Characteristics of Serrated Adenomas in Non-Hispanic Whites and African Americans Undergoing Screening Colonoscopy.

Lauren Stemboroski,Ena Gupta,Joshua Samuel,Ahmad Alkaddour,Kenneth J Vega,John Erikson L Yap,Carlos Palacio,Juan Carlos Munoz,Amie Deutch,Nicholas Agresti

doi:10.7759/cureus.16200

Abstract

Background and aimAdenomatous polyps are precursor lesions for colorectal cancer (CRC). Serrated adenomas/polyps are considered a risk factor for the development of proximal and interval CRC. African-Americans are at higher risk for right-sided CRC. Minimal data evaluating serrated adenoma characteristics by race/ethnicity on initial screening colonoscopy (SC) exist. The aim of this investigation was to compare the characteristics of serrated adenomas found in non-Hispanic whites (nHw) and African-Americans (AA) undergoing initial SC.MethodsThe University of Florida-Jacksonville endoscopy database was searched for all SC performed between January 2000 and December 2014. Inclusion criteria were nHw or AA race/ethnicity and histologically proven serrated adenoma found at SC. Data were collected for all included age at SC, sex, number, location, and size of serrated adenomas found.ResultsA total of 8693 individuals (nHw - 4199 and AA - 4494) underwent SC between January 2000 and December 2014. Serrated adenomas were found in 479 individuals (nHw, n=294; AA, n=185), and AA were significantly less likely than nHw to have serrated adenomas on SC (AA 4.1% vs nHw 7%; p< 0.0001). No difference was observed in mean age, location, or size between nHw and AA with serrated adenomas.ConclusionsSerrated adenomas are more frequent in nHw compared to AA at initial SC. No difference was seen in size or location of serrated adenomas, as well as patient age, between AA and nHw. A study of genetic factors predisposing to serrated adenoma formation and the impact of socioeconomic disparities should be performed across ethnic groups to understand this difference.

Highlights

Colorectal adenomatous polyps are well-recognized as precursor lesions of colorectal cancer (CRC)
Serrated adenomas were found in 479 individuals, and AA were significantly less likely than non-Hispanic whites (nHw) to have serrated adenomas on screening colonoscopy (SC) (AA 4.1% vs nHw 7%; p< 0.0001)
Serrated adenomas are more frequent in nHw compared to AA at initial SC

Summary

Introduction

Colorectal adenomatous polyps are well-recognized as precursor lesions of colorectal cancer (CRC). Serrated adenomas have recently been identified as an additional CRC precursor through an alternative pathway and are considered a target for colonoscopy surveillance, potentially accounting for 15-20% of CRC [2,4]. Serrated adenomas are defined as hyperplastic polyps with a “sawtooth” pattern histologically, and recent investigations have revealed that serrated lesions are precursors to CRC due to distinct genetic mutations such as CPG island methylation and BRAF mutations [4,5]. Serrated adenomas/polyps are considered a risk factor for the development of proximal and interval CRC. Minimal data evaluating serrated adenoma characteristics by race/ethnicity on initial screening colonoscopy (SC) exist. The aim of this investigation was to compare the characteristics of serrated adenomas found in non-Hispanic whites (nHw) and African-Americans (AA) undergoing initial SC

Methods

Discussion

Conclusion