Prevalence Of Colorectal Cancer Research Articles

Risk factors for endoscopic severity of diverticular disease of the colon and its outcome: a real-life case-control study.

Diverticular disease is an increasing global problem. To assess the factors associated with the severity of diverticular disease and its outcome, analyzing a real-life population. A cohort of patients, submitted to colonoscopy from 1 January 2012 to 30 April 2018 was revised. The endoscopic severity of diverticular disease was scored according to the Diverticular Inflammation and Complications Assessment (DICA) classification. A cohort of 11 086 patients was identified during the study period, 5635 with diverticulitis and 5451 without diverticulosis. Blood hypertension, diabetes and angiotensin receptor blocker users occurred more frequently in the study group, while the prevalence of colorectal cancer (CRC) was significantly lower. Age >70 years, BMI >30 and blood hypertension were factors independently related to the presence of diverticulosis, while diabetes and CRC were significantly associated with the absence of diverticulosis. Female sex, age, smoke, appendectomy, proton-pump inhibitors and acetyl-salicylic acid use were directly related to the severity of diverticular disease, while CRC and colonic polyp occurrence were inversely related to the severity of diverticular disease, significantly. Female sex, age >70 years and smoke were significantly related to the severity of diverticular disease. CRC and colonic polyps were significantly less in DICA 3 patients. DICA 3 patients were more often symptomatic, at higher risk of hospital admission, longer hospital stay and higher mean costs. Several factors are associated with the severity of diverticular disease according to the DICA classification. The DICA classification is also predictive of the outcome of the disease in terms of hospital admission, stay and costs.

Trends of Colorectal Cancer Prevalence in Kazakhstan Related to Screening.

We carried out an analysis of the total incidence of colon cancer throughout Kazakhstan. Retrospectively, according to the regional reports on endoscopic screening, the study showed an increase in the age-related incidence of colorectal cancer (CRC) cases from 2004–2008 to 2009–2014. The peak of morbidity in both periods was noted in the age category of >70 years. The indicators of the territorial distribution of CRC incidence make it possible to divide the regions into areas with low or high rates of CRC. Specific indicators showed newly diagnosed cases of CRC stages I, II, III, and IV in 2004–2018. The incidence rates of stages I and II showed a two-fold increase (35%–67.4%) and the incidence of stage IV showed a decline from 19.3% to 13.1% and of stage III from 45.7% to 19.5% from 2004 to 2018, respectively. An analysis of CRC incidence throughout Kazakhstan showed an increase in the overall incidence. Since population-based CRC screening was introduced in 2011, the morbidity was found to increase for stages I and II.

Epidemiological & Clinico-pathological Characteristics of Colo-rectal Cancer (Retrospective Analysis)

Background and purpose: Colorectal Cancer (CRC) is the third most common cancer worldwide and in Egypt the 7th most common cancer in men and 4th most common cancer in women. It is the second leading cause of cancer-related deaths. So the present study was conducted to identify the epidemiological and clinico pathological features of colorectal cancers as studying these characteristics can improve patients’ survival rates. Patients and Method: This study is a retrospective study that included CRC patients treated at clinical oncology department, Zagazig University Hospital in the duration from 2012 to 2017. Medical records of 385 patients, who were referred to clinical oncology department after proven diagnosis with CRC and underwent colonoscopy, or discovered during emergency laparotomy were collected and analyzed. Results: The highest incidence (19.2%) was in 2017. The male & female cases were almost the same. About where (40%) of cases were presented with rectal and ano-rectal lesions, the majority of cases (46.7%) had fungating tumor mass and (91.5%) of cases had Adenocarcinoma and (76.1%) of cases were of grade II by histological grading. Least percentage of metastatic cases was noticed in patients with rectal and ano-rectal masses (10.8-14.8%). About (50%) of patients were node negative by operation pathology, while 50% of patients were of pathological stage III. Conclusion: The present study demonstrated a high prevalence of CRC among the studied patients, advance stage at presentation of this type of cancer, high probability of recurrence, and it significantly correlated with poor survival.

Can FIT rule out colorectal cancer in symptomatic patients? Diagnostic test accuracy results from 9,822 patients in the NICE FIT study.

4093 Background: The faecal immunochemical test (FIT) is a non-invasive quantitative test that measures occult blood in faeces (faecal haemoglobin, FHb). FIT is already used worldwide in colorectal cancer (CRC) screening programmes. Bowel symptoms have low specificity for CRC; to diagnose one patient with CRC, a large number of symptomatic patients require investigation. A negative FIT test, when blood is not detected, could be used to rule out CRC in symptomatic patients without invasive investigations such as colonoscopy. We report on the largest diagnostic accuracy study to date of FIT in symptomatic patients. Methods: Patients were eligible for recruitment if they experienced bowel symptoms meeting national high-risk criteria and were triaged to investigation with colonoscopy. Patients were excluded from analysis if they did not provide a valid FIT or did not undergo complete colonoscopy. Colonoscopy results were compared to FIT measurements of FHb, and the conduct of the tests was double-blinded. Quality assurance of endoscopy and clinical data was performed by senior clinicians. External statisticians analysed anonymised data. Results: 9822 patients from 50 sites across England participated in the study between October 2017 to March 2019. The most common colonoscopy finding was absence of any colorectal disease (31%). The prevalence of CRC at colonoscopy was 3.3%. The sensitivity of FIT at FHb thresholds of 2, 10 and 150 μg/g significantly decreased from 97.0% to 90.9% and 70.8% respectively (p < 0.01). FIT positivity rate at these thresholds increased from 7.6%, to 19% and 37.2% respectively (p < 0.01). The positive predictive value of FIT for CRC at FHb thresholds of 2, 10 and 150 μg/g was 8.7%, 16.1% and 31.1% respectively and the negative predictive value of FIT at these thresholds was 99.8%, 99.6% and 98.9% respectively. Conclusions: The results of this study support the use of FIT at the threshold of detectable blood (2μg/g) as an initial CRC rule-out test to triage patients with high risk CRC symptoms, reducing the number of unnecessary investigations. This is the first study to report that at the lowest threshold of detectable blood, FIT sensitivity is equivalent to the current gold standard investigation of colonoscopy. Clinical trial information: ISRCTN49676259 .

Epidemiology, mortality and prevalence of colorectal cancer in ulcerative colitis patients between 2010-2016 in Hungary – a population-based study

The incidence and prevalence of ulcerative colitis (UC) varies geographically. The risk of colorectal cancer (CRC) and possibly some other malignancies is increased among patients with UC. It is still debated if patients with UC are at a greater risk of dying compared with the general population. Our aim was to describe the epidemiology and mortality of the Hungarian UC population from 2010 to 2016 and to analyze the associated malignancies with a special focus on CRC. This is an observational, descriptive, epidemiological study based on the National Health Insurance Fund social security databases from 2010 to 2016. All adult patients who had at least two events in outpatient care or at least two medication prescriptions, or at least one inpatient event with UC diagnosis were analyzed. Malignancies and CRC were defined using ICD-10 codes. We also evaluated the survival of patients suffering from UC compared with the general population using a 3 to 1 matched random sample (age, gender, geography) from the full population of Hungary. We found the annual prevalence of UC 0.24-0.34%. The incidence in 2015 was 21.7/100 000 inhabitants. Annual mortality rate was 0.019-0.023%. In this subpopulation, CRC was the most common cancer, followed by non-melanotic skin and prostate cancer. 8.5% of the UC incident subpopulation was diagnosed with CRC. 470 (33%) of the CRC patients died during the course of the study (25% of all deaths were due to CRC), the median survival was 9.6 years. UC patients had significantly worse survival than their matched controls (HR = 1.65, 95% CI: 1.56-1.75). This is the first population-based study from Eastern Europe to estimate the different malignancies and mortality data amongst Hungarian ulcerative colitis patients. Our results revealed a significantly worse survival of patients suffering from UC compared to the general population.

SAT-155 High Prevalence Alterations on DNA Mismatch Repair Genes Related to Lynch Syndrome in Pediatric Patients with Adrenocortical Tumor Carried of the Germline Mutation on TP53

Background: Adrenocortical cancer (ACC) is a rare malignant neoplasia associated with a variable clinical presentation. Pediatric patients generally have a better prognosis when compared to adults. In addition, unlike in adults where ACC which is usually sporadic, 50-80% of pediatric ACC is associated with genetic disorders such as Beckwith-Wiedemann and Li-Fraumeni syndromes. Recently, was showed that 3-5% of adult patients with ACC presented germline variants in DNA mismatch repair genes such as MSH2 and MSH6, the cause of Lynch syndrome (LS). The prevalence of these alterations in pediatric ACC is unknown. We aimed to investigate the prevalence of germline alterations in DNA mismatch repair genes among pediatric and adult patients with adrenocortical tumors (benign and malignant) carriers of the germline TP53 p.R337H mutation. Methods: 35 patients selected (30 pediatric and 5 adult) with functional tumors. ACC was diagnosed in 4 pediatric and in all adult patients. NGS was performed in 35 DNA blood samples by HNPCC MASTR Plus for the identification of SNV in 4 genes (MLH1, MSH2, MSH6, and PMS2) and 3’ UTR of EPCAM. Copy number variation (CNV) analyses were done by Copy Number Targeted Resequencing Analysis (CONTRA) and MLPA. The variants were classified, according to ACMG (American College Medical Genome) by Varsome platform. The protein expression was evaluated by Immunohistochemistry (IHC): MLH1 (clone ES05), MSH2 (FE11), MSH6 (EP49), and PMS2 (EP51). All patients were evaluated for variants in TP53. Results: NGS: 2 children presented 2 pathogenic allelic variants associated with LS (2/30, 6.6%), both patients with benign outcome and follow up of 4 years: 1 deletion in MLH1 (c.1500_1502del) and 1 nonsense in the MSH6 gene (c.328C>T p.Arg110X. CNV: MLPA specific for MLH1/MSH2 showed a normal copy number. ICH: the loss of expression in MLH1/PMS2 was identified in only one case without allelic variants. Discussion: Although our cohort is small, we observed 2 allelic pathogenic variants associated with LS among pediatric with adrenocortical tumors. It is higher than the prevalence of colorectal and endometrial cancer (3.2%) in LS. A personal and family history of LS tumors should be strongly considered for genetic risk assessment in pediatric patients with ACT. If the association with TP53 alteration can influence the tumor’s behavior with early clinical presentation, as seen in hereditary nonpolyposis colorectal cancer, it needs to be investigated. The patients with both alterations must be followed with surveillance, according to the US Multi-Society task force guideline for Lynch syndrome and for Li-Fraumeni syndrome.

Information Seeking and Scanning about Colorectal Cancer Screening among Black and White Americans, Ages 45–74: Comparing Information Sources and Screening Behaviors

Cancer information seeking and scanning predict a variety of preventive health behaviors. However, previous work has rarely gauged seeking and scanning of specific cancer screening information. Moreover, colorectal cancer prevalence and mortality rates are higher among black than white Americans and it remains unclear if these groups differ in their cancer screening information acquisition patterns. We surveyed black and white Americans between 45 and 74 years of age to investigate rates, sources, and correlates of colorectal cancer screening (CRCS) information seeking and scanning. Black and white Americans had similar likelihoods of engaging in information seeking and scanning regarding CRCS. However, black Americans reported using significantly more sources for CRCS information seeking and scanning than did white Americans. Both screening test-specific information seeking and scanning are associated with stool-based tests, but only information seeking is associated with flexible sigmoidoscopy or colonoscopy. We discuss study implications for reaching out to different racial groups to promote colorectal cancer screening behavior.

Colonoscopy later than 270 days in a fecal immunochemical test-based population screening program is associated with higher prevalence of colorectal cancer.

BACKGROUND : Colorectal cancer (CRC) screening programs based on fecal immunochemical testing (FIT) generate substantial pressure on colonoscopy capacity in Europe. Thus, a relevant proportion of FIT-positive patients undergo colonoscopy after the recommended 30-day interval, which may be associated with an excess CRC risk. METHODS : In a cohort of 50-69-year-old patients undergoing biennial rounds of FIT (OC-Hemodia latex agglutination test; cutoff 20 µg hemoglobin/g feces) between 2004 and 2017, we assessed the outcome at colonoscopy (low/high risk adenoma/CRC/advanced stage CRC) among FIT-positive patients, according to different time intervals. The association of each outcome with waiting time, and demographic and clinical factors, was analyzed through multivariable analysis. RESULTS : 123 138/154 213 FIT-positive patients (79.8 %) underwent post-FIT colonoscopy. Time to colonoscopy was ≤ 30 days, 31-180 days, and ≥ 181 days in 50 406 (40.9 %), 71 724 (58.3 %), and 1008 (0.8 %) patients, respectively. At colonoscopy, CRC, high risk adenoma, and low risk adenoma were diagnosed in 4813 (3.9 %), 30 500 (24.8 %), and 22 986 (18.7 %) patients, respectively. An increased CRC prevalence at colonoscopy was observed for a time to colonoscopy of ≥ 270 days (odds ratio [OR] 1.75, 95 % confidence interval [CI] 1.15-2.67), whereas it was stable for waiting times of < 180 days. The proportion of advanced CRC also increased after 270 days (OR 2.79, 95 %CI 1.03-7.57). No increase for low or high risk adenomas according to time to colonoscopy was observed. CONCLUSION : In a European FIT-based screening program, post-FIT colonoscopy after 9 months was associated with an increased risk of CRC and CRC progression.

Hospital Prevalence of Colorectal Cancer among Colonoscopy Recipients Attending a Tertiary Hospital in Oman: A Cross-Sectional Study.

Purpose Evidence from industrialized/developed countries showed that colorectal cancer (CRC) incidence rates have significantly dropped due to the widespread use of colonoscopy. In Arab countries, however, the CRC had been reported to have increased. Despite the concerted effort in the primary prevention and widespread use of colonoscopy, to our knowledge, there have been no reports of the prevalence rate of CRC among colonoscopy recipients from Oman. This study aims to explore the CRC prevalence estimates over selected sociodemographic characteristics among colonoscopy-recipients at a tertiary hospital in Oman over five years of follow-up. The regional variations in Oman were also examined in this study. Methods This hospital-based cross-sectional study reviewed reports of colonoscopies performed over 5-years of retrospective follow-up at a tertiary hospital in Oman. CRC prevalence estimates were calculated over age, gender, governorate, and time of follow-up. Results A total of 442 CRC cases were enumerated among 3701 colonoscopies, with an overall CRC prevalence estimate of 11.9 per 100 colonoscopies (95% CI: 10.9, 13.0). Gender-specific CRC prevalence was higher among males compared with females (13.3 vs. 10.5). Age-specific CRC prevalence increased with advancing age, from 2.8 among those less than 40 years of age to 26.5 among aged 70 years or more. Regional CRC prevalence was highest among residents in Batinah Governorate. Over the 5-years of follow-up, there was a slow rise in CRC prevalence with an annual increment of 0.59%. Conclusion The study provides supportive evidence for a steady increase in CRC prevalence over age categories and years of follow-up and depicted the variations of gender-specific CRC prevalence estimates over increasing age categories. The study calls for timely formulation and adoption of national CRC screening programs centered on the colonoscopy use as primary prevention and maximizing its utilization and efficiency.

TFPI2 and NDRG4 gene promoter methylation analysis in peripheral blood mononuclear cells are novel epigenetic noninvasive biomarkers for colorectal cancer diagnosis

As a result of the growing prevalence of colorectal cancer (CRC), new screening and early detection methods are required. Among the novel biomarkers, DNA methylation has emerged as a high-potential diagnosis/screening molecular marker. The present study aimed to assess non-invasive early diagnosis of CRC by examining promoter methylation of TFPI2 and NDRG4 genes in peripheral blood mononuclear cells (PBMCs). Fifty CRC patients and 50 normal controls were recruited to the present study. Quantitative methylation of the promoter region of the TFPI2 and NDRG4 genes was analyzed in DNA extracted from PBMCs of all cases and control subjects using a methylation-quantification endonuclease-resistant DNA (MethyQESD) method. The sensitivity and specificity of the TFPI2 gene for the diagnosis of CRC was 88% and 92%, respectively, and, for the NDRG4 gene, it was 86% and 92%, respectively. The methylation range for the TFPI2 gene was 43.93% and 11.56% in patients and controls, respectively, and, for the NDRG4 gene, it was 38.8% in CRC patients and 12.23% in healthy controls (p < 0.001). In addition, we observed that a higher percentage of methylation was correlated with the higher stage of CRC. The results of the present study reveal that PBMCs are reliable sources of methylation analysis for CRC screening. Furthermore, the TFPI2 and NDRG4 genes provide sufficiently high sensitivity and specificity to be nominated for use in a novel noninvasive CRC screening method in PBMCs.

Schistosoma Japonicum Infection is a Critical Risk Factor for Presence and Pathologic Subtypes Redistribution of Colorectal Cancer in Rural China

Background: Infection of Schistosome japonicum (S. japonicum) had been endemic in China. However, the association between Schistosome japonicum (S. japonicum) infection and the epidemiology or pathologic features of colorectal cancer was unknown. Methods: A cross-sectional survey was carried out in 220,175 participants aged 45 years and older in Songjiang County of Shanghai, an endemic region of schistosome infection. Furthermore, schistosome infection associated pathologic subtypes of colorectal cancer were also analyzed among participants. Findings: In cross-sectional survey, 9,986 subjects were defined as having previous schistosome infection, of which 249 were diagnosed as having colorectal cancer, and the overall prevalence of colorectal cancer was 2.49%. While remaining 210,189 participants without schistosome infection, 885 also suffered from colorectal cancer, and the corresponding rate was only 0.42%. Unconditional logistic regression analysis suggested a strong association between the infection and risk of colorectal cancer, with an adjusted OR of 4.248 and 95% CI of 3.656-4.935. Furthermore, compared with colorectal cancer without schistosome infection, there was a high percentage of mucinous adenocarcinoma (21.4% vs 11.8%, adjusted OR = 2.149, 95% CI = 1.474-3.134) and signet-ring cell carcinoma with schistosome infection (4.5% vs 1.1%, adjusted OR = 5.341, 95% CI = 2.145-13.296). Notably, mucinous adenocarcinoma in rectum showed a higher proportion (27.5% vs 8.2%). By contrast, signet-ring cell carcinoma had a predilection to occur in sigmoid colon (16.7% vs 0). Interpretation: S. japonicum infection is a critical risk factor and a pathologic subtype redistribution driver of colorectal cancer. Moreover, these redistributions have location-specificity and higher mucus secretion. Funding: None Declaration of Interest: We declare no competing interests. Ethical Approval: The institutional review board or ethics committee at each of the participating institutions approved the study protocol. Written informed consent was obtained from each participant before data collection.

The diagnostic value of a change in bowel habit for colorectal cancer within different age groups.

Change in bowel habit as a sole alarm symptom for colorectal cancer is disputed. We investigated the diagnostic value of change in bowel habit for colorectal cancer, particularly as a single symptom and within different age groups. This retrospective cohort study examined colorectal cancer fast track referrals and outcomes across four Swedish hospitals (April 2016-May 2017). Entry criteria constituted one or more of three alarm features: anaemia, visible rectal bleeding, or change in bowel habit for more than 4 weeks in patients over 40 years of age. Patients were grouped as having only change in bowel habit, change in bowel habit plus anaemia/bleeding or anaemia/bleeding only. Of 628 patients, 22% were diagnosed with colorectal cancer. There were no cases of colorectal cancer in the only change in bowel habit group under 55 years, while this was 6% for 55-64 years, 8% for 65-74 years and 14% for 75 years and older. Among subjects under 55 years, 2% with anaemia/bleeding had colorectal cancer, this increased to 34% for 55 years and older (P < 0.0001). Change in bowel habit plus anaemia/bleeding gave a colorectal cancer prevalence of 16% in under 55 years and increased to 30% for 55 years and older (P = 0.07). Change in bowel habit as the only alarm feature has a low diagnostic yield for colorectal cancer in patients under 55 years.

A91 SARCOMATOID CARCINOMA OF THE COLON PRESENTING AS IRON DEFICIENCY ANEMIA

Abstract Background Gastrointestinal malignancy is a common cause of iron deficiency and occult gastrointestinal bleeding among adults in developed countries. Given the high prevalence of colorectal cancer and adenomatous polyps in our population, it is imperative that these patients undergo early colonoscopy. Sarcomatoid carcinoma (SCA) of the colon is a very rare condition, with less than 30 cases reported in the literature. Given the highly aggressive nature of this neoplasm, it is important to familiarize oneself with its presentation, histopathology and treatment options. Aims Describe a case of SCA of the colon in a cirrhotic patient, presenting initially as iron deficiency anemia of unknown etiology. Methods Case report and literature review. Results A 69-year-old female presented to the emergency department with complaints of progressive weakness and failure to thrive. Past medical history was significant for chronic kidney disease, NASH cirrhosis Child-Pugh C and recurrent hepatocellular carcinoma despite previous radiofrequency ablation. Investigations demonstrated de novo iron deficiency anemia with the following blood results: hemoglobin of 96, iron of 8.6, iron saturation of 20% and ferritin of 56. Subsequently, gastroenterology was consulted in order to assess for an occult source of bleeding. A gastroscopy was first performed in which no abnormalities were found. She then underwent a colonoscopy, which demonstrated a very large indurated nodular ulcer in the ascending colon, suggestive of invasive neoplasm (Figure A). Indeed, the biopsies demonstrated a malignant spindle cell neoplasm consistent with SCA. On immunohistochemistry, the tumor cells stained positive for keratin AE1/AE3, weakly positive for SMA and S-100, but negative for SMM, HMB45, DOG1, C-KIT and CD31. Given her severe comorbidities, no therapeutic options were available for this patient, thus further staging investigations were not pursued. Unfortunately, the patient rapidly deteriorated and died less than 8 weeks following her diagnosis. Conclusions Sarcomatoid carcinoma of the colon is an extremely rare neoplasm with very poor prognosis. Histologically, this tumor is characterized by a typical biphasic pattern, composed of both mesenchymal and epithelial cells. However, as demonstrated in this case, some SCA display a rather predominantly mesenchymal pattern, rendering the diagnosis difficult using morphology only. Immunostaining is therefore used to identify carcinoma features and to rule out similar tumors such as sarcoma, GIST, mesothelioma and melanoma. SCA of the colon is exceedingly aggressive, with remarkably rapid tumor growth and early distant metastasis. Indeed, median survival is reported to be less than 6 months. Given its rarity, no well-defined treatment guidelines exist, however most patients are managed with early radical surgery, adjuvant chemotherapy and close follow-up. Funding Agencies None

A Correlation Study of the Colorectal Cancer Statistics and Economic Indicators in Selected Balkan Countries

Colorectal cancer (CRC) is one of the most commonly diagnosed malignant neoplasms. The aim of the study was to evaluate and correlate most important epidemiological and economic indicators of CRC in 11 selected Balkan countries. The number of new CRC cases was 56,960, and the highest 5-year CRC prevalence was in Slovenia, Croatia, and Greece. Age-standardized CRC incidence rates were highest in Slovenia, Serbia, and Croatia, and age-standardized mortality rates were highest in Croatia, Serbia, and Bulgaria. Current Health Expenditure as % of Gross Domestic Product was the highest in Bosnia and Herzegovina and Serbia. The GDP per capita levels have shown positive correlation with the CRC incidence rate and prevalence. Absolute numbers of new and death-related CRC cases and 5-year prevalence in absolute numbers have shown strong positive correlation with GDP in million current US$. It has been shown that various economic indicators can be linked to the rate of incidence and prevalence of the CRC patients in the selected Balkan countries. Therefore, economic factors can influence the epidemiology of CRC, and heavy CRC burden in the Balkan region may be one of the indexes of the economic development.

Utility of the methylated SEPT9 test for the early detection of colorectal cancer: a systematic review and meta-analysis of diagnostic test accuracy

BackgroundCirculating tumour DNA from colorectal cancer (CRC) is a biomarker for early detection of the disease and therefore potentially useful for screening. One such biomarker is the methylated SEPT9 (mSEPT9)...

Colorectal cancer prevalence and risk factors among the uninsured of Tampa Bay: A free clinic study.

61 Background: Uninsured patients with low socioeconomic status are at higher risk for developing colorectal cancer. There is limited quantifiable data regarding risk factors and prevalence of colorectal cancer in this vulnerable population. The purpose of this study is to assess the risk factors for colorectal cancer in the low income and uninsured patient population across nine free clinics around Tampa Bay, Florida. Methods: An IRB-approved manually extracted retrospective query of several medical record systems from nine free clinics in the Tampa Bay area in 2017 revealed 1,836 (36.1%) of 5,076 total patients who are over 50 years old. Patient demographics, weight, smoking status, alcohol use, type 2 diabetes status, inflammatory bowel disease and colorectal cancer prevalence were also extracted and analyzed. Results: Among patients over 50, the majority of patients were female (n = 1073, 58.4%) and of Hispanic ethnicity (n = 752, 41.0%). Of the 1,349 patients who reported their smoking status, 213 (15.8%) were active smokers and 218 (16.2%) were past smokers, with a mean 16.3 (SD = 15.5) pack year history. Of the 1,124 patients who reported their history of alcohol consumption, 217 (19.3%) were current consumers and 40 (3.6%) were past consumers. The average BMI of patients over 50 years was 30.2 (SD = 6.9), with 558 (30.4%) cases of diabetes. Eleven patients (0.6%) had a history of inflammatory bowel disease. The prevalence of documented colorectal cancer in this sample was 0.6% (n = 11) in our sample population. Conclusions: There is a high prevalence of risk factors for colorectal cancer in this sample of uninsured patients but a lower reported prevalence of colorectal cancer compared to the general population. Additionally, many known risk factors for colorectal cancer, such as diet, physical activity, or family history, are not routinely documented by free clinics. As these clinics provide opportune points of primary care, this baseline data should prompt more attention to colorectal screening and risk factor modification in this vulnerable population.

Adjuvant chemotherapy in patients with colorectal cancer. Is there a role in the older adult?

As global life expectancy has increased in most countries, there is a rising percentage of patients over 65 years old being diagnosed with colorectal cancer. Despite an increase in the incidence and prevalence of colorectal cancer in older adults, this cohort receives adjuvant therapy at a decreased rate due to anticipated intolerance. The presumed limitations seem to be based on chronologic age, competing life limiting diagnoses, and the paucity of data studying this population in major clinical trials. This review explores the data regarding disparities in the treatment of older patients with colorectal cancer, safety and efficacy of adjuvant therapy, and newer tools to make decisions based on the biologic age, rather than chronologic age, of the patient.

Suction marking method: a novel technique to prevent overlookingof polyps detected upon endoscope insertion.

Suction marking method: a novel technique to prevent overlookingof polyps detected upon endoscope insertion.

Prevalence and Risk Factors of Gastric and Colorectal Cancer after Cholecystectomy.

BackgroundPrevious studies on the relationship between gastrointestinal (GI) cancer and cholecystectomy remain inconclusive. We aimed to evaluate this relationship, albeit particularly between cholecystectomy and gastric cancer or colorectal cancer (CRC), and the risk factors of cancer among individuals who have undergone cholecystectomy in Korea.MethodsIn total, 4,222 patients who underwent laparoscopic or open cholecystectomy at our institution between January 2006 and December 2013 were included. Patients who underwent cholecystectomy for gallbladder cancer or were undergoing surgery for GI, hepatic, or pancreatobiliary cancers were excluded, as were those who developed stomach cancer or CRC within a year of their cholecystectomy. The included patients were followed until July 20, 2020. The standardized incidence ratio (SIR) was used to calculate the relative risk of GI cancer in cholecystectomy patients.ResultsThe median patient age (n = 3,588) at the time of cholecystectomy was 54.0 (range, 19–95) years, and the male-to-female ratio was 1:1.04. The median follow-up period after cholecystectomy was 15.0 (range, 0–146) months. We found a 108% greater risk of CRC (SIR, 2.08; 95% confidence interval [CI], 1.28–3.17) and 154% increased risk of CRC in females (SIR, 2.54; 95% CI, 1.16–4.84). Based on multivariate analysis, an age of > 60 years was a significant risk factor for GI cancer in cholecystectomy patients.ConclusionCholecystectomy may increase risk of CRC, especially in females. Age was considered a risk factor of GI cancers in patients with history of cholecystectomy.

Gender difference in colorectal cancer indicators for exercise interventions: the National Health Insurance Sharing Service-Derived Big Data Analysis

We aimed to examine various characterized features and effects of gender-associated different parameters including exercise on the prevalence of colorectal cancer by using data from the National Health Insurance Sharing Service Database (NHISS DB). Data from NHISS were collected on Koreans aged from 40 to 85 years and were subjected to thematic analysis. The colorectal cancer codes (C19, C20, D011, and D012) from Korean Standard Classification of Disease and Causes of Death selected a target study group, and t-test and logistic regression were used. As results, the age was higher for men who had colorectal cancer than the noncancer group; however, high and low blood pressure, hemoglobin, and age had lower values for the cancer group compared to their counterparts in women. Only total cholesterol in men and waist size in women between cancer and noncancer groups were shown to have significant differences. Serum glutamic pyruvic transaminase and alanine aminotransaminase (SGPT_ALT) showed significant differences for both sexes. In exercise-related parameter, the response number 2 (1–2 times/wk, 0.535 for odd ratio) in women and response number 3 (3–4 times/wk, 0.466 for odd ratio) in men were associated with a reduced incidence of colon cancer. There was a difference in parameters in colorectal cancer patients over 40 years old for both sexes, but not in SGPT_ALT. Regular physical activity might be one of strong factors affecting or predicting colorectal cancer incidence.