Incidence Of Colorectal Cancer In Patients Research Articles

Fertility preservation in reproductive-aged female patients with colorectal cancer: a scoping review.

Colorectal cancer (CRC) incidence in adults younger than 50 years is steadily increasing in the USA, and treatment for CRC can impact future fertility. However, fertility decision-making in female patients with CRC can be complex, with fertility preservation (FP) counseling occurring inconsistently. The goal of this scoping review was to assess the literature regarding the frequency and quality of fertility preservation (FP) discussions taking place among oncology clinicians and their reproductive-age female patients with colorectal cancer (CRC) in order to identify existing gaps in care and inform future research, interventions, or potential changes in practice. A comprehensive literature search was conducted using the Ovid Medline, PsycInfo, and Scopus databases in order to identify studies pertaining to FP counseling in reproductive-age female patients with CRC. We used Covidence to screen studies for relevance and to extract data. Findings of interest included rate of fertility and/or FP discussions, patient characteristics associated with fertility discussions, initiators of discussions, rate of referrals to fertility specialists, patient utilization of FP services, and unmet fertility needs. We performed both quantitative and qualitative data synthesis. We identified five studies that met our inclusion criteria, all published between 2007 and 2022. Frequency of fertility counseling discussions was low across studies, with a range of 15 to 52.5% of female patients with CRC receiving counseling. Patient characteristics which may be associated with likelihood of fertility discussion included age, parity, number of children, cancer location and stage, treatment type, and quality of life. The literature suggested that fertility discussions were initiated by clinicians about two-thirds of the time, and medical oncologists were the clinicians most likely to initiate. Studies did capture unmet fertility-related patient needs; participants who did not receive counseling often expressed desire for these discussions and regret that they did not occur. Despite increasing incidence of CRC in patients at younger ages, this scoping review found a dearth of research conducted on young female CRC patients' experiences with fertility counseling and referrals. Notably, the existing research reveals that relatively few of these patients are receiving appropriate counseling. Additional research is needed to clarify current FP counseling practices, patient and clinician perceptions about FP, and ways to improve the quantity and quality of FP counseling in this patient population.

Inflammatory Bowel Disease and Colorectal Cancer: Epidemiology, Etiology, Surveillance, and Management.

Patients with inflammatory bowel diseases (IBDs), such as ulcerative colitis and Crohn's disease, have an increased risk of developing colorectal cancer (CRC). Although advancements in endoscopic imaging techniques, integrated surveillance programs, and improved medical therapies have contributed to a decreased incidence of CRC in patients with IBD, the rate of CRC remains higher in patients with IBD than in individuals without chronic colitis. Patients with IBD-related CRCs exhibit a poorer prognosis than those with sporadic CRCs, owing to their aggressive histological characteristics and lower curative resection rate. In this review, we present an updated overview of the epidemiology, etiology, risk factors, surveillance strategies, treatment recommendations, and prognosis of IBD-related CRCs.

Association between nonalcoholic fatty liver disease and colorectal cancer: A population-based study.

Colorectal cancer (CRC) and nonalcoholic fatty liver disease (NAFLD) have high prevalence rates and place a considerable burden on the health-care industry. The association between both diseases is controversial. Our aim was to examine the association between NAFLD and CRC. Using data extracted from the Taiwan National Health Insurance Research Database (NHIRD) from 2000 to 2015, we enrolled 60 298 patients with NAFLD. Of these, 52,986 met the inclusion criteria. A comparison group was selected using 4-fold propensity score matching by age, sex, and year of index date. The primary outcome was the cumulative incidence of CRC in patients with NAFLD. Over a mean follow-up period of 8.5 years, 160 new cases of CRC were identified. The incidence rate of CRC was higher in the NAFLD group (12.23 per 100,000 person-years) than in the comparison cohort (6.0 per 100,000 person-years). Cox proportional hazards regression analysis revealed that the adjusted hazard ratio (HR) of CRC was 1.259 in the study group (95% confidence interval [CI]: 1.047-1.486, P = .003). Using Kaplan-Meier analysis, we ascertained that the cumulative incidence of CRC was significantly high in the NAFLD group. Patients older than 50 years, with diabetes mellitus (DM), and with chronic liver disease also exhibited a high risk of CRC. NAFLD was associated with a high risk of CRC. CRC occurs more frequently in patients with NAFLD aged between 50 and 59 years and those older than 60 years with comorbidities, including DM and chronic liver disease. Physicians should consider the subsequent risk of CRC when treating patients with NAFLD.

1519. Increased incidence of colorectal cancer in Veteran Health Administration hospital patients with pyogenic liver abscess: A matched cohort study

Abstract Background Colorectal cancer (CRC) remains the third leading cause of death in the United States (US), and incidence has increased among patients < 50 years of age over the last few decades. Although many patients with early CRC remain asymptomatic, infections such as Streptococcus gallolyticus bacteremia, can be an early finding. There is increasing evidence that pyogenic liver abscesses (PLA) may also be associated with CRC. However, studies of US populations remain limited. Methods We retrospectively evaluated patients with a diagnosis of PLA at Veteran Health Administration hospitals across the US from 2003 to 2020. For each case, up to three uninfected controls matched for age (+/- 5), gender, and healthcare facilities at the time of index infection from the outpatient population were selected. PLA patients and matched controls were followed for ten years. Our primary outcome was a new diagnosis of CRC after index infection. Stratified cumulative incidence function plots with Gray’s test for equality were used to examine CRC incidence. Then we used Fine-Gray sub-distribution hazard regression models with interaction terms using the logarithm of time to estimate cause-specific time-dependent hazard ratios (HRs) for CRC incidence while accounting for mortality. Results We compared 8,294 PLA patients to 23,111 matched controls. Median age was 65.7 in PLA patients and 66.0 in matched controls. The median number of colonoscopies was ten in PLA patients and five in matched controls over the study period (p < 0.001). Our analysis revealed a 1.9% incidence of new CRC in the liver abscess group, compared to 0.8% in the matched cohort (p < 0.001, Figure 1). The multivariate sub-distribution hazard regression model showed higher time-dependent HRs of CRC up to two years from diagnosis of PLA but not higher afterward (Table 1). Incidence of colorectal cancer (CRC) in patients with liver abscess (dashed yellow line) compared to patients with no liver abscess (solid blue line). Our analysis revealed a 1.9% incidence of CRC in patients with liver abscess compared to 0.8% in the matched control cohort. Conclusion We found a significantly higher incidence of CRC for patients with PLA, especially during the first two years from diagnosis, although some of our findings may be explained by increased screening around the time of diagnosis. We believe our findings support the importance of CRC screening after the diagnosis of PLA. Disclosures Michihiko Goto, MD MSCI, Merck & Co.: Grant/Research Support.

ODP488 Incidental papillary thyroid cancer found after hemi-thyroidectomy in man with MUTYH-associated polyposis

Abstract MUTYH-associated polyposis (MAP) is an autosomal recessive syndrome caused by a mutation to the MUTYH gene, a base excision repair gene that repairs oxidative damage to DNA. Mutations to both allelic copies of this gene typically manifest as multiple colonic polyps, which develop by middle age. Individuals with MAP are also at higher risk for developing non-gastrointestinal (GI) cancers including those affecting the ovary, bladder, breast, endometrium, and possibly thyroid. A 66-year-old man with a history of MAP complicated by colonic polyposis requiring subtotal colectomy, an esophageal adenocarcinoma resected by esophagectomy, and a gastrointestinal stromal tumor also resected was referred to endocrinology clinic for an incidental thyroid nodule found on routine surveillance. The patient denied prior neck radiation but reported having a daughter and cousin with thyroid cancer. Ultrasound showed a left 3.3 by 2.8 by 1.6 cm thyroid nodule with multiple lobulations. Although a fine needle aspiration (FNA) of the nodule was benign, a repeat ultrasound several months later noted an increase in size to 3.5 by 3.5 by 2. 0 cm. Given the nodule's significant growth, the patient's history of MAP, and family history of thyroid cancer, the patient underwent a left hemi-thyroidectomy. Pathology revealed that the nodule was a follicular adenoma, however also identified two papillary microcarcinomas, measuring 1 and 2 mm. The patient was started on levothyroxine 50 mcg with a goal TSH below 0.5 mU/L and was monitored with ultrasounds which were unremarkable. In 2021, the national cancer institute estimated approximately 150,000 cases of colorectal cancer (CRC) with a 65% 5-year survival, compared to 44,000 cases of thyroid cancer with a 98% 5-year survival. Although the incidence of CRC in patients with MAP is high, approximately 43-63% by age 60, the risks of several associated non-GI malignancies are not as well defined. The national comprehensive cancer network (NCCN) and the American College of Gastroenterology (ACG) both published guidelines regarding appropriate screening for both GI and associated non-GI malignancies. In regards to thyroid cancer, both advise screening in patients with familiar adenomatous polyposis (FAP), another familial condition, due to the increased risk of papillary thyroid cancer (PTC) of approximately 1-2%. The evidence concerning MUTYH is not as strong, with the ACG recommending annual thyroid cancer screening, although the quality of evidence is low. Since a thyroid ultrasound is both low-cost and non-invasive and the overall survival of patients with PTC is high, we agree that patients with MAP be screened with thyroid ultrasounds. This case highlights the possibility that thyroid cancer is a manifestation of MAP, and a lower threshold to send for surgery may be warranted for those with other risk factors such as a family history or prior neck radiation. Presentation: No date and time listed

Incidence and Mortality of Post-Polypectomy Colorectal Cancer in Patients with Low-Risk Adenomas: A Systematic Review and Meta-Analysis of Observational Studies

Introduction: The long-term risks of post-polypectomy colorectal cancer (CRC) incidence and mortality among patients with low-risk adenomas (LRAs) are unclear. This study aimed to perform a systematic review and meta-analysis of the risk of CRC incidence and mortality following LRAs removal. Methods: We searched the PubMed, Embase, and Cochrane library for studies that reported the risk of metachronous CRC incidence and mortality after colonoscopy. The primary outcome was the risk of CRC incidence and mortality in patients with LRAs. Random-effects models were used to calculate the pooled risk ratio (RR) with a 95% confidence interval (CI). Results: Thirteen observational studies with 1,750,305 patients (45.4% male; follow-up: 4.5–16.5 years) were included. A meta-analysis of seven studies showed a higher CRC incidence in patients with LRAs than those without adenomas (per 10,000 person-years: 5.2 vs. 3.9; RR 1.25 [95% CI 1.05–1.49], I² = 0%). However, the CRC-related death rate was not significantly different between the two groups (RR 1.13 [95% CI 0.75–1.69], I² = 0%). When compared with the general population, the meta-analysis showed a significantly lower risk of CRC incidence in patients with LRAs (RR 0.59 [95% CI 0.45–0.77], I² = 0%), and another three studies, which could not be pooled, showed a reduction in the risk of CRC-related death in the LRAs group. Conclusions: Patients with LRAs have a small but higher risk of post-polypectomy CRC incidence than patients without adenomas. The marginally higher absolute incidence seemed insufficient for more intensive surveillance colonoscopy, but the significant difference suggested different follow-up strategies between patients with LRAs and those without adenomas.

Diabetes and Colorectal Cancer Risk: A New Look at Molecular Mechanisms and Potential Role of Novel Antidiabetic Agents.

Epidemiological data have demonstrated a significant association between the presence of type 2 diabetes mellitus (T2DM) and the development of colorectal cancer (CRC). Chronic hyperglycemia, insulin resistance, oxidative stress, and inflammation, the processes inherent to T2DM, also play active roles in the onset and progression of CRC. Recently, small dense low-density lipoprotein (LDL) particles, a typical characteristic of diabetic dyslipidemia, emerged as another possible underlying link between T2DM and CRC. Growing evidence suggests that antidiabetic medications may have beneficial effects in CRC prevention. According to findings from a limited number of preclinical and clinical studies, glucagon-like peptide-1 receptor agonists (GLP-1RAs) could be a promising strategy in reducing the incidence of CRC in patients with diabetes. However, available findings are inconclusive, and further studies are required. In this review, novel evidence on molecular mechanisms linking T2DM with CRC development, progression, and survival will be discussed. In addition, the potential role of GLP-1RAs therapies in CRC prevention will also be evaluated.

Abstract 1103: Aspirin reduces the incidence of metastasis in a preclinical study of Braf mutant colorectal cancer

Abstract Background. Aspirin is a well-studied chemopreventive agent for the prevention of conventional colorectal adenomas and cancer. Post hoc analyses of cardiovascular prevention trials demonstrate a long-term reduction in colorectal cancer incidence and mortality with aspirin treatment. Randomized controlled trials have shown a long-term benefit for reducing colorectal cancer incidence in patients with Lynch Syndrome, a form of hereditary colorectal cancer. These findings have led to the recommendation of aspirin as a chemopreventive for colorectal cancer by the U.S. Preventive Services Task Force and Cancer Council Australia. However, future research questions have noted a lack of knowledge of the differential benefits of aspirin in preventing sessile serrated lesions versus conventional adenomas and cancer. In our study, we hypothesized that aspirin will be an effective long-term treatment for the prevention of colorectal cancer resulting from sessile serrated lesions. We aimed to investigate this in a preclinical study utilizing a murine model of Braf mutant serrated neoplasia with a primary end-point investigating cancer incidence. Methods. BrafV637E/+/Villin-CreERT2/+ mice were injected with tamoxifen (i.p. 75mg/kg) at 2 weeks of age to activate the Braf mutation within the intestine, then commenced on an aspirin-supplemented (n=78) or control standard (n=83) diet at wean. Aspirin was supplemented into the diet and provided ad libitum, at a human equivalent dose of 80-120mg per day, until sacrifice at 14 months. The gastrointestinal tract was excised and evaluated for the presence of carcinoma. In addition, the peritoneal and thoracic cavities were inspected for metastatic disease. A gastrointestinal pathologist (CL) assessed all histology sections. Results. At sacrifice, 14 months post induction of mutant Braf, all mice developed murine serrated lesions reminiscent of human sessile serrated lesions. We observed a carcinoma incidence of 31% (26/83) of which 35% (9/26) had metastasized to the liver or peritoneal cavity. When mice were treated with an aspirin-supplemented diet there was no significant reduction in carcinoma incidence (22/78, 28%, P = 0.7315). However, there was a significant reduction in the incidence of metastasis (1/22, 5%, P = 0.0134). Mice in the control group had lesions of a significantly greater size when compared to aspirin treated mice (P=0.0032). Conclusions. Aspirin resulted in a 7-fold decrease in metastases. This study demonstrates that the benefit of aspirin in preventing Braf mutant serrated neoplasia occurs at the carcinoma-metastasis phase of colorectal carcinogenesis. This could have potential clinical benefit in reducing recurrence and mortality. Citation Format: Alexandra Kane, Cheng Liu, Lochlan Fennell, Diane McKeone, Jennifer Borowsky, Barbara Leggett, Vicki Whitehall. Aspirin reduces the incidence of metastasis in a preclinical study of Braf mutant colorectal cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1103.

P-191 Optimal age to start screening for colorectal cancer in average-risk adults: 50 or 45 years old?

According to current international colorectal cancer (CRC) screening guidelines, regular screening for CRC should start at 50 years of age in average-risk adults. Recent epidemiological data show constantly increasing incidence of CRC in patients of younger age, which led the American Cancer Society to issue a guideline suggesting that regular screening for colorectal cancer should start at 45 years of age (American Cancer Society, qualified recommendation). The aim of the study was to compare the screening colonoscopy findings in 3 different age groups (40-44, 45-49, 50-54 years) in a Greek referral centre. We retrospectively studied people of 40 to 54 years old who underwent colonoscopy screening with high definition endoscopes during the last 2 years in the Endoscopy Unit of the Gastroenterology Department. High-risk patients were excluded (polyposis syndrome, positive family history for colon cancer, inflammatory bowel disease), as well as symptomatic patients (with the exception of irritable bowel syndrome symptoms) and those with inadequate bowel preparation. Sex, age, endoscopic findings (cancer, advanced adenomas, any adenomas, serrated polyps, localization) and bowel preparation (Boston Bowel Preparation Scale) were registered. From November 2016 to December 2019 a total of 411 patients (282 female) were assessed: 40 patients aged 40-44, 110 patients aged 45-49, and 261 patients aged 50-54. The bowel preparation was characterized as excellent in 63.3% of the patients, average in 5,1% and good in the remaining. The overall adenoma detection percentage was 18.6% for men and 6.5% for women. No cancers were reported. The percentage of findings for every age group respectively were for advanced adenomas 0%, 6.5% and 1.9%, for any adenomas 2.5%, 13% and 10.4%, for serrated polyps 0%, 1.9% and 2.7% and for isolated right colon adenomas 0%, 23.1% and 33.3%. No significant statistical difference was found in the comparison between age groups. Logistic regression analysis showed that adenomas were 3.3 times more frequent in male patients. No statistically significant differences were detected, especially between age groups 45-49 and 50-54 years. Notably, there was a very low percentage of findings in the age group 40-44 years. Interestingly female patients were more prone to undergo screening colonoscopy, while they presented with a 70% lower probability of finding adenomas compared to male patients. The topic of starting regular screening colonoscopy at 45 years of age remains under discussion.

Increasing rate of colorectal cancer in younger patients: a review of colonoscopy findings in patients under 50 at a tertiary institution.

In Australia, colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death. It is more common in patients over 50 years, with previous evidence showing patients under 50 years account for only 9% of CRC. However, recent Australian and International studies have shown an increase in CRC incidence in patients under 50 years of age. The main aim of this study was to analyse the incidence of CRC in patients under 50 and to determine if screening would be beneficial in this population. A retrospective cohort study was performed on all patients under 50 years of age who underwent a colonoscopy, performed by a colorectal surgeon, at the Gold Coast Hospital and Health Service between January 2013 and December 2017. A total of 557 patients were included in the study; 120 (21.5%) colonoscopies had a significant finding (CRC or adenoma with malignant potential). 1.9% of patients were diagnosed with CRC, all were symptomatic at time of diagnosis, the majority were stage 3 or 4. A total of 1.9% of patients under 50 who underwent colonoscopy were diagnosed with CRC, whilst 21.5% of patients had significant findings. These rates are greater than previously quoted figures and data for patients under 50, and provides evidence to support lowering of the CRC faecal occult blood testing screening age.

Colorectal cancer surveillance in inflammatory bowel disease: Practice guidelines and recent developments

Patients with long-standing inflammatory bowel disease (IBD) involving at least 1/3 of the colon are at increased risk for colorectal cancer (CRC). Advancements in CRC screening and surveillance and improved treatment of IBD has reduced CRC incidence in patients with ulcerative colitis and Crohn’s colitis. Most cases of CRC are thought to arise from dysplasia, and recent evidence suggests that the majority of dysplastic lesions in patients with IBD are visible, in part thanks to advancements in high definition colonoscopy and chromoendoscopy. Recent practice guidelines have supported the use of chromoendoscopy with targeted biopsies of visible lesions rather than traditional random biopsies. Endoscopists are encouraged to endoscopically resect visible dysplasia and only recommend surgery when a complete resection is not possible. New technologies such as virtual chromoendoscopy are emerging as potential tools in CRC screening. Patients with IBD at increased risk for developing CRC should undergo surveillance colonoscopy using new approaches and techniques.

Young-age onset colorectal cancer in Brazil: Analysis of incidence, clinical features, and outcomes in a tertiary cancer center

BackgroundRecent studies report increasing incidence of colorectal cancer (CRC) in the young-age population, but data concerning clinical behavior, pathologic findings, and prognosis are controversial for this group. Early recognition of CRC in young patients is a challenge and diagnosis at advanced stage is clearly associated with worse outcomes. Materials and methodsWe retrospectively reviewed medical records of 5806 patients diagnosed with CRC between January/2011 and November/2016 and identified 781 patients aged less than 50-years-old. ResultsWe found an absolute increasing in the incidence of CRC in patients <50 years old of 1.88%–2.23% annually, with a relative increasing of 35.3% between 2011 and 2016. Median age was 42 years, 57.4% were female and 20.9% reported family history of CRC. Left-sided tumors were more frequent and the majority of patients were symptomatic. The most common stages at diagnosis were III (34.1%) and IV (37.3%). The median overall survival (OS) for stage IV was 25 months (95% CI 20.7-29.3) and was not reached for Stages I-III (P < 0.001). Family history of CRC was independently associated with better OS in stage IV(P = 0.02). For stages I-III, wild-type KRAS, family history of CRC, and absence of angiolymphatic invasion were associated with better OS (P = 0.02, P = 0.01 and P < 0.001, respectively). ConclusionsIn our cohort, the incidence of early-onset CRC is increasing over the past years. Young patients were more likely to be diagnosed with metastatic disease, left-sided and/or rectum site and symptoms at presentation. These findings highlight the emerging importance of young-age onset CRC and the need to discuss strategies to early diagnosis.

Genomic landscape, clinical characteristics and outcomes of early onset (EO) compared with average onset (AO) colorectal cancer (CRC).

3520Background: The incidence of CRC in patients (pts) under the age of 50 has been rising over the past decade. Little is known about the biologic differences between early and AO (over the age of...

New trend in colorectal cancer in Germany: are young patients at increased risk for advanced colorectal cancer?

BackgroundThe role of colonoscopy in the screening of colorectal cancer (CRC) has been unequivocally established. In Germany, screening colonoscopy with full insurance reimbursement is available for individuals aged 55 and above, and/or for persons with well-known risk factors for CRC. However, advanced CRC is not uncommon in individuals below 55 years. This study was designed to investigate the incidence of advanced CRC in patients < 55 years.MethodsA retrospective analysis of data from a prospectively maintained CRC database of a university hospital in Germany was performed. Using the recommended age for screening colonoscopy as cutoff, the study population was divided into two groups: < 55 years (study group) and ≥ 55 years (control group). Both groups were compared with regard to the extent of CRC using the UICC stages. Only surgically managed patients were included for analysis. Advanced CRC was defined as UICC stage III or IV.ResultsComplete follow-up data was available for 609 patients treated between 2009 and 2013. The study group included 83 patients, 42 females and 41 males with a median age of 48.0 ± 10 years, while the control group was made up of 526 patients, 230 females and 296 males with a median age of 75.5 ± 8.3 years. Both groups were comparable with regard to gender distribution, p = 0.24. Significantly more patients from the study group were diagnosed with advanced CRC in comparison to the control group, 56.6 vs. 43.9%, p = 0.03. There was no statistically significant difference amongst both groups with respect to cancer-related mortality, 10.8 vs. 12.5%, p = 0.66.ConclusionPatients below the recommended age for screening colonoscopy might be at increased risk for advanced CRC. There is need to decrease the recommended age for screening colonoscopy to prevent CRC or enable an early diagnosis in patients below 55 years.

Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study

SummaryBackgroundRemoval of adenomas reduces colorectal cancer incidence and mortality; however, the benefit of surveillance colonoscopy on colorectal cancer risk remains unclear. We examined heterogeneity in colorectal cancer incidence in intermediate-risk patients and the effect of surveillance on colorectal cancer incidence.MethodsWe did this retrospective, multicentre, cohort study using routine lower gastrointestinal endoscopy and pathology data from patients who, after baseline colonoscopy and polypectomy, were diagnosed with intermediate-risk adenomas mostly (>99%) between Jan 1, 1990, and Dec 31, 2010, at 17 hospitals in the UK. These patients are currently offered surveillance colonoscopy at intervals of 3 years. Patients were followed up through to Dec 31, 2014.We assessed the effect of surveillance on colorectal cancer incidence using Cox regression with adjustment for patient, procedural, and polyp characteristics. We defined lower-risk and higher-risk subgroups on the basis of polyp and procedural characteristics identified as colorectal cancer risk factors. We estimated colorectal cancer incidence and standardised incidence ratios (SIRs) using as standard the general population of England in 2007. This trial is registered, number ISRCTN15213649.Findings253 798 patients who underwent colonic endoscopy were identified, of whom 11 944 with intermediate-risk adenomas were included in this analysis. After a median follow-up of 7·9 years (IQR 5·6–11·1), 210 colorectal cancers were diagnosed. 5019 (42%) patients did not attend surveillance and 6925 (58%) attended one or more surveillance visits. Compared to no surveillance, one or two surveillance visits were associated with a significant reduction in colorectal cancer incidence rate (adjusted hazard ratio 0·57, 95% CI 0·40–0·80 for one visit; 0·51, 0·31–0·84 for two visits). Without surveillance, colorectal cancer incidence in patients with a suboptimal quality colonoscopy, proximal polyps, or a high-grade or large adenoma (≥20 mm) at baseline (8865 [74%] patients) was significantly higher than in the general population (SIR 1·30, 95% CI 1·06–1·57). By contrast, in patients without these features, colorectal cancer incidence was lower than that of the general population (SIR 0·51, 95% CI 0·29–0·84).InterpretationColonoscopy surveillance benefits most patients with intermediate-risk adenomas. However, some patients are already at low risk after baseline colonoscopy and the value of surveillance for them is unclear.FundingNational Institute for Health Research Health Technology Assessment, Cancer Research UK.

Folic Acid Supplementation May Reduce Colorectal Cancer Risk in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.

To evaluate the role of folic acid supplementation in colorectal cancer (CRC) chemoprevention in patients with inflammatory bowel disease (IBD). CRC is a serious complication of IBD. Folic acid supplementation has been shown to be chemopreventative in sporadic CRC. Patients with IBD are at risk of folate deficiency though intestinal malabsorption and also competitive inhibition by concurrent sulfasalazine use. To date, there have been several studies reporting on folic acid supplementation in patients with IBD and CRC. We searched electronic databases for studies reporting folic acid use and CRC incidence in patients with IBD. We produced a pooled hazard ratio with 95% confidence intervals using a random-effects model. Preplanned subgroup analyses were performed to explore for any potential sources of heterogeneity. Ten studies reporting on 4517 patients were included. We found an overall protective effect for folic acid supplementation on the development of CRC, pooled hazard ratio=0.58 (95% confidence interval, 0.37-0.80). There was low to moderate heterogeneity among studies, I=29.7%. Subgroup analyses suggested that folic acid use was protective in hospital-based studies, studies from North America and those that were performed before folate fortification of foods in 1998. CRC remains an important complication of IBD. Chemoprevention is an attractive strategy and folic acid as a cheap, safe, and well-tolerated supplement may have a role. Focused prospective studies are required to precisely define any potential effect.

Colorectal polypoid lesions and expression of vascular endothelial growth factor in a consecutive series of endoscopic and surgical patients.

Colorectal cancer incidence in patients undergoing screening protocols is decreasing because of the higher rate of discovered preneoplastic colonic lesions; however, adenomatous polyps may not always be removable endoscopically and surgery may still be necessary. The aim of this study was to assess the vascular endothelial growth factor expression in the different steps of colorectal carcinogenesis to explore its potential role as a marker of malignancy in polypoid lesions. A total of 92 subjects with colonic adenoma or cancer who underwent screening colonoscopy or surgery were prospectively enrolled. Real-time reverse transcription polymerase chain reaction for VEGF-A messenger RNA expression and immunohistochemistry for VEGF-A were performed. Immunoassays for VEGF-A, VEGF-C, VEGFR-1, VEGFR-2, and VEGFR-3 were also performed. Non-parametric statistics, receiver operating characteristic curve analysis, and logistic multiple regression analysis were used. VEGF-A messenger RNA expression was higher in patients with high-grade dysplasia or colorectal cancer than in those with low-grade dysplasia adenomas (p = 0.01). At immunohistochemistry, VEGF-A expression was significantly higher in colorectal cancer patients compared to dysplastic adenomas (p < 0.001), and the accuracy of VEGF-A expression for prediction of malignancy was 91.7 (95% confidence interval = 78.7-97.9). VEGF-C protein expression was lower in colorectal cancer patients than in simple adenomas (p = 0.02). VEGF-A levels were directly correlated to polyp size (rho = 0.73, p = 0.0062). Multivariate analysis demonstrated that malignancy and polyp size were independent predictors of VEGF-A mucosal levels. This study demonstrated that the VEGF-A expression changes along the colorectal carcinogenesis pathway showing a neat step up at the passage from high-grade dysplasia to invasive cancer. This feature might potentially be useful to stratify colorectal polyps in different risks of progression classes. Moreover, the high level of VEGF-A expression predicted the presence of lymphovascular invasion with good accuracy.

Reduced Incidence of Colorectal Cancers With Repeated Screening With Fecal Immunochemical Tests

Background and AimsScreening for fecal occult blood test with fecal immunochemical tests (FIT), a widely utilized test for colorectal cancer (CRC) screening in Japan, has reduced the mortality from CRC in the country. This study aimed to evaluate the importance of repeated FIT screening by comparing the incidence of CRC in patients undergoing initial and repeated screening.MethodsParticipants aged ≥40 years in Saga, Japan, were invited to undergo a 2-day FIT. FIT was analyzed by latex agglutination immune-turbidimetry. The presence of CRC in FIT positive (≥100ng/mL) subjects was verified by colonoscopy, and CRC incidence rates calculated.ResultsFrom 2005 to 2007, 55,595 individuals were invited to undergo CRC screening, including 47,168 undergoing repeated and 8427 undergoing initial screening. Of the 5832 FIT-positive subjects, 4615 were assessed by colonoscopy and 114 subjects were diagnosed as having CRC. Of these 114 patients, 67 had early and 47 had advanced CRC. The incidence of CRC was 63% lower in the repeated than in the initial screening group (P < .0001). The rate of curative endoscopic treatment for early CRC was higher in the repeated than in the initial screening group. Overall survival was longer in screened subjects than in those who visited hospitals with clinical symptoms.ConclusionsRepeated annual CRC screening with FIT reduced the incidence of CRC compared with initial screening. Background and AimsScreening for fecal occult blood test with fecal immunochemical tests (FIT), a widely utilized test for colorectal cancer (CRC) screening in Japan, has reduced the mortality from CRC in the country. This study aimed to evaluate the importance of repeated FIT screening by comparing the incidence of CRC in patients undergoing initial and repeated screening. Screening for fecal occult blood test with fecal immunochemical tests (FIT), a widely utilized test for colorectal cancer (CRC) screening in Japan, has reduced the mortality from CRC in the country. This study aimed to evaluate the importance of repeated FIT screening by comparing the incidence of CRC in patients undergoing initial and repeated screening. MethodsParticipants aged ≥40 years in Saga, Japan, were invited to undergo a 2-day FIT. FIT was analyzed by latex agglutination immune-turbidimetry. The presence of CRC in FIT positive (≥100ng/mL) subjects was verified by colonoscopy, and CRC incidence rates calculated. Participants aged ≥40 years in Saga, Japan, were invited to undergo a 2-day FIT. FIT was analyzed by latex agglutination immune-turbidimetry. The presence of CRC in FIT positive (≥100ng/mL) subjects was verified by colonoscopy, and CRC incidence rates calculated. ResultsFrom 2005 to 2007, 55,595 individuals were invited to undergo CRC screening, including 47,168 undergoing repeated and 8427 undergoing initial screening. Of the 5832 FIT-positive subjects, 4615 were assessed by colonoscopy and 114 subjects were diagnosed as having CRC. Of these 114 patients, 67 had early and 47 had advanced CRC. The incidence of CRC was 63% lower in the repeated than in the initial screening group (P < .0001). The rate of curative endoscopic treatment for early CRC was higher in the repeated than in the initial screening group. Overall survival was longer in screened subjects than in those who visited hospitals with clinical symptoms. From 2005 to 2007, 55,595 individuals were invited to undergo CRC screening, including 47,168 undergoing repeated and 8427 undergoing initial screening. Of the 5832 FIT-positive subjects, 4615 were assessed by colonoscopy and 114 subjects were diagnosed as having CRC. Of these 114 patients, 67 had early and 47 had advanced CRC. The incidence of CRC was 63% lower in the repeated than in the initial screening group (P < .0001). The rate of curative endoscopic treatment for early CRC was higher in the repeated than in the initial screening group. Overall survival was longer in screened subjects than in those who visited hospitals with clinical symptoms. ConclusionsRepeated annual CRC screening with FIT reduced the incidence of CRC compared with initial screening. Repeated annual CRC screening with FIT reduced the incidence of CRC compared with initial screening.

Colonoscopy Is Associated With a Reduced Risk for Colon Cancer and Mortality in Patients With Inflammatory Bowel Diseases

Crohn's disease and ulcerative colitis are associated with an increased risk of colorectal cancer (CRC). Surveillance colonoscopy is recommended at 2- to 3-year intervals beginning 8 years after diagnosis of inflammatory bowel disease (IBD). However, there have been no reports of whether colonoscopy examination reduces the risk for CRC in patients with IBD. In a retrospective study, we analyzed data from 6823 patients with IBD (2764 with a recent colonoscopy, 4059 without a recent colonoscopy) seen and followed up for at least 3 years at 2 tertiary referral hospitals in Boston, Massachusetts. The primary outcome was diagnosis of CRC. We examined the proportion of patients undergoing a colonoscopy within 36 months before a diagnosis of CRC or at the end of the follow-up period, excluding colonoscopies performed within 6 months before a diagnosis of CRC, to avoid inclusion of prevalent cancers. Multivariate logistic regression was performed, adjusting for plausible confounders. A total of 154 patients developed CRC. The incidence of CRC among patients without a recent colonoscopy (2.7%) was significantly higher than among patients with a recent colonoscopy (1.6%) (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.39-0.80). This difference persisted in multivariate analysis (OR, 0.65; 95% CI, 0.45-0.93) and was robust when adjusted for a range of assumptions in sensitivity analyses. Among patients with CRC, a colonoscopy within 6 to 36 months before diagnosis was associated with a reduced mortality rate (OR, 0.34; 95% CI, 0.12-0.95). Recent colonoscopy (within 36 months) is associated with a reduced incidence of CRC in patients with IBD, and lower mortality rates in those diagnosed with CRC.

The Use of Metformin and Colorectal Cancer Incidence in Patients with Type II Diabetes Mellitus

Experimental studies have suggested that metformin may decrease the incidence of colorectal cancer in patients with type II diabetes. However, previous observational studies have reported contradictory results, which are likely due to important methodologic limitations. Thus, the objective of this study was to assess whether the use of metformin is associated with the incidence of colorectal cancer in patients with type II diabetes. A cohort study of patients newly treated with non-insulin antidiabetic agents was assembled using the United Kingdom Clinical Practice Research Datalink. A nested case-control analysis was conducted, where all incident cases of colorectal cancer occurring during follow-up were identified and randomly matched with up to 10 controls. Conditional logistic regression was used to estimate adjusted rate ratios (RR) of colorectal cancer associated with ever use, and cumulative duration of use of metformin. All models accounted for latency and were adjusted for relevant potential confounding factors. Overall, ever use of metformin was not associated with the incidence of colorectal cancer [RR: 0.93; 95% confidence interval (CI), 0.73-1.18]. Similarly, no dose-response relationship was observed in terms of cumulative duration of use. The use of metformin was not associated with the incidence of colorectal cancer in patients with type II diabetes. The results of this study do not support the launch of metformin randomized controlled trials for the chemoprevention of colorectal cancer.