Risk of Proximal Colonic Neoplasms in Asymptomatic Adults Older Than 50 Years Found to Have Distal Hyperplastic Polyps on Routine Colorectal Cancer Screening

Abstract

A retrospective case-control study was conducted to evaluate whether hyperplastic polyps (HPs) found in the lower 50 cm of colon could be used as indicators for synchronous proximal neoplasms (SPNs) in the large intestine. Additionally, other characteristics considered included age; sex; ethnicity; history of cancer, cholecystectomy, or appendectomy; current use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs); current use of estrogen or hormone replacement therapy (HRT) in women; current smoking status; and the size, number, and location of the distal HP if present. Convenience sampling of medical charts and colonoscopy reports compiled during a ten-year period was used to glean the sample of 1792 participants. Distal HPs in the lower 50 cm of colon were not significantly associated with SPN when patients with HPs were compared with those without any distal polyps at all (odds ratio [OR] = 0.94; 95% confidence interval [CI] = 0.73-1.22). However, significant relationships with proximal neoplasms (adenomas, advanced adenomas, and colon cancer) were noted in patients with a prior diagnosis of cancer (OR = 1.62; 95% CI =1.25-2.11), advancing age (OR = 1.02; 95% CI = 1.01-1.03), non-Caucasian (men only) ethnicity (OR = 0.72; 95% CI = 0.55-0.96), a history (men only) of taking aspirin or NSAIDs (OR = 0.73; 95% CI = 0.56-0.95), and a history (women only) of taking estrogen or receiving HRT (OR = 1.51; 95% CI = 1.04-2.20). Routinely recommending a colonoscopy for every patient with distal HPs found only by screening flexible sigmoidoscopy is neither justified nor necessary. Nevertheless, further investigation (ie, colonoscopy) may be warranted in the aforementioned subgroups.