Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40–49 years undergoing screening colonoscopy

Chung, Su Jin; Kim, Young Sun; Yang, Sun Young; Song, Ji Hyun; Park, Min Jung; Kim, Sang Woo; Jung, Hyun Chae; Song, In Sung

doi:10.1111/j.1440-1746.2009.06147.x

Cited by 87 publications

(99 citation statements)

References 28 publications

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“…Researchers from Asian-pacific developed countries have also reported a significant increase of CRC over the last decades. It seems that these countries actually have the same incidence as western countries; this could be due to the "westernization" of lifestyles in these countries (Choe et al, 2007;Chung et al, 2010;Aswakul et al, 2012;Ng and Wong 2013;Yang et al, 2014). This discrepancy between our findings and theirs might be related to lifestyle, diet, younger population and also genetic differences.…”

Section: Discussioncontrasting

confidence: 51%

“…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: Discussioncontrasting

confidence: 47%

“…However, a remarkable portion (54%) of adenomas was detected beyond the rectosigmoid and was not detected by sigmoidoscopy alone. Chung also reported that two-thirds of the overall adenomas were detected above the sigmoid colon (Chung, Kim et al, 2010). Moreover, about 30% of advanced adenomas in our study were detected in the proximal colon which in turn advocates the performance of colonoscopy in the asymptomatic average-risk population as a preferable screening method.…”

Section: Discussionmentioning

confidence: 74%

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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: Discussioncontrasting

confidence: 51%

Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 74%

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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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“…Of some interest was the finding that higher BMI was associated with increased risk of neoplasia independent of age group, a finding that persisted in adjusted analyses. Subgroup analyses that had advanced adenoma as the outcome were not done, probably [8][9][10][11]. Collectively, the study findings show a consistently low risk of advanced adenoma and a nearly zero risk of adenocarcinoma.…”

mentioning

confidence: 92%

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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“…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...

show abstract

Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40–49 years undergoing screening colonoscopy

Abstract: Prevalence of adenoma in subjects aged 40-49 years was higher than in previous studies. Male sex and current smoking habits along with a family history of colorectal cancer were associated with advanced adenoma in this age group.

Cited by 87 publications

References 28 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?

CRC Screening: Is It Worthwhile in Younger Adults?

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