Retrospective study of colorectal cancer in Zimbabwe: Colonoscopic and clinical correlates

Katsidzira, Leolin

doi:10.3748/wjg.v21.i8.2374

Cited by 13 publications

(15 citation statements)

References 21 publications

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“…This strategy was put in place in order to assess the appropriateness of all referrals. An audit done in Zimbabwe found that 52% of the colonoscopies were normal, while in Nigeria it was 29% 6 , 11 .…”

Section: Discussionmentioning

confidence: 99%

“…Similar to colorectal cancer, diverticular disease was thought to be rare in Africa, but evidence is emerging in support of a higher prevalence of the disease than previously believed 4 , 5 . However, the exact burden of diverticular disease in sub-Saharan Africa is not clear but it has been reported to be significantly higher among whites than blacks 6 . It is known that only 10–20% of individuals with diverticular disease present with symptoms making it difficult to ascertain prevalence in countries that do not offer screening colonoscopies 7 .…”

Section: Introductionmentioning

confidence: 99%

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A seven-year retrospective review of colonoscopy records from a single centre in Zambia

et al. 2018

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IntroductionColorectal disease is common throughout the world, but the spectrum of diagnoses across Africa remains largely unexplored. There is anecdotal evidence of changing colorectal disease but this has not been systematically investigated. The aim of this study was to enhance our insight into the spectrum of colonoscopic diagnoses in Zambia.MethodsWe retrieved written colonoscopy reports from January 2008 to December 2015. Collected data were coded by experienced endoscopists and analysed by age, sex, referral source, indication and diagnosis.ResultsIncluded in this analysis were 573 colonoscopy reports. The most common diagnosis was haemorrhoids (n=151, 26%), followed by tumours (n=96,17%). Over this time period, the proportion of normal colonoscopies decreased by 32% (P<0.001), presumably due to introduction of screening of all requests, while the rate of polyp detection increased from 5% to 10% (P=0.006). The detection of polyps was highest in patients less than 16 years (OR 8.4; 95% CI 2.4–26.2, P<0.001). Of those with colorectal tumours, 33/96 (35%) were less than 45 years although the occurrence was higher with advancing age (P=0.02). Diverticular disease was more common in older age groups (median (IQR) age 70 (60–75) years, versus 47 (34–62) years for those without the disease; P=0.0001).ConclusionThis audit has shown that more than a third of colorectal tumours seen during colonoscopy are in patients below the age of 45 years, with the occurrence of polyps being highest in those below 16 years. Diverticular disease is most common in older age groups.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A seven-year retrospective review of colonoscopy records from a single centre in Zambia

et al. 2018

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“…In particular, blacks have an increased prevalence of precursor lesions >9 mm as compared to white individuals [31] and show a higher number of polyps at a young age compared to Hispanic Americans [59], with whom they share an increased risk of adenomas than whites at an older age [60]. Katsidzira et al conducted a study that demonstrated racial differences in the incidence of polyps in Zimbabwe: a less occurrence of polyps among black Africans (5%) and more frequent onset of adenomatous polyps in Caucasians (8%) and Asians (9%), whereas colorectal cancer was more diffused among black Africans [61]. ese geographic differences might be supported by diversities in lifestyles and exposition to different environmental factors.…”

Section: Unmodifiable Factorsmentioning

confidence: 99%

Molecular Aspects of Colorectal Adenomas: The Interplay among Microenvironment, Oxidative Stress, and Predisposition

Aceto

Catalano

Curia

2020

BioMed Research International

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The development of colorectal cancer (CRC) is a multistep process initiated by a benign polyp that has the potential to evolve into in situ carcinoma through the interactions between environmental and genetic factors. CRC incidence rates are constantly increased for young adult patients presenting an advanced tumor stage. The majority of CRCs arise from colonic adenomas originating from aberrant cell proliferation of colon epithelium. Endoscopic polypectomy represents a tool for early detection and removal of polyps, although the occurrence of cancers after negative colonoscopy shows a significant incidence. It has long been recognized that the aberrant regulation of Wingless/It (Wnt)/β-Catenin signaling in the pathogenesis of colorectal cancer is supported by its critical role in the differentiation of stem cells in intestinal crypts and in the maintenance of intestinal homeostasis. For this review, we will focus on the development of adenomatous polyps through the interplay between renewal signaling in the colon epithelium and reactive oxygen species (ROS) production. The current knowledge of molecular pathology allows us to deepen the relationships between oxidative stress and other risk factors as lifestyle, microbiota, and predisposition. We underline that the chronic inflammation and ROS production in the colon epithelium can impair the Wnt/β-catenin and/or base excision repair (BER) pathways and predispose to polyp development. In fact, the coexistence of oxidative DNA damage and errors in DNA polymerase can foster C>T transitions in various types of cancer and adenomas, leading to a hypermutated phenotype of tumor cells. Moreover, the function of Adenomatous Polyposis Coli (APC) protein in regulating DNA repair is very important as therapeutic implication making DNA damaging chemotherapeutic agents more effective in CRC cells that tend to accumulate mutations. Additional studies will determine whether approaches based on Wnt inhibition would provide long-term therapeutic value in CRC, but it is clear that APC disruption plays a central role in driving and maintaining tumorigenesis.

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“…In addition, a disproportionally large number of Black patients are presenting with CRC at a young age, with a lower adenoma burden than that observed in other population groups. In isolated reports, these differences have been ascribed to genetics, changes in dietary habits and gut transit time, rural versus urban demography, and socioeconomic disparities, particularly with reference to access to health services …”

Section: Introductionmentioning

confidence: 99%

“…In isolated reports, these differences have been ascribed to genetics, changes in dietary habits and gut transit time, rural versus urban demography, and socioeconomic disparities, particularly with reference to access to health services. 9,[15][16][17][18] We have established a prospective, longitudinal cohort study in response to the increasing burden of cancer in SSA in general and, in particular, to address the paucity of data on CRC. We are principally interested in addressing disparities observed in different population groups; determining associated risk factors; and describing clinical presentation, tumor histology, treatment modalities, and outcomes (morbidity and mortality).…”

Section: Introductionmentioning

confidence: 99%

Design and methodology of a study on colorectal cancer in Johannesburg, South Africa

et al. 2018

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Background and AimCancer is one of the foremost causes of morbidity and mortality worldwide. Globally, colorectal cancer (CRC) is the third most diagnosed and fourth most important cause of cancer death. A total of 70% of all CRC‐related deaths occur in low‐ and middle‐income countries. In Sub‐Saharan Africa (SSA), estimating the burden of CRC is difficult. Only 27 of 43 SSA countries have formalized cancer registration systems; data quality is variable and national coverage rare.MethodsThis is a multidisciplinary, longitudinal cohort study started in January 2016. Patients >18 years with histologically confirmed primary adenocarcinoma of the colon and rectum, diagnosed within the previous 12 months, are eligible. Participants were assessed and were followed up for 3 years. Baseline information, including demographics, socioeconomic status, family history, medical and surgical non‐cancer‐related history, dietary history, colonoscopic findings, staging at presentation, treatment, and disease recurrence, is collected, as well as blood tests and histology results. Outcomes include disease recurrence (local and metastatic) and survival.Results and ConclusionThis study aims to describe the clinical presentation, management, and outcomes of adults with CRC in a multiethnic, urban South African population. It will be the first prospective study to describe clinical presentation, demographics, risk factors, treatment, and outcomes according to population group, from both private and state health‐care facilities in Johannesburg, South Africa. The results of this study will be relevant not only to South Africa but also to other SSA countries undergoing similar rates of rapid urbanization and epidemiological transition.

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Retrospective study of colorectal cancer in Zimbabwe: Colonoscopic and clinical correlates

Abstract: The likelihood of diagnosing colorectal cancer in patients referred for colonoscopy in Zimbabwe is at least as likely among black Africans as it is among Caucasians.

Cited by 13 publications

References 21 publications

A seven-year retrospective review of colonoscopy records from a single centre in Zambia

A seven-year retrospective review of colonoscopy records from a single centre in Zambia

Molecular Aspects of Colorectal Adenomas: The Interplay among Microenvironment, Oxidative Stress, and Predisposition

Design and methodology of a study on colorectal cancer in Johannesburg, South Africa

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