264 The Differences in Prevalence, Distribution, and Detection Rates of Colonic Polyps Between Genders

Abstract

INTRODUCTION: Gender disparities in colorectal cancer (CRC) incidence and mortality are well recognized in the literature with polyp characteristics and location being amongst some of the most important factors contributing to these disparities. Prior studies have shown an increased prevalence of proximal adenomas and CRC in women. We aimed in this study to compare the distribution and the prevalence of colonic polyps between both genders, as well as evaluating gender-specific lesion detection rates. METHODS: A retrospective review of all screening colonoscopies in patients ≥50 years of age performed at our center between 2012 and 2014 was done. Average risk patients who had a complete colonoscopy with excellent, good and fair bowel preparation were included. Overall, gender-specific, and segment-specific adenoma detection rates (ADR), sessile serrated polyp detection rates (SSPDR) and polypectomy rates (PR) were calculated and compared using t-tests. Proximal colon was defined as the cecum, ascending, and the transverse colon. RESULTS: A total of 4151 patients were included in the analysis. Average patient age was 60.0 ± 7.7 years and 53.2% were females. A total of 652 (15.7%) had excellent preparation, 2675 (64.4%) had good preparation, while 824 (19.9%) had fair preparation (Table 1). Of the 3476 polyps found, 1660 (47%) polyps were found in the proximal colon. Generally, males had more polyps and adenomas all throughout the colon (Table 2). Compared to males, females had less proximal polyps per patient (0.35 ± 0.24 vs. 0.50 ± 0.33; P < 0.001), less proximal adenomas per patient (0.22 ± 0.18 vs. 0.35 ± 0.26, P < 0.001), and less overall large adenomas (>1 cm) per patient (0.05 ± 0.07 vs. 0.09 ± 0.13, P < 0.008). In males, endoscopists had better overall ADR (32.7 ± 14.7 vs. 22.0 ± 12.7, P < 0.001), PR (51.9 ± 17.9 vs. 40.3 ± 18.8, P < 0.001), and SSPDR (22.6 ± 15.7 vs. 16.6 ± 13.7, P < 0.001) (Table 3). CONCLUSION: Our study demonstrates a significant difference in polyp distribution based on patient sex. This is contradictory to what has previously been reported in the literature with more proximal polyps noted in female patients. We believe the advancement in colonoscopy techniques and training in addition to the increased awareness of female sex association with right-sided tumors contributed to this topographic distribution shift of colonic polyps. Although the involved endoscopists met the recommended national ADR benchmarks, women had lower ADR reflecting the differences in the adenoma prevalence in these populations.