History Of Adenomatous Polyps Research Articles

Colorectal Cancer Risk and Prevention Knowledge among Adults Attending Public Health Facilities in Obudu, Cross River State, Nigeria

Background: Colorectal cancer (CRC) is the 5th most frequent cause of cancer-related deaths in Nigeria. As with other cancers, CRC risk is multifactorial, including issues such as poor diet, obesity, alcohol abuse, physical inactivity, age above 50 years, history of adenomatous polyps, inflammatory bowel disease, and family history of CRCs or polyps.
 Aim: The study aimed to ascertain the level of knowledge of risk factors and preventive measures against CRC among adults attending health facilities in Obudu Local Government area Cross River State, Nigeria.
 Study Design: A descriptive survey research design was used.
 Place and Duration of Study: Urban health facilities in Obudu Local government area, Cross River state between 2017 and 2019.
 Methodology: The sample of the study comprised 310 attendees of health facilities. A structured questionnaire was the main instrument used for data collection. Face validity was employed. The split-half method was used to establish the reliability of the instrument with thirty adults in a neighboring town.
 Results: Findings showed that males had better knowledge of risk factors (75.3%) than females (45.8%); and males had better knowledge of prevention of CRC (82.1%) than females (57.2%), hence showing a significant association (P=.002, P=.003) between gender with knowledge of risk factors and prevention of CRC respectively. There were also significant associations between age (P=.007, .001) and educational level (P=.002, .006) with knowledge of risk factors and prevention of CRC respectively. This showed that younger ages and higher education were associated with better knowledge of CRC.
 Conclusions: Less knowledgeable women and persons with low educational level should be targeted with messages on CRC. Health educators should intensify their health education campaign on the importance of screening as the major preventive measure against CRC at the household level. Government and non-governmental organizations (NGOs) should sponsor the provision of resources and screening facilities.

Are adults with a family history of adenomatous polyps at increased risk of developing colorectal cancer?

Are adults with a family history of adenomatous polyps at increased risk of developing colorectal cancer?

Impact of Electronic Medical Record Intervention on OP-29 and OP-30 Scores at St. Lukeʼs University Health Network

Introduction: The Centers for Medicare and Medicaid Services (CMS) Hospital Outpatient Quality Reporting Program (HOQR) is a program that utilizes data collected from various methods to promote more efficient and higher quality healthcare for Medicare beneficiaries. This study will focus on the two quality measures OP-29 and OP-30 at St. Luke's University Health Network. OP-29 examines the appropriate follow up interval for normal colonoscopy in average risk patients and OP-30 examines colonoscopy interval for patients with a history of adenomatous polyps<./p> In October 2017, St. Luke's Health Network implemented additional quality documentation into our electronic medical record (EMR) that allowed providers to efficiently enter the purpose of the colonoscopy, the time interval since the patient's last colonoscopy, the patient's medical history regarding colon polyps and colon cancer, and when the next colonoscopy was indicated. The goal of this study is to examine if these electronic interventions have resulted in improved OP-29 and OP-30 scores across our health network. Methods: This study examines data obtained from St. Luke's Health Network starting on January 1, 2017 and ending on May 31, 2018. OP-29 and OP-30 scores were calculated for St. Luke's regional campuses each month during the study through an analysis of EMR colonoscopy procedure charts based on screening criteria outlined by CMS. Results: Since the EMR intervention in October 2017, OP-29 scores have improved on average by 5% and OP-30 scores have increased 12% on average. Each month in 2018 except January 2018 has shown a positive improvement for OP-29 data over the prior year and all months in 2018 have shown a positive improvement for OP-30 data over the prior year. For both 2017 and 2018, the average OP-29 scores at St. Luke's Health Network exceeded the 2016 national average. In 2018, the average OP-30 score at St. Luke's Health Network exceeded the 2016 national average. Conclusion: The decline in OP-29 scores during the month of January 2018 was a result of the EMR upgrade that month which temporarily hindered provider input and additional education about the EMR intervention was provided to our endoscopists in January 2018. Excluding January's 2018 data results in an OP-29 score improvement of 9% overall following EMR intervention.1083_A Figure 1. OP-29 Score Trend at St. Luke's University Health Network1083_B Figure 2. OP-30 Score Trend at St.Luke's University Health Network1083_C Figure 3. Percent Improvement for OP-29 and OP-30 Scores at St. Luke's University Health Network in 2018 compared with 2017

Clinical Characterization of Fibroblastic Polyps

Introduction: Fibroblastic polyps (FPs) are a rare, recently described colorectal polyp subtype histologically characterized by the proliferation of bland spindled cells within the lamina propria. FPs are distinguishable immunohistochemically (IHC) from other mucosal polyps and are generally discovered incidentally. While considered benign and unassociated with polyposis syndromes, a paucity of clinical information exists regarding this polyp subtype. As a large tertiary endoscopy practice, we sought to describe our clinical experience in patients diagnosed with FPs. Methods: Cases were identified between Jan 1994 and May 2017 among patients 18-99 years of age at the time of diagnosis using an institutional pathology database. Clinical data was abstracted using existing clinical and endoscopic records. IHC was performed at the discretion of the reviewing pathologist and only those cases with compatible histology and supportive IHC (negative S-100, EMA, CD117) were included for review. Results: A total of 21 patients with a diagnosis of FP (n=32 polyps) were identified. Following diagnosis, none of the patients were found to have FPs on subsequent colonoscopies. The median age at FP diagnosis was 59 years (range 31-84) with 13 (62%) being male. A single FP was identified in all but one case; in the remaining case, 12 FPs were simultaneously diagnosed in a patient with Cowden syndrome. The median FP size was 4 mm (range 2-8 mm) while by configuration, 27 (84%) and 5 (16%) were sessile and pedunculated, respectively. FPs were predominately located in the left colon with 17 (53%), and 5 (16%) discovered in the rectosigmoid and descending colon, respectively. In 11(52%) cases, FPs were concomitantly diagnosed with other polyp subtypes including tubular adenoma with low-grade dysplasia (7/11), hyperplastic polyp (3/11), and sessile serrated adenoma (1/11). Among patients diagnosed with FPs, indications for colonoscopy varied; routine follow-up for known history of adenomatous polyps and initial colorectal cancer (CRC) screening were the most common in 9 (43%) and 6 (29%) patients, respectively. Conclusion: FPs are rare, predominately left-sided colonic polyps which vary between sessile and pedunculated configuration. Though predominately solitary, multiple FPs were observed in a patient with Cowden syndrome and no patients had FPs diagnosed on subsequent endoscopy. Further study is needed to elucidate the pathogenesis and significance of FPs.

Dietary fibre for the prevention of recurrent colorectal adenomas and carcinomas.

This is an update of the Cochrane review published in 2002.Colorectal cancer (CRC) is a major cause of morbidity and mortality in industrialised countries. Experimental evidence has supported the hypothesis that dietary fibre may protect against the development of CRC, although epidemiologic data have been inconclusive. To assess the effect of dietary fibre on the recurrence of colorectal adenomatous polyps in people with a known history of adenomatous polyps and on the incidence of CRC compared to placebo. Further, to identify the reported incidence of adverse effects, such as abdominal pain or diarrhoea, that resulted from the fibre intervention. We identified randomised controlled trials (RCTs) from Cochrane Colorectal Cancer's Specialised Register, CENTRAL, MEDLINE and Embase (search date, 4 April 2016). We also searched ClinicalTrials.gov and WHO International Trials Registry Platform on October 2016. We included RCTs or quasi-RCTs. The population were those having a history of adenomatous polyps, but no previous history of CRC, and repeated visualisation of the colon/rectum after at least two-years' follow-up. Dietary fibre was the intervention. The primary outcomes were the number of participants with: 1. at least one adenoma, 2. more than one adenoma, 3. at least one adenoma greater than or equal to 1 cm, or 4. a new diagnosis of CRC. The secondary outcome was the number of adverse events. Two reviewers independently extracted data, assessed trial quality and resolved discrepancies by consensus. We used risk ratios (RR) and risk difference (RD) with 95% confidence intervals (CI) to measure the effect. If statistical significance was reached, we reported the number needed to treat for an additional beneficial outcome (NNTB) or harmful outcome (NNTH). We combined the study data using the fixed-effect model if it was clinically, methodologically, and statistically reasonable. We included seven studies, of which five studies with 4798 participants provided data for analyses in this review. The mean ages of the participants ranged from 56 to 66 years. All participants had a history of adenomas, which had been removed to achieve a polyp-free colon at baseline. The interventions were wheat bran fibre, ispaghula husk, or a comprehensive dietary intervention with high fibre whole food sources alone or in combination. The comparators were low-fibre (2 to 3 g per day), placebo, or a regular diet. The combined data showed no statistically significant difference between the intervention and control groups for the number of participants with at least one adenoma (5 RCTs, n = 3641, RR 1.04, 95% CI 0.95 to 1.13, low-quality evidence), more than one adenoma (2 RCTs, n = 2542, RR 1.06, 95% CI 0.94 to 1.20, low-quality evidence), or at least one adenoma 1 cm or greater (4 RCTs, n = 3224, RR 0.99, 95% CI 0.82 to 1.20, low-quality evidence) at three to four years. The results on the number of participants diagnosed with colorectal cancer favoured the control group over the dietary fibre group (2 RCTS, n = 2794, RR 2.70, 95% CI 1.07 to 6.85, low-quality evidence). After 8 years of comprehensive dietary intervention, no statistically significant difference was found in the number of participants with at least one recurrent adenoma (1 RCT, n = 1905, RR 0.97, 95% CI 0.78 to 1.20), or with more than one adenoma (1 RCT, n = 1905, RR 0.89, 95% CI 0.64 to 1.24). More participants given ispaghula husk group had at least one recurrent adenoma than the control group (1 RCT, n = 376, RR 1.45, 95% CI 1.01 to 2.08). Other analyses by types of fibre intervention were not statistically significant. The overall dropout rate was over 16% in these trials with no reasons given for these losses. Sensitivity analysis incorporating these missing data shows that none of the results can be considered as robust; when the large numbers of participants lost to follow-up were assumed to have had an event or not, the results changed sufficiently to alter the conclusions that we would draw. Therefore, the reliability of the findings may have been compromised by these missing data (attrition bias) and should be interpreted with caution. There is a lack of evidence from existing RCTs to suggest that increased dietary fibre intake will reduce the recurrence of adenomatous polyps in those with a history of adenomatous polyps within a two to eight year period. However, these results may be unreliable and should be interpreted cautiously, not only because of the high rate of loss to follow-up, but also because adenomatous polyp is a surrogate outcome for the unobserved true endpoint CRC. Longer-term trials with higher dietary fibre levels are needed to enable confident conclusion.

Does the addition of whole-fiber food reduce the new diagnosis of colorectal cancer in adults with a history of adenomatous polyps?

Does the addition of whole-fiber food reduce the new diagnosis of colorectal cancer in adults with a history of adenomatous polyps?

Adenoma Detection Rate in a Community Setting Is Similar to Academic Setting: A 9-Month Prospective Study

Introduction: Adenoma detection rate (ADR) is an important quality indicator for screening colonoscopies. The recommended benchmark ADR for screening examinations is 20% (15% for women; 25% for men ≥50 years old). In addition, data suggest a higher ADR in surveillance exams versus screening exams. We measured ADR in screening and surveillance colonoscopies in this study. Methods: ADR was prospectively recorded in all patients over a 9-month period at a community ambulatory surgery center. Screening colonoscopies were performed in adults based on USPSTF criteria. Surveillance colonoscopies were performed per guidelines on subjects who had a history of adenomatous polyps or colon cancer. Data was securely recorded in spreadsheet format. No unique patient identifiers were recorded at time of data entry. Two endoscopists were responsible for performance of colonoscopies. Results: A total of 748 screening colonoscopies were performed, while 134 surveillance colonoscopies were performed. The cecal intubation rate was 99.8% (747/748). The complication rate in the overall cohort was 0.01% (1/748). One or more than 1 adenoma was found in 248 patients (33%) in the screening group. In the surveillance cohort, 67 examinations (50%) revealed at least 1 adenoma. Conclusion: ADR in the community is at par with academic settings. We found ADR to be significantly higher in surveillance group as compared to screening group. In addition, colonoscopy can be performed efficaciously and safely in the community setting while maintaining quality standards for CRC prevention.

Overlapping phenotypes with AFAP and FAP in patients with Lynch syndrome gene mutations.

402 Background: Lynch syndrome is a well-described cause of hereditary colon cancer. A point of the Amsterdam II criteria, which defines Lynch syndrome, is to exclude familial adenomatous polyposis (FAP). FAP is caused by mutations in the APC gene and is defined as the presence of 100+ adenomas. The attenuated form of familial adenomatous polyposis (AFAP) can be considered when an individual has 10-99 adenomas. While adenomatous polyps may be a part of the Lynch syndrome phenotype (as a precursor to carcinoma), the assumption is that Lynch syndrome and APC-associated polyposis do not have overlapping phenotypes. Methods: A retrospective analysis was performed on 8,202 individuals with a personal history of adenomatous polyps that had clinical genetic testing for Lynch syndrome (including genes MLH1, MSH2, MSH6, PMS2, and EPCAM) between January 2006 and July 2013. Patient adenoma history was collected on the test request form. The inclusion criterion was limited to personal history of adenomatous polyps and did not depend on personal or family history of cancer. Patients were excluded if the test performed was either targeted mutation testing or single gene testing, presumably based on prior immunohistochemistry tumor testing. Results: Of 8,202 patients with a personal history of adenomatous polyps that underwent Lynch syndrome testing, 610 (7.4%) were positive for a mutation. Mutations were detected in patients with a wide distribution of cumulative adenomas (Table). Seventy-five of the patients with a Lynch syndrome mutation had an adenomatous polyp phenotype suggestive of either FAP (100+ adenomas) or AFAP (10-99 adenomas). Of these 75 patients, 19 underwent APCtesting, all of whom were negative for a mutation. Conclusions: Individuals with an adenoma history, who were tested for Lynch syndrome, had an overall 7.4% mutation positive rate, indicating an overlapping phenotype between Lynch syndrome and FAP/AFAP. This overlap supports consideration of a gene panel test approach. [Table: see text]

Colonoscopy quality assurance in Ontario: Systematic review and clinical practice guideline.

Colonoscopy is fundamental to the diagnosis and management of digestive diseases and plays a key role in colorectal cancer (CRC) screening and diagnosis. Therefore, it is important to ensure that colonoscopy is of high quality. The present guidance document updates the evidence and recommendations in Cancer Care Ontario's 2007 Colonoscopy Standards, and was conducted under the aegis of the Program in Evidence-Based Care. It is intended to support quality improvement for colonoscopies for all indications, including follow-up to a positive fecal occult blood test, screening for individuals who have a family history of CRC and those at average risk, investigation for symptomatic patients, and surveillance of those with a history of adenomatous polyps or CRC. A systematic review was performed to evaluate the existing evidence concerning the following three key aspects of colonoscopy: physician endoscopist training and maintenance of competency; institutional quality assurance parameters; and colonoscopy quality indicators and auditable outcomes. Where appropriate, indicators were designated quality indicators (where there was sufficient evidence to recommend a specific target) and auditable outcomes (insufficient evidence to recommend a specific target, but which should be monitored for quality assurance purposes). The guidance document may be used to support colonoscopy quality assurance programs to improve the quality of colonoscopy regardless of indication. Improvements in colonoscopy quality are anticipated to improve important outcomes in digestive diseases, such as reduction of the incidence of and mortality from CRC.

Mo1588 Early Surveillance Colonoscopy for History of Adenomatous Polyps Is Primarily Done in the Absence of New Clinical Signs and Symptoms

Mo1588 Early Surveillance Colonoscopy for History of Adenomatous Polyps Is Primarily Done in the Absence of New Clinical Signs and Symptoms

389 Supervised Screening Colonoscopies: More or Less? An Assessment of Gastroenterology Fellow-Attending Supervised Colonoscopy on Quality Measures

Background: Prior studies have indicated greater adenoma detection rates with longer mean withdrawal times, however little data exists on the impact of trainees on screening colonoscopy quality indicators of withdrawal time and adenoma detection rate (ADR). The purpose of this study was to assess the differences in the quality indicators of withdrawal time and adenoma detection rates during screening colonoscopies with and without GI fellows. Methods: Single-center, retrospective cohort study from July 2008-Sept 2008, and January 2009-Febuary 2009 for patients undergoing screening colonoscopies. ICD-9 codes for: Personal history of colonic polyps, rectal adenoma; FH of Colon Cancer 1st degree relative, distant relative; average risk screening for malignant neoplasm in the colon; high risk colon CA screening: personal history of adenomatous polyps were selected. Gender, race, withdrawal time, bowel preparation quality and pathology results were recorded. Patients who had an incomplete exam or poor preparation were excluded from the study. Results: A total of 678 screening colonoscopy procedures were evaluated, of which 455 were with an attending alone and 223werewith fellows supervised by one of the same 19 attendings. The mean withdrawal time for fellow performed, GI attending supervised screening colonoscopy procedures was significantly greater at 17.2 minutes while the mean GI attending withdrawal time was 10.4 minutes (p<0.05). Attending only screening colonoscopies were significantly more likely to be less than 6 minutes duration (9.2% vs. 0.9%, p<0.05). Polyp identification was equal between fellow supervised procedures and attending only procedures (49.8% vs. 49.4%, respectively). Fellow performed screening colonoscopy procedures had an insignificant difference in ADR as compared to attendings only with an ADR of 27.8% vs. 32.7% (p =.22). Conclusion: Gastroenterology fellow supervised colonoscopy procedures have a significantly increased duration of withdrawal times as compared to attending alone procedures and are more likely to meet the 6 minute minimum withdrawal time. However, despite the longer withdrawal times, there was no significant increase in polyp or adenoma detection rates. Distribution of Polyps Detected Pathology

Noninvasive Detection of Candidate Molecular Biomarkers in Subjects with a History of Insulin Resistance and Colorectal Adenomas

We have developed novel molecular methods using a stool sample, which contains intact sloughed colon cells, to quantify colonic gene expression profiles. In this study, our goal was to identify diagnostic gene sets (combinations) for the noninvasive classification of different phenotypes. For this purpose, the effects of a legume-enriched, low glycemic index, high fermentable fiber diet was evaluated in subjects with four possible combinations of risk factors, including insulin resistance and a history of adenomatous polyps. In a randomized crossover design controlled feeding study, each participant (a total of 23; 5-12 per group) consumed the experimental diet (1.5 cups of cooked dry beans) and a control diet (isocaloric average American diet) for 4 weeks with a 3-week washout period between diets. Using prior biological knowledge, the complexity of feature selection was reduced to perform an exhaustive search on all allowable feature (gene) sets of size 3, and among these, 27 had (unbiased) error estimates of 0.15 or less. Linear discriminant analysis was successfully used to identify the best single genes and two- to three-gene combinations for distinguishing subjects with insulin resistance, a history of polyps, or exposure to a chemoprotective legume-rich diet. These results support our premise that gene products (RNA) isolated from stool have diagnostic value in terms of assessing colon cancer risk.

The Legume Inflammation Feeding Experiment (LIFE): Weight Loss Effects

The LIFE study was a randomized controlled crossover feeding experiment intended to assess the effects of a low‐glycemic legume‐rich diet on biomarkers of inflammation and insulin resistance (IR). Sixty‐four male participants (35‐75 yrs) were recruited from Central Pennsylvania and divided into 4 possible groups: IR (Y or N) and history of adenomatous polyps (Y or N). All participants consumed a legume diet (LG; 1 1/2 cup cooked dry beans) and an average American diet (AA), each for four weeks split by a 3‐week washout interlude. A total of 44 of the subjects completed the required two dietary periods and then completed an optional 4‐week weight‐loss period. During the weight loss period we tested whether the legume rich diet would facilitate weight loss. Subjects were asked to consume the bean‐containing foods but were able to eliminate other foods. For the weight loss period, incipient mean BMI (±S.D.) was 29.04 (3.39). Initial results indicate a mean change in BMI of 1.36 (1.01) accounting for a 5.09% decrease in BMI with a significant difference over the dietary period (P=0.0001). Mean change in BMI was calculated for each of the classifications and proved to be significantly different from across strata (P= 0.0033). Those participants experiencing the most weight loss (&gt; 5.2kg) also experienced a significant decrease in serum total cholesterol (TC) and LDL cholesterol (LDL‐C) (P=0.0345 and 0.001, respectively). Results indicate that the legume‐rich diet may have favorable effects on weight‐loss among individuals at high risk for colon cancer. Supported by the National Cancer Institute; partial support provided by the GCRC, PSU.

Performance value of high risk factors in colorectal cancerscreening in China

To analyze the performance value of high risk factors in population-based colorectal cancer (CRC) screening in China. We compared the performance value of the immunochemical fecal occult blood test (iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation. Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy. The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia. The iFOBT had the highest sensitivity, lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas. A history of chronic cholecystitis or cholecystectomy, chronic appendicitis or appendectomy, and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas. The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for non-adenomatous polyps. A history of chronic appendicitis or appendectomy, chronic constipation, chronic diarrhea, mucous and bloody stool, CRC in first degree relatives, malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps. Except for a history of malignant tumor in screening for non-adenomatous polyps, the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality. The iFOBT may be the best marker for screening for advanced neoplasias and adenomas. Some unique high risk factors may play an important role in CRC screening in China.

The Legume Inflammation Feeding Experiment (LIFE): Effects of Serum Lipid Levels

The LIFE Study was a randomized controlled crossover feeding study designed to test the effects of a low‐glycemic index diet rich in legumes on biomarkers of inflammation and insulin resistance (IR). Sixty four male subjects (35–75 yrs), who had undergone a screening colonoscopy within the past 2 years, were recruited in Central Pennsylvania, representing 4 combinations: IR (Y or N) and history of adenomatous polyps (Y or N). All subjects consumed a 4‐wk legume diet (LG; 1 ½ cups of cooked dry beans) and a 4‐wk isocaloric average American diet (AA) separated by a 3‐wk washout period. At baseline, mean (±S.D.) levels of serum total, HDL and LDL cholesterol (TC, HDL‐C and LDL‐C), and triglycerides (TG) were 200.2 (37.4), 45.1 (11.1), 128.9 (32.5), and 135.2 (72.3) mg/dL. Preliminary results show that serum TC was significantly reduced on both LG and AA diet (9.4% and 3.5%, respectively), with a significant difference between diets (P=0.0002). HDL‐C levels were reduced by 6.1% on LG diet and 1.9% on AA diet, and LDL‐C declined by 9.4% on LG diet and 1.6% on AA diet. For both HDL‐C and LDL‐C the differences between diets were significant (P=0.0138 and 0.0008, respectively). Serum TG levels were reduced significantly on both diets (LG diet, 7.2%; AA diet, 7.4%); however, the difference between diets was not significant (P=0.9620). These results suggest that a legume‐rich diet may have favorable effects on serum lipids and lipoproteins.Supported by the National Cancer Institute; partial support provided by the GCRC, PSU.

The natural history of aberrant crypt foci

Aberrant crypt foci (ACF) are the putative precursors to colorectal adenomas and may be useful as biomarkers. Knowledge of their natural history is essential to understanding their potential utility. Our purpose was to examine ACF detection 1 year after initial observation. We conducted a multicenter study of ACF by using a standardized protocol. ACF in the rectum were assessed and subjects returned 1 year later to evaluate the natural history of the lesions. Ancillary study to the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Of 78 subjects enrolled, 64 (82%) returned for a repeat examination 1 year later. The mean age was 71 years, 70% were male, and 54% had a history of adenomatous polyps. At the initial examination, 66% of subjects had at least 1 ACF detected in the rectum, with a mean of 2.1 +/- 2.3 per person. One year later, 60% of these subjects had at least 1 of the original ACF reidentified, but only 43% of all ACF were reidentified. A total of 56% of subjects had new ACF identified. These results are generated from the pilot phase. Improvements or change in technique over time could have influenced the results. A total of 60% of subjects who had ACF continued to have at least one ACF 1 year later, but less than half the specific ACF could be reidentified, and more than 50% of subjects had new ACF. These results imply a considerable dynamic to ACF detection over a 1-year period of observation.

No Effect of Exercise on Colon Mucosal Prostaglandin Concentrations: A 12-Month Randomized Controlled Trial

Epidemiologic studies provide evidence that exercise is associated with reduced risk of colon cancer. Exercise may exert protective effects on the colon by influencing prostaglandin production. We hypothesized that an exercise intervention would decrease prostaglandin E(2) concentrations and increase prostaglandin F(2alpha) in colon biopsies compared with controls. A 12-month randomized controlled trial testing the effects of exercise on colon mucosal prostaglandin concentrations was conducted in men (n=95) and women (n=89). The exercise intervention included moderate-to-vigorous aerobic activity, 60 min/d, 6 days/wk versus controls. Prostaglandin E(2) and F(2alpha) concentrations were measured in colon biopsies using an enzyme-linked immunoassay at baseline and at 12 months to assess changes in mean concentration for each group. Baseline colon prostaglandin E(2) and F(2alpha) concentrations were not correlated with age, race, education, family history of colon cancer, previous polyps, body size, diet, smoking, nonsteroidal antiinflammatory drug use, metabolic factors, or sex hormone levels. For both men and women, the exercise and control groups showed no change in mean prostaglandin E(2) or F(2alpha) between the baseline and 12-month biopsies. There was no difference in mean prostaglandin concentrations between exercisers and controls when exercisers were grouped by level of intervention adherence. Results were not modified by baseline age, body mass index, percentage of body fat, nonsteroidal antiinflammatory drug use, history of adenomatous polyps, or family history of colon cancer. A 12-month moderate-to-vigorous intensity aerobic exercise intervention did not result in significant changes in colon mucosal prostaglandin concentrations.

Primary dietary prevention: Is the fiber story over?

Colorectal cancer is a major cause of morbidity in developed countries, and epidemiological and experimental research suggests that environmental factors, particularly diet, may play a key etiologic role. Among the various dietary factors that have been proposed to affect the risk and progression of colon cancer, dietary fiber has been of greatest interest, due to the effects of fiber on the function of the large bowel. Dietary fiber is a heterogeneous group of compounds, consisting of the remnants of plant cells resistant to hydrolysis by human alimentary enzymes. Several case-control studies and a few cohort studies have linked higher fiber intake to reduced risk for colorectal cancer, although the results of these observational studies have been inconsistent. In the large European Prospective Investigation into Cancer and Nutrition observational study, higher dietary fiber from foods was associated with an estimated 25% reduction in risk for large bowel cancer. However, no significant relationship between fiber intake (or major food sources of fiber) and risk for colorectal cancer was observed in a recently reported large pooled analysis of several cohort studies. Well-known limitations of observational studies, particularly relating to the collection and interpretation of dietary data, constrain conclusions from these studies. To date, intervention studies testing the relationship between dietary fiber and colon cancer have focused on whether fiber supplementation or diet modification can affect the risk for adenoma recurrence and growth in individuals with a history of adenomatous polyps. In four of these intervention studies, subjects in the intervention arm were prescribed dietary fiber supplements, and beneficial effects on adenoma recurrence were not observed over 3-5 years of follow-up. In a large randomized U.S. study, the Polyp Prevention Trial, the effect of prescribing diet modification (increased fiber and reduced fat intakes) was tested, and no effects on adenoma recurrence were observed, although dietary biomarker data suggest that the change in dietary intakes in the intervention arm was not substantial. The effect of increased dietary fiber intake on risk for colorectal cancer has not been adequately addressed in studies conducted to date. Longer-term trials and higher levels of fi- ber intake are strategies that have been suggested to increase knowledge in this area. Also, laboratory and clinical studies that continue to provide insight into biological mechanisms may help to better target intervention efforts.

Virtual colonoscopy detected colorectal polyps in asymptomatic patients with average risk of colorectal neoplasia

Pickhardt PJ, Choi JR, Hwang I, et al . Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 2003;349:2191–200. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Q...

Phenotypic characteristics associated with the APC gene I1307K mutation in Ashkenazi Jewish patients with colorectal polyps.

The I1307K mutation of the APC gene is found in approximately 6% of the Ashkenazi Jewish population and is associated with elevated risk of colorectal cancer. The incidence of the mutation in patients with colorectal adenomas is unknown. To determine the carrier rate of the I1307K mutation in Ashkenazi Jewish patients with a history of colorectal polyps but without colorectal cancer and to compare phenotypic characteristics and family history of carriers vs noncarriers. A total of 231 patients who had at least 1 large bowel polyp diagnosed between January 1, 1992, and January 31, 1999, at 1 of 5 centers in Boston, Mass, were included, of whom 183 were Ashkenazi Jewish. DNA was isolated from cheek swab samples. Presence of the I1307K variant in the APC gene. The I1307K variant was identified in 22 (14%) of 161 Ashkenazi Jewish patients with a history of adenomatous polyps and in 1 (5%) of 20 Ashkenazi Jewish patients with hyperplastic polyps. The phenotypic features of adenomas, family history of polyps, colorectal cancer, and other cancers were indistinguishable between I1307K carriers and noncarriers. The frequency of the APC I1307K mutation is elevated in Ashkenazi Jewish patients with adenomatous polyps, but not hyperplastic polyps. The I1307K mutation represents a novel paradigm for cancer-predisposing genes, as it is associated with moderately increased risk of neoplasia without other associated distinguishing phenotypic features. JAMA. 2000;284:857-860