279 Rate of Colorectal Neoplasia in Patients With Hodgkin Lymphoma

Abstract

INTRODUCTION: Survivors of Hodgkin lymphoma (HL) are at increased risk of breast, lung, thyroid, stomach, pancreas, and colon cancer. However, information on the utility of endoscopic screening for colon cancer in this population is limited. The adenoma detection rate (ADR) reported in the literature is 25–35% in patients between 50 and 70 years of age. We aimed to describe the ADR in patients previously treated for HL to determine the appropriate timing of colonoscopy screening initiation. METHODS: We retrospectively studied patients with HL who underwent colonoscopy after HL diagnosis between 2000 and 2017. Patients with a history of colorectal cancer were excluded. RESULTS: Of the 4190 patients who were diagnosed with HL during the study period, 251 underwent colonoscopy. Eighty (32%) patients had 151 colonic polyps. About a third of the polyps (45 polyps, 30%) exhibited high-grade dysplasia, and invasive colon adenocarcinoma was found in 10 patients (Table 1). Patients with the nodular sclerosing subtype of HL had a significantly lower ADR than other subtypes (P = 0.002) (Table 2). The ADR was 5% in patients younger than 35 years (n = 64), 23% in patients between 35 and 40 years of age (n = 22), 39% in patients between 40 and 50 years of age (n = 51), and 46% in patients older than 50 years (n = 114) (Figure 1). The median time from HL diagnosis to first endoscopy was 3 years (interquartile range [IQR], 1–6 y). Thirty-seven patients (15%) underwent repeat colonoscopy. The ADR for repeat colonoscopies was 41%. CONCLUSION: The ADR in patients with HL is higher than the ADR of the general population reported in the literature, particularly in patients younger than 50 years of age. These data suggest that a previous diagnosis of HL should be considered as a risk factor warranting colonoscopy screening before 50 years of age.