Tu1214 The High Frequency of Adenomas Detected on Screening in Older Patients Warrants the Inclusion of This Cohort in National Programmes

Abstract

Background: Colorectal cancer (CRC) is the second commonest malignancy in developed countries. The efficacy of CRC screening is well recognised, with many countries adopting a two stage approach with either gFOBT or FIT. Age is a recognised risk factor for CRC, yet the upper age limit for screening can vary substantially. Aim: To identify patterns of anatomical distribution and histological types of screening detected colorectal polyps in differnt age groups. Methods: A retrospective database review from Ireland's first FIT based pilot CRC screening programme over a two year period. In all, 9993 people between 5074 were invited, 51% (n=5063) participated and 10% (n=514) of FIT kits were positive and referred for colonoscopy. Subjects were excluded if they had a history of IBD, CRC or had undergone a colonoscopy within five years. Patient demographics, colonoscopy reports and histology results were recorded. Patients were divided into five age groups, 50-54, 55-59, 60-64, 65-69, and 70-74. Polyps were classified as either left sided (rectal,sigmoid,descending colon) or right sided (transverse colon, descending colon, caecum). Results: A total of 419 colonoscopies were performed, 409 (98%) were complete and 53% (n=216) had either a polyp or malignancy. There were 442 polyps diagnosed in 216 people, 32% (n=70) of people had more than one polyp. In all, 167 people had 318 adenomas. Of the adenomas, 59% (n=188) were tubular adenomas and 41% (n=130) were tubulovillous and 10% (n= 32) had areas of high grade dysplasia. Sixty seven (40%) of patients with adenomas were female and 38 (23%) were over 70 years of age. The incidence and distribution of adenomas according to age was n=6 (25%) and n=1 (14%) right sided for 50-54 years, n=30 (30%) and n=15 (29%) right sided for 55-59 age group, n=41 (41%) with n=29 (35%) right sided in the 60-64 age group, n=52 (49.5%) with n=31 (35%) right sided in the 65-69 age group and n=38 (47.5%) with n=29 (38%) right sided in the 70-74 age group. Conclusion: this study shows an increased incidence and preponderance of proximal adenomas with increasing age, highlighting that evaluation of the proximal colon is particularly important in elderly people. As 23% (n=38) of people with adenomaswere between 70-74, it would be appropriate to include this age group in future screening programmes.