribution of sessile serrated lesions and conventional adenomas in an outpatient colonoscopy population–implications for colorectal cancer screening?

Abstract

Purpose Colorectal cancer (CRC) is increasingly diagnosed in individuals aged < 50 years, resulting in advocacy of screening from age 45 years. Despite existing knowledge associating CRC with conventional adenomas, the significance of sessile serrated lesions (SSLs) on the burden of CRC is less detailed. We aimed to provide contemporary estimates for SSL prevalence and examine patient and procedure factors associated with SSL detection. Methods Retrospective observational study examining associations between SSL and conventional adenoma detection, polyp histopathology, patient, and procedure characteristics in an outpatient colonoscopy unit over 12 months. Results From 2097 colonoscopies, SSL detection was 13.8% overall and 12.5% in patients < 50 years. SSLs were mostly proximal in location (64%), and SSL detection was significantly higher in females compared with males (16.2% vs. 11.7%, p = 0.003), particularly in those < 50 years (16.8% vs. 8.6%, p < 0.001). In multivariable analysis, SSL detection was associated with female sex (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.15–1.91), synchronous conventional adenoma detection (aOR 1.36, 95% CI 1.04–1.78) and BMI ≥ 25 kg/m2 (aOR 1.34, 95% CI 1.02–1.77). Conventional adenoma detection was 33.6% and associated with age ≥ 50 years (aOR 3.57, 95% CI 2.84–4.47) and synchronous SSL detection (aOR 1.36, 95% CI 1.03–1.79). Conclusions We observed age and sex disparities in polyp types and prevalence in this outpatient colonoscopy population. SSLs were most prevalent in females aged < 50 years, suggesting a potential increased susceptibility of young females to SSLs and CRC. Our findings may have implications for the design of CRC screening programs.

Colorectal adenomatous and serrated polyps in rural South Australia: who, why, what and where?

“…A number of studies have shown the majority of SP to be located in the right colon. 14,16 this observation has been implicated in the development right sided colon cancer. 16 We found the majority of CSSL to be located in the distal colon (56.3%).…”

“…The results from this study show that patients aged 40–49 had lower adenoma detection rate (ADR) and serrated polyp detection rate (SPDR, 13.1% and 3.6%) compared to other age groups. However, other Australian studies have reported higher rates of adenomatous (AP) and serrated polyps (SP) in younger patients and especially in females 12,14 . Patients aged 40–49 years old who underwent colonoscopy for positive faecal occult blood had a higher ADR and SPDR of 25.0% and 6.3% respectively when compared to other indications for colonoscopy in this age group (Table S2).…”

“…However, other Australian studies have reported higher rates of adenomatous (AP) and serrated polyps (SP) in younger patients and especially in females. 12,14 Patients aged 40-49 years old who underwent colonoscopy for positive faecal occult blood had a higher ADR and SPDR of 25.0% and 6.3% respectively when compared to other indications for colonoscopy in this age group (Table S2). This may support reducing the age of commencement of CRC screening given the significant findings in patients with faecal occult blood aged 40 to 49 years of age.…”

“…Other Australian studies, on the other hand, have shown increased rates in female patients. 13,14,18 Despite having lower rates of CSSL, women may have higher rates of CSSL that then develop dysplasia and carcinoma. 19 Results for AP detection were also higher in males, this is consistent with previous studies.…”

Colorectal serrated lesions and polyps in the Danish population: A large nationwide register-based cohort study

“…An Australian cohort study found that SP in younger patients may have a lower potential for malignancy than in older patients [16]. In contrast, another Australian cohort study hypothesized that SSL in younger women may be part of the reason for the rising incidence of CRC in women aged < 50 years [30]. However, whether there is a difference in SSL incidence in males and females remains unclear.…”