Metabolic syndrome and smoking may justify earlier colorectal cancer screening in men

Chang, Li-Chun; Wu, Ming–Shiang; Tu, Chia‐Hung; Lee, Yi–Chia; Shun, Chia‐Tung; Chiu, Han–Mo

doi:10.1016/j.gie.2013.11.035

Cited by 67 publications

(66 citation statements)

References 29 publications

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“…The prevalence of colorectal neoplasia in our study was 20.5%, almost twice that of the 9.8–14% reported in prior studies, and similar to recent South Korean and Taiwan series . All study cohorts composed of 40‐ to 49‐year olds and consisted almost equally or predominantly of men (49–81% men), whereas our study included mostly women (38% men).…”

Section: Discussionsupporting

confidence: 88%

“…The change in endoscopy equipment, however, was not associated with significantly higher advanced adenoma detection . Similarly, prevalence of advanced adenoma was comparable across prior studies, but non‐advanced adenoma prevalence doubled from ~8% in the earliest studies to over 15% in more recent reports, including our results . Although perceived as conferring a lower risk for CRC, the National Cancer Institute pooling study have demonstrated that, on 3‐ to 5‐year follow up after an index finding of low risk adenoma, advanced adenomas were found in a non‐negligible 6.9% of patients .…”

Section: Discussionsupporting

confidence: 73%

“…All study cohorts composed of 40‐ to 49‐year olds and consisted almost equally or predominantly of men (49–81% men), whereas our study included mostly women (38% men). Our observed neoplasia rates would likely be even higher after adjusting for gender differences, as men have higher disease prevalence than women . Ethnic differences also existed among the published studies, but a retrospective study did not identify differences in adenoma rates between Caucasians and Asians .…”

Section: Discussionmentioning

confidence: 67%

See 2 more Smart Citations

Prevalence, distribution, and risk factor for colonic neoplasia in 1133 subjects aged 40–49 undergoing screening colonoscopy

Wong

Lau

Suen

et al. 2017

J of Gastro and Hepatol

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 67%

See 1 more Smart Citation

Prevalence, distribution, and risk factor for colonic neoplasia in 1133 subjects aged 40–49 undergoing screening colonoscopy

Wong

Lau

Suen

et al. 2017

J of Gastro and Hepatol

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“…A study by Chang et al [17] found that the overall prevalence of Dig Dis Sci colonic neoplasms and advanced adenomas was increased in men ages 40-49 years with metabolic syndrome with or without cigarette smoking, as compared to women in the same age-group and average-risk women ages 50-59 years. The number of colonoscopies needed to detect one advanced adenoma in these younger men with metabolic syndrome and smoking, smoking alone, metabolic syndrome alone and women who are average-risk ages 50-59 years was 14.6, 24.8, 39.8 and 47.8, respectively.…”

Section: Behavioral and Environmental Etiologies Of Crcmentioning

confidence: 99%

Colorectal Cancer in Young Adults

Inra

Syngal

2014

Dig Dis Sci

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The incidence and mortality rates of colorectal cancer (CRC) have been decreasing in adults over 50 years of age, however, these rates have been increasing in adults under 50. The majority of CRC in young adults is sporadic, and is likely due to behavioral and environmental causes, however the exact etiology still remains unclear. The minority of CRC in this population is due to inherited CRC syndromes. Young adults with CRC are often symptomatic (abdominal pain, rectal bleeding), and diagnosis is often delayed due to reasons such as under-utilized health care services, and physicians attributing symptoms to diagnoses other than CRC. Young adults with CRC often have more aggressive tumor characteristics, but they tend to have better survival rates when compared with older adults when matched for stage. Treatment is the same for young patients with CRC, however there are issues that arise in this population that do not necessarily affect older adults, such as the negative effect of chemotherapy/radiation on fertility. It is not clear that screening individuals for CRC at ages under 50 is beneficial or cost-effective. Further studies are needed regarding this topic.

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“…Smoking, at even higher exposure levels of 30 or more pack-years, has a twofold risk of adenomas in young and older adults [5,7,11]. Other similar studies have also documented that smoking is an important predictor in younger adults when using a definition of current smoking as an exposure variable [12,13]. Thus, it is possible that the stratification of smoking exposure may have had an impact on the outcome.…”

mentioning

confidence: 99%

CRC Screening: Is It Worthwhile in Younger Adults?

Bortniker

Anderson

2016

Dig Dis Sci

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Although current guidelines recommend screening for colorectal cancer (CRC) in average-risk individual starting at age 50 [1], more than 10 % of CRC is diagnosed prior to this age [2]. Furthermore, while the rates for older individuals have decreased, the rates for younger adults may be increasing [2]. Current guidelines recommend that individuals with a family history of CRC or a genetic syndrome should be screened at an age younger than 50 years, preferentially with colonoscopy [1]. In 2009, the American College of Gastroenterology (ACG) recommended colonoscopic screening of African-Americans starting at age 45 [1]. Can other groups of adults who may be at risk of CRC at an early age be identified? In the current issue of Digestive Diseases and Sciences, Jung et al.[3] describe a strategy designed to identify high-risk individuals\50 years old who might benefit from screening colonoscopy and thus reduce the substantial burden of colorectal cancer in this age group.Jung et al. report a cross-sectional analysis of 27,894 Korean adults who underwent an initial colonoscopy for preventative health care. The investigators collected data that included age, sex, height, weight, medications, family history of colorectal neoplasia, smoking exposure, alcohol intake, physical activity, self-reported comprehensive medical and surgical history, and blood pressure measurements. Laboratory data collected included hepatic sonographic data, serum concentrations of triglyceride, cholesterol, and glucose in addition to screening colonoscopy reports. Using these data, the authors stratified the participants by risk factors including sex and age. The investigators then calculated the number needed to screen (NNS) to identify one adult with advanced colorectal neoplasm for each group. The NNS was calculated as the inverse of the prevalence of advanced lesions for each group. Thus, a group with a lower NNS might derive greater benefit from screening colonoscopy than a group with a higher NNS. They compared the NNS in men, stratified into age groups under 50 years as well as varying risk exposures, to those of a low-risk group of women 50 years and older with no known risk factors.The investigators observed that the only group with a lower NNS than the control group of women over age of 50 years (26.4; 95 % CI 19.0-43.5) was the cohort of men 45-49 years old who had all of the risk factors considered by the authors: smoking, metabolic syndrome, obesity, and fatty liver disease (18.4;). Thus, they concluded that there was no benefit to screening high-risk individuals \ 45 years old. Do these data suggest that the effort to find a high-risk group in young adults may be futile?There are many strong points in the current study, which help to support its findings. The major strength is the sample size, which included over 25,000 individuals younger than 50 years, a group that has not been included in most of the previously published screening studies. Furthermore, the exclusion of adults with a family history of CRC is also important since...

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Metabolic syndrome and smoking may justify earlier colorectal cancer screening in men

Cited by 67 publications

References 29 publications

Prevalence, distribution, and risk factor for colonic neoplasia in 1133 subjects aged 40–49 undergoing screening colonoscopy

Prevalence, distribution, and risk factor for colonic neoplasia in 1133 subjects aged 40–49 undergoing screening colonoscopy

Colorectal Cancer in Young Adults

CRC Screening: Is It Worthwhile in Younger Adults?

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