A Retrospective Review of Colonic Polyp Distribution and Pathology in a Minority Population

Abstract

Purpose: Colon cancer is the second leading cause of cancer deaths in the United States. Previous studies have shown an increase in the proximal distribution of cancerous lesions in African Americans. We retrospectively analyzed colonoscopies done in inner city African Americans (AA) and Hispanics (H) to determine the distribution of polyps with respect to location, age, and pathology. Methods: 6,845 colonoscopies were performed at the University Hospital in Newark, NJ from 1998–2004. Of these, 1,414 contained polyp biopsies from 926 AA and 488 H patients with available pathology reports for analysis. Results: The number of polyps in AA (n = 1790) and H (n = 837) found in the proximal colon (proximal to the splenic flexure) was 818 and 396, respectively. Thus 46% of polyps in AA and 47% of polyps in H were in this region. Furthermore, the pathology of these polyps shows that 60% and 56% of polyps found in the proximal colon were of pathological significance (Tubular adenoma, Villous Adenoma, Tubulovillous Adenoma, Adenocarcinoma) in AA and H, respectively. In the AA population, there was a positive association between age and the percentage of pathologically significant proximal colon polyps. Within this population 51% of proximal polyps in patients younger than 50 were pathologically significant, 58% in those aged 50–64, and 67% in those over 64 (Pearson Chi-Square, P-Value = 0.001). This association was not present in the H population. In AA, there were 63 instances of cancerous lesions in 57 patients. 34 of these lesions were in the proximal colon. Therefore, 6.8% of polyps found in AA were cancerous, with 54% of these being in the proximal colon. In H, there were 20 instances of cancerous lesions found in 17 patients. 8 of these were in the proximal colon. Thus, 4.1% of polyps found in H were cancerous with 40% of these located in the proximal colon. Conclusions: Our study provides further evidence to support that there is a higher percentage of pathologically significant polyps in the proximal colon in AA and H when compared to the distal colon. In addition, it shows that in the AA population, older patients have a higher percentage of pathologically significant proximal colonic lesions when compared to younger age groups. This finding is not true of the H population.