Risk Of Polyps Research Articles

The Prevalence and Risk Factors of Gastric Polyp in Endoscopy Unit at Prof. Dr. R.D. Kandou Hospital

Background: Gastric polyps are usually asymptomatic; they are often incidentally discovered during an esophagogastroduodenoscopy (EGD) for other indication. Most of gastric polyps are benign, however, some have malignant potential. Therefore, identifying gastric polyp risk factors are crucial. This article aims to determine the prevalence and risk factor of gastric polyp in Endoscopy Unit at Prof. Dr. R.D. Kandou Hospital between April 2021-2022.Method: The retrospective study was using medical record data of all patients who underwent EGD between April 2021-2022. Data regarding patient’s characteristic, endoscopic finding, and risk factors were collected. Data was analyzed using SPSSv25.0 with Mann-Whitney, Chi-square-test, and logistic-regression.Results: There were 241 patients included, 56.4% were males. The median age was 53 years old. The most common symptom was epigastric pain (69.3%). The main indication of EGD was dyspepsia with alarm symptoms (79.25%). We found 24.1% of patients had gastric polyps. Most polyps were found in corpus (93.1%) and 70.7% were fundic gland polyp. We found that older age (p=0.001), female (p=0.003), gastritis (p=0.037), active-smoker (p=0.000), and one-year-PPI-usage (p=0.000) were significantly associated with gastric polyp. Logistic-regression analysis showed active smoking was the most significant risk factor (OR=9.3), followed by female gender (OR=6.4), and PPI-usage (OR=3.4). We found no significant association between esophagitis, bile-reflux, gastric ulcer, H. pylori infection, NSAID use, and alcohol abuse with gastric polyp.Conclusions: We found 24.1% gastric polyp prevalence with significant risk factors such as older age, female gender, gastritis, smoking, and long-term-PPI-usage.

Inflammatory Bowel Disease and Risk of Colorectal Polyps: A Nationwide Population-Based Cohort Study From Sweden.

Inflammatory bowel disease [IBD] has been linked to an increased risk of colorectal neoplasia. However, the types and risks of specific polyp types in IBD are less clear. We identified 41 880 individuals with IBD (Crohn's disease [CD: n = 12 850]; ulcerative colitis [UC]: n = 29 030]) from Sweden matched with 41 880 reference individuals. Using Cox regression, we calculated adjusted hazard ratios [aHRs] for neoplastic colorectal polyps [tubular, serrated/sessile, advanced and villous] defined by histopathology codes. During follow-up, 1648 [3.9%] IBD patients and 1143 [2.7%] reference individuals had an incident neoplastic colorectal polyp, corresponding to an incidence rate of 46.1 and 34.2 per 10 000 person-years, respectively. This correlated to an aHR of 1.23 (95% confidence interval [CI] 1.12-1.35) with the highest HRs seen for sessile serrated polyps [8.50, 95% CI 1.10-65.90] and traditional serrated adenomas [1.72, 95% CI 1.02-2.91]. aHRs for colorectal polyps were particularly elevated in those diagnosed with IBD at a young age and at 10 years after diagnosis. Both absolute and relative risks of colorectal polyps were higher in UC than in CD [aHRs 1.31 vs 1.06, respectively], with a 20-year cumulative risk difference of 4.4% in UC and 1.5% in CD, corresponding to one extra polyp in 23 patients with UC and one in 67 CD patients during the first 20 years after IBD diagnosis. In this nationwide population-based study, there was an increased risk of neoplastic colorectal polyps in IBD patients. Colonoscopic surveillance in IBD appears important, especially in UC and after 10 years of disease.

Polycystic ovary syndrome is associated with a higher risk of premalignant and malignant endometrial polyps in premenopausal women: a retrospective study in a tertiary teaching hospital

BackgroundPolycystic ovary syndrome (PCOS) is characterized by anovulation, insufficient progesterone, hyperandrogenism, and insulin resistance. These factors can disrupt the endometrium of PCOS patients and can lead to chronic low-grade inflammation in the endometrium, endometrial hyperplasia, or even endometrial cancer.ObjectiveThe aim of this study was to investigate the prevalence of premalignant and malignant endometrial polyps in premenopausal women and to further explore whether PCOS is associated with premalignant and malignant changes in endometrial polyps.MethodsThis study was conducted by retrieving the medical data of 4236 premenopausal women who underwent hysteroscopic polypectomies between January 2015 and December 2021. Demographic and clinical data regarding age, height, weight, parity, hormone replacement therapy, oral contraceptives, abnormal uterine bleeding, hypertension, diabetes mellitus, PCOS, number of polyps, and size of polyps were collected, and their associations with premalignant and malignant changes in endometrial polyps were analysed.ResultAmong the endometrial polyps removed by hysteroscopic polypectomy in premenopausal women, the prevalence of premalignant and malignant polyps was 2.15%, which comprised hyperplasia with atypia at 1.13% and endometrial carcinoma at 1.02%. PCOS was associated with a higher risk of premalignant and malignant endometrial polyps in premenopausal women after adjustment for potential confounding factors.ConclusionPCOS is associated with a higher risk of premalignant and malignant endometrial polyps in premenopausal women. Therefore, it is important to evaluate the endometrium in PCOS patients with ultrasonography or hysteroscopy, and active management involving hysteroscopic polypectomy should be offered to PCOS patients diagnosed with endometrial polyps regardless of symptoms.

Irritable Bowel Syndrome Is Not Associated with an Increased Risk of Polyps and Colorectal Cancer: A Systematic Review and Meta-Analysis

ObjectivesColorectal cancer (CRC) is the third most common malignancy in the US. Several factors are associated with increased/decreased CRC risk and often linked to adenomatous colorectal polyps (CRP). Recent studies suggest a lower risk of neoplastic lesions among irritable bowel syndrome (IBS) patients. We aimed to systematically assess the occurrence of CRC and CRP in IBS patients.MethodsSearches of the Medline, Cochrane, and EMBASE databases were performed, blindly and independently, by two investigators. Studies of CRC or CRP incidence in IBS patients (diagnosed by Rome or other symptom-based criteria) were eligible for inclusion. CRC and CRP effect estimates were pooled in meta-analyses using random models.ResultsOf 4941 non-duplicate studies, 14 were included, comprising 654,764 IBS patients and 2,277,195 controls in 8 cohort studies, and 26,641 IBS patients and 87,803 controls in 6 cross-sectional studies. Pooled analysis revealed a significantly decreased prevalence of CRP in IBS subjects vs. controls, with a pooled odds ratio (OR) of 0.29 (95% CI (0.15, 0.54)). There was significant heterogeneity between studies (I2 = 96%, p < 0.01). This finding persisted when studies which did not report pre-cancerous polyps separately were excluded (OR 0.23, 95% CI (0.15, 0.35), I2 = 85%, p < 0.01). CRC prevalence was lower in IBS subjects, but this did not reach statistical significance (OR 0.40, 95% CI (0.09, 1.77]).ConclusionOur analyses reveal a decreased incidence of colorectal polyps in IBS, although CRC did not reach significance. Mechanistic studies with detailed genotypic analysis and clinical phenotyping are needed to better elucidate the potentially protective effect of IBS on CRC development.

Update of penetrance estimates in Birt-Hogg-Dubé syndrome

BackgroundBirt-Hogg-Dubé (BHD) syndrome is a rare genetic syndrome caused by pathogenic or likely pathogenic germline variants in the FLCN gene. Patients with BHD syndrome have an increased risk of fibrofolliculomas,...

Association of wnt signalling with metachronous colonic polyp risk.

232 Background: Following colorectal polypectomy, 20-50% of patients develop metachronous polyps, and a proportion have increased colorectal cancer (CRC) risk. However, there are currently no molecular biomarkers for predicting metachronous polyp risk. Constitutive activation of the Wnt signalling cascade is a hallmark of polyp development and carcinogenesis, therefore biomarkers from this pathway were investigated for association with detection of metachronous polyps. Methods: A retrospective study was performed on a tissue microarray (TMA) of left sided colonic polyps from 279 patients undergoing screening polypectomy (May’09-Dec’16) followed by surveillance colonoscopy (up to 6 years). Mutational analysis was performed using the GPOL cancer plus panel, protein expression by Immunohistochemistry and RNA-sequencing by TempO-Seq (BioClavis). Log rank statistics determined associations with time to detection of metachronous polyp. Index polyp number, histology and size were compared to metachronous lesion outcome using χ2/ANOVA and multivariate polynomial regression identified independent predictors of advanced future lesions. Results: APC (91%), KRAS (30%) and SOX9 (23%) were the most frequently mutated genes and APC and SOX9 are both implicated in Wnt signalling. Mutations in APC and co-mutations in SOX9 with ARID1 were associated with a shorter time to detection of metachronous polyps. Neither variant classification nor location of mutations were associated with metachronous polyp detection. Luminal epithelial cells with high expression of E-Cadherin or SOX9 were significantly associated with earlier detection of metachronous polyps or CRC (HR 2.3, 95%CI 1.6-3.3: p&lt;0.001 and: HR 2.0, 95%CI 1.3-3.0; p=0.001 respectively). By χ2/ANOVA analysis, E-Cadherin and SOX9 expression was associated with detection of metachronous polyp (p&gt;0.001, p=0.037 respectively). On multivariate regression, number of polyps (HR 1.2, 95%CI 1.1-1.3; p&lt;0.001), and E-Cadherin expression (HR 2.1, 95%CI 1.5-3; p&lt;0.001), independently predicted metachronous lesions. Gene set enrichment analysis (GSEA) was used to explore differential biology between high and low E-Cadherin or SOX9 expression. For E-Cadherin, all seven immune-annotated MSigDB hallmarks had negative enrichment, however Wnt--catenin signaling was positively enriched (NES=1.50, p-adj&lt;0.1). The top signature enriched for SOX9 was ‘NFB signaling via TNF (NES=1.70, p-adj&lt;0.001). The LGR5 stemness signature was enriched in both high E-Cadherin (NES=1.97 p-adj&lt;0.0001) and high SOX9 (NES=1.48, p-adj&lt;0.0001) groups. Conclusions: Wnt signalling-associated protein expression within index polyp tissue is valuable for predicting metachronous polyp risk. In addition, expression of E-Cadherin and SOX9 in colonic polyps are linked to immune and stemness signatures, suggesting immune and stemness biology may be an underlying driver of metachronous polyp development.

Gallbladder polyp size and risk of neoplasia

Introduction: Gallbladder carcinoma is the most common biliary tract carcinoma. A subset develops in polypoidal precursors that are detectable by ultrasound but are not reliably distinguishable from non-neoplastic polyps. Most guidelines recommend cholecystectomy for polyps ≥ 10mm based on a higher rate of neoplasia, however, disagreements exist with management recommendations for smaller incidentally detected polyps. We investigated gallbladder polyps examined at a single institution to determine the relationship between polyp size and a finding of neoplasia. Methods and results: 136 gallbladders (F:M = 2.3:1) with a pre-operative diagnosis and histologically confirmed polyp were identified. 59.6% of polyps were <6 mm and 80.9% <10 mm. 21 (15.4%) of all polyps were neoplastic. Twenty-one point eight percent of polyps ≥6 mm and 30.8% of polyps ≥10 mm were neoplastic. Eighty-eight point nine percent of polyps showing either high grade dysplasia or carcinoma were ≥6 mm (including all carcinomas). Conclusion: Our results are in line with previously published data and reinforce the relationship between polyp size and risk of neoplasia and, more importantly, carcinoma. All polyps ≥10 mm should be well sampled to look for advanced neoplasia.

A Real-Time Polyp-Detection System with Clinical Application in Colonoscopy Using Deep Convolutional Neural Networks

Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. The best method to prevent CRC is with a colonoscopy. During this procedure, the gastroenterologist searches for polyps. However, there is a potential risk of polyps being missed by the gastroenterologist. Automated detection of polyps helps to assist the gastroenterologist during a colonoscopy. There are already publications examining the problem of polyp detection in the literature. Nevertheless, most of these systems are only used in the research context and are not implemented for clinical application. Therefore, we introduce the first fully open-source automated polyp-detection system scoring best on current benchmark data and implementing it ready for clinical application. To create the polyp-detection system (ENDOMIND-Advanced), we combined our own collected data from different hospitals and practices in Germany with open-source datasets to create a dataset with over 500,000 annotated images. ENDOMIND-Advanced leverages a post-processing technique based on video detection to work in real-time with a stream of images. It is integrated into a prototype ready for application in clinical interventions. We achieve better performance compared to the best system in the literature and score a F1-score of 90.24% on the open-source CVC-VideoClinicDB benchmark.

Differences in the Impact of Obesity and Metabolic Unhealthiness on the Risk of Gallbladder Polyp.

Differences in the impact of obesity and metabolic health status on the risk of gallbladder polyp (GBP) remain uncertain. Herein, we aimed to compare the risk of GBP ≥5 mm among individuals with different phenotypes based on obesity and metabolic health status. A cohort of 253485 asymptomatic adults who underwent abdominal ultrasonography screening were categorized into the following four groups according to obesity and metabolic health status: 1) metabolically healthy non-obese (MHNO), 2) metabolically unhealthy and non-obese (MUNO), 3) metabolically healthy but obese (MHO), and 4) metabolically unhealthy obese (MUO). The prevalences of GBP ≥5 mm were 2.4%, 3.1%, 3.7%, and 4.0% in the MHNO, MUNO, MHO, and MUO groups, respectively. The multivariable-adjusted odds ratio (OR) values for prevalence of GBP ≥5 mm by comparing the MUNO, MHO, and MUO with the MHNO group were 1.11 [95% confidence interval (CI), 1.04-1.19], 1.30 (95% CI, 1.15-1.47), and 1.37 (95% CI, 1.28-1.45), respectively. The risk of GBP ≥5 mm in the MHO group was significantly higher than that in the MUNO group, but not significantly different from that in the MUO group. Obesity and metabolic unhealthiness appear to be independent risk factors for the prevalence of GBP, and the impact of obesity is greater than that of metabolic unhealthiness, suggesting that maintaining both normal weight and metabolic health may help reduce the risk of GBP.

Полипы эндометрия: состояние проблемы и предикция

The purpose — to study the current state of the problem of endometrial polyps, to analyze the prevalence of alleles and genotypes of the rs11841589 polymorphism of the KLF12 gene and their association with the risk of endometrial polyps and endometrial cancer in women. Material and methods. The article presents an overview of publications based on search results in the electronic resources PubMed, Elibrary, EMBASE and Google Scholar. The study included 247 women living in the Republic of Tatarstan: 86 with endometrial polyps (PE), 60 with endometrial cancer (RE), 101 patients without pathological changes in the endometrium. Clinical and laboratory examination, genotyping of the polymorphism rs11841589 of the KLF12 gene, pathomorphological examination of the endometrium were carried out. The biomaterial for genotyping the polymorphism rs11841589 of the KLF12 gene was DNA from whole blood (TestGen, Ulyanovsk). A set of reagents «Rapid-Genetics Test» by DNA-Technology LLC (Moscow, Russia) was used. The study was carried out within the framework of KSMU research No. 122082300042-2 in compliance with the principles and conditions of the Helsinki Declaration. Results. Endometrial polyps, due to their prevalence, high frequency of abnormal uterine bleeding and the risk of malignancy, represent one of the most serious gynecological problems worldwide. The mutant allele with the rs11841589 polymorphism of the KLF12 gene and the CC genotype, according to the study, do not significantly increase the risk of developing endometrial polyps and endometrial cancer in women living in the Republic of Tatarstan. It is proved that the prevalence of alleles and genotypes is comparable to the European population. Conclusion. This study showed that 247 residents of the Republic of Tatarstan included in the study had no association of rs11841589 polymorphism of the KLF12 gene with the risk of developing endometrial polyps and endometrial cancer.

Awareness and Risk Factors of Colorectal Polys of Selected Adults in Imo State Nigeria

Background One of the greatest health issues in the world is colorectal cancer. It was formerly believed that this illness only affected residents of industrialized nations; however, recent research has shown a growing prevalence in underdeveloped nations. The majority of individuals in Nigeria report their cases at a stage when curative resection is not feasible; hence, increasing understanding and awareness of early symptoms as well as early detection techniques and screening tools have been highlighted as crucial for greater success. Aim This study elucidated the awareness, knowledge, and risk factors of colorectal polyps among studied adults aged 40–65 years of age in Imo State, Nigeria. Methods The sample of the study comprised a thousand (1000) adults drawn through a multistage sampling selection method and included urban and rural dwellers in selected communities in Imo State, Nigeria. A pre-tested, semi-structured questionnaire was the main instrument of data collection for awareness, knowledge, and risk factors for colorectal polyps. Statistical Package for Social Sciences (SPSS) Version 17 was used for analysis. Results Findings showed that more than half of the respondents (62.5%) were aware of colorectal polyps; however, factors such as lack of funds (34.8%), inaccessibility to screening services (24.0%), absence of screening facilities (24.5%), and passive behavior towards screening service providers (31.8%) in healthcare centers affected regular screening among participants. Respondents possessed good knowledge of colorectal polyps, although there is a need for thorough sensitization on the risk factors of colorectal polyps, especially lifestyle behaviors. People who smoked more cigarettes per day were found to be more likely to develop colorectal polyps (AHR 1.878; 95% CI 1.018–3.463; P = 0.044) than those who smoked less (AHR 1.811; 95% CI 1.003–3.270; P = 0.049). The study found that subjects with both smoking and drinking habits had a significantly higher risk for colorectal polyps (AHR 2.073; 95% CI 1.196–3.593; P = 0.009) than non-smokers and those who drank fewer alcoholic drinks. Conclusion Relevant educational and screening interventions are required to promote early detection and management of colorectal polyps among adults in Imo State, Nigeria.

Leveraging Natural Language Processing to Extract Features of Colorectal Polyps From Pathology Reports for Epidemiologic Study.

Histopathologic features are critical for studying risk factors of colorectal polyps, but remain deeply embedded within unstructured pathology reports, requiring costly and time-consuming manual abstraction for research. In this study, we developed and evaluated a natural language processing (NLP) pipeline to automatically extract histopathologic features of colorectal polyps from pathology reports, with an emphasis on individual polyp size. These data were then linked with structured electronic health record (EHR) data, creating an analysis-ready epidemiologic data set. We obtained 24,584 pathology reports from colonoscopies performed at the University of Utah's Gastroenterology Clinic. Two investigators annotated 350 reports to determine inter-rater agreement, develop an annotation scheme, and create a reference standard for performance evaluation. The pipeline was then developed, and performance was compared against the reference for extracting polyp location, histology, size, shape, dysplasia, and the number of polyps. Finally, the pipeline was applied to 24,225 unseen reports and NLP-extracted data were linked with structured EHR data. Across all features, our pipeline achieved a precision of 98.9%, a recall of 98.0%, and an F1-score of 98.4%. In patients with polyps, the pipeline correctly extracted 95.6% of sizes, 97.2% of polyp locations, 97.8% of histology, 98.3% of shapes, and 98.3% of dysplasia levels. When applied to unseen data, the pipeline classified 12,889 patients as having polyps, 4,907 patients without polyps, and extracted the features of 28,387 polyps. Tubular adenomas were the most common subtype (55.9%), 8.1% of polyps were advanced adenomas, and the mean polyp size was 0.57 (±0.4) cm. Our pipeline extracted histopathologic features of colorectal polyps from colonoscopy pathology reports, most notably individual polyp sizes, with considerable accuracy. This study demonstrates the utility of NLP for extracting polyp features and linking these data with EHR data to create an epidemiologic data set to study colorectal polyp risk factors and outcomes.

Association between diverticular disease and prevalence of colorectal adenomatous polyps or adenocarcinomas

Background/Aim: Although the link between diverticular disease (DD) of the colon and colon polyp is known, the relationship between colon adenocarcinoma is not clear. This study evaluated the association between DD and adenomatous polyp or colon adenocarcinoma. Methods: Patients who underwent colonoscopy for the first time in 2020-2021 were evaluated and included in this retrospective cohort study. Patients with a previous history of cancer diagnosis, colon surgery, DD, and inflammatory bowel disease were excluded from the study. Age, gender, colonoscopy indications, colonoscopy diagnoses, presence of DD, characteristics of polyps (pathology, diameter, number, localization), and presence of adenocarcinoma were recorded. Obtained data were analyzed between DD and non-DD groups. Results: A total of 2633 patients were included in the study. The prevalence of DD was 16.4%. Colon adenocarcinoma was detected in 4.7%. The adenomatous polyp rate was 14.1%. A significantly higher rate of adenomatous polyps was detected in the DD group compared to the non-DD group (19.7% vs. 12.9%; P = 0.001). Higher rates of high-grade dysplasia (3.0 vs. 1.1%; P = 0.002) and colon adenocarcinoma (7.2% vs. 4.2%; P = 0.008) were observed in the DD group also. In logistic regression analyses, it was observed that the presence of concomitant DD increases the risk of adenomatous polyps (OR: 1.469, 95% CI: 1.158–1.865), the risk of adenomatous polyps with positive villous component (OR: 2.378, 95% CI: 1.437–3.934), the risk of adenomatous polyps with high-grade dysplasia (OR: 2.822, 95% CI: 1.426–5.582), and the risk of colon adenocarcinoma (OR: 2.953, 95% CI: 1.445–6.533). Conclusion: DD is associated with precancerous lesions of the colon (adenomatous polyp, villous adenoma, high-grade dysplasia) and colon adenocarcinoma. Further studies are needed to investigate its association with colon carcinogenesis and its role and value in cancer screening.

OGBN P11 Gallbladder polyps: an audit of management in an NHS trust

Abstract Background Gallbladder polyps are elevations in the gallbladder wall which project into the lumen. These can be either true polyps or “pseudopolyps” (such as cholesterol or inflammatory deposits or focal adenomyomatosis). Polyp prevalence has been estimated as high as 9.5% in some studies, of which 70% may be pseudopolyps. A small minority of true polyps may display malignant potential. Gallbladder malignancy is aggressive, especially when diagnosed at later stages of disease with poor treatment options and survival outcomes. However, Stage I disease has excellent 5 year survival rates, nearing 100%. Early identification of patients at risk of gallbladder malignancy is highly important and may detect curable disease. Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery (EAES), International Society of Digestive Surgery – European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE) have outlined best practice in regards to management of gallbladder polyps. This audit compared the current practice in a NHS healthcare trust against these guidelines in order to develop trust-wide consensus and guidelines for future management. Methods A PACS based radiology search was conducted, identifying all patients who underwent an ultrasound between 10th December 2020 and 10th December 2021, whose imaging report used the term “gallbladder polyp(s)” within a hospital trust. Patients without a diagnosis of gallbladder polyp were excluded from the audit. Historical patient records were accessed via the trust-based online patient database (Clinical Portal). Data were collected and analysed using Microsoft excel. Patient management was compared against the following ESGAR/EAES/EFISDS/ESGE guidelines: Results A total of fifty six patients fit the inclusion criteria, with an age range of 8 to 96 years. The majority were female (63%). Polyp size ranged from &amp;lt;2mm to 14mm. Patients were predominantly managed by Upper GI surgery, gastroenterology and general practice with the Radiology department performing and reporting ultrasounds and advising management or follow up. Results showed that 86% of patients were appropriately offered surgery for polyps ≥ 10mm. However, 40% of patients with polyps &amp;gt;5mm with risk factors, were not offered cholecystectomy and 44% of those without risk factors were not offered appropriate follow up. The majority of patients with polyps ≤ 5mm with risk factors were not offered ultrasound surveillance. All patients without risk factors with polyps ≤ 5mm were appropriately managed. Conclusions Key findings suggest discrepancies in the management of patients with gallbladder polyps in a NHS Trust. In particular, patients with risk factors and polyps between 6–9mm were not always identified as requiring operative management. Likewise, over half of those without risk factors were not offered surveillance imaging. Poor management and lack of follow up may put patients at risk. The results of this audit demonstrate the need for unified local or national guidelines concerning management of gallbladder polyps and consensus across multiple disciplines.

Risk of Endometrial Polyps, Hyperplasia, Carcinoma, and Uterine Cancer After Tamoxifen Treatment in Premenopausal Women With Breast Cancer

The association of tamoxifen use with the risk of uterine diseases, such as endometrial cancer, in premenopausal women with breast cancer remains controversial. However, many studies have reported an increased risk of uterine disease among postmenopausal tamoxifen users. To investigate the association of tamoxifen use with the risk of endometrial cancer and other uterine diseases in premenopausal women with breast cancer. A nationwide, population-based, retrospective longitudinal cohort study with an 18-year study period was conducted using data obtained from the Korean National Health Insurance Service. Participants included premenopausal women aged 20 to 50 years with breast cancer diagnoses between January 2003 and December 2018. Data were analyzed from April to December 2021. Tamoxifen treatment. The incidence of uterine diseases, including endometrial cancer, hyperplasia, polyps, and other uterine cancers, was identified in the study cohort using insurance claim codes. The incidence of uterine diseases per 1000 person-years was compared between women receiving tamoxifen and those not treated with adjuvant hormone therapy. Multivariable Cox proportional hazard regression analysis was performed to determine the risk of each uterine disease. Among 78 320 female participants with a mean (SD) age of 42.1 (6.1) years, 34 637 (44.2%) were categorized into the tamoxifen group and 43 683 (55.8%) were categorized into the control group. Among tamoxifen users, during the mean (SD) follow-up duration of 6.13 (4.15) years, the incidence of newly diagnosed endometrial polyps was 20.13 cases per 1000 person-years, that of endometrial hyperplasia was 13.49 cases per 1000 person-years, that of endometrial cancer was 2.01 cases per 1000 person-years, and that of other uterine cancers was 0.45 cases per 1000 person-years. The risk of endometrial cancer was higher in the tamoxifen group than in the control group (hazard ratio, 3.77; 95% CI, 3.04-4.66) after adjusting for age, body mass index, history of diabetes, hypertension, dyslipidemia, polycystic ovary syndrome, gonadotropin-releasing hormone agonist treatment, and trastuzumab treatment. In this longitudinal cohort study, premenopausal Korean women with breast cancer who received tamoxifen as adjuvant hormone therapy had a significantly increased risk of endometrial hyperplasia, polyps, carcinoma, and other uterine cancers compared with those who were not treated with adjuvant hormone therapy. These findings suggest that clinicians should consider the risk of uterine disease among tamoxifen users, including premenopausal women.

Urinary phthalate metabolites and the risk of endometrial polyp: A pilot study from the TREE cohort

Phthalates, as endocrine disrupting chemicals that can alter the endogenous hormones, may be involved in the incidence of endometrial polyp, a benign hormone-dependent condition. We conducted a pilot case-control study from the Tongji Reproductive and Environmental (TREE) cohort to investigate the associations between phthalate exposures and the risk of endometrial polyp. A total of 40 endometrial polyp patients were matched to 80 controls by age and body mass index in the ratio of 1:2. Two spot urine samples from each subject were quantified for eight phthalate metabolites to enhance exposure assessment. The conditional logistic regression and quantile-based g-computation models were separately used to explore the associations between individual and mixture of urinary phthalate metabolites and the risk of endometrial polyp. After adjusting for covariates, individual chemical analyses showed that urinary monobenzyl phthalate (MBzP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono(2-ethylhexyl) phthalate (MEHHP) and the sum of di(2-ethylhexyl) phthalate (ΣDEHP) were associated with increased risks of endometrial polyp, with adjusted odds ratios ranging from 2.62 (95% CI: 0.88, 7.84) for MECPP to 6.96 (95% CI: 1.87, 25.87) for ΣDEHP comparing the extreme exposure categories (all P for trends <0.05 or = 0.057). These associations still persisted when these exposures were modeled as continuous variables. Chemical mixture analyses showed that a simultaneous one-quartile increase in concentrations of eight phthalate metabolites was associated with an elevated odds ratio of 3.14 (95% CI: 1.49, 6.60) in endometrial polyp. Our data suggests that exposure to individual benzylbutyl phthalate (BBzP) and DEHP, as well as mixture of phthalates is associated with increased risk of endometrial polyp. This may inform public health recommendations and policies to avoid phthalate exposures for improving female reproductive health.

Association of gallbladder diseases with risk of gastrointestinal polyps

BackgroundIt has not yet been determined whether gastroscopy and colonoscopy screening help patients with gallbladder diseases. We aim to retrospectively investigate the relationship between gallbladder diseases and gastrointestinal polyps in order to provide a theoretical basis for the early screening of gastrointestinal polyps in patients with gallbladder disease.MethodsThis is a retrospective cross-sectional study involving 1662 patients who underwent gastroscopy, colonoscopy, and abdominal ultrasound as part of their health check-up from January 2015 to July 2020. We also compared the patients with and without gallbladder diseases to determine the prevalence of gastrointestinal polyps.ResultsPatients with gallbladder polyps had greater odds of having colorectal polyps (adjusted odds ratio (OR)=1.77, 95% confidence interval [Cl]: 1.23 to 2.54, p=0.002) and gastric plus colorectal polyps (adjusted OR=2.94, 95%Cl: 1.62 to 5.32, p<0.001) than those without. Patients with multiple gallbladder polyps had greater odds of having colorectal polyps (adjusted OR=2.33, 95% CI: 1.33 to 4.07, p=0.003) and gastric plus colorectal polyps (adjusted OR=3.95, 95% CI: 1.72 to 9.11, p=0.001), and patients with gallbladder polyps had greater odds of having left-colon polyps (adjusted OR=1.90, 95% CI: 1.25 to 2.88, p=0.003) and colorectal adenoma (adjusted OR=1.78, 95% CI: 1.19 to 2.66, p=0.005). We also noted that women with gallbladder polyps had a higher prevalence of colorectal polyps (OR=2.13, 95% CI: 1.20 to 3.77, p=0.010) and gastric plus colorectal polyps (OR=3.69, 95% CI: 1.58 to 8.62, p=0.003). However, no positive correlation was observed between gallbladder stones and gastrointestinal polyps.ConclusionsGallbladder polyps are significant indicators of colorectal and gastric plus colorectal polyps. Hence, gastroscopy and colonoscopy screening should be performed for patients with gallbladder polyps, particularly female patients and those with multiple gallbladder polyps.

The Emerging Role of Metformin in the Prevention and Treatment of Colorectal Cancer: A Game Changer for the Management of Colorectal Cancer.

Metformin is an old, inexpensive, and relatively safe anti-diabetic medication that can decrease the risk of several types of cancer in patients with diabetes. Recent meta-analyses have revealed that metformin markedly decreased the incidence of colorectal adenoma, advanced adenoma, and colorectal cancer (CRC) among patients with diabetes. Potential mechanisms by which metformin may decrease colorectal cancer risk include its effects on ameliorating intestinal inflammation and dysbiosis, suppressing major proliferative pathways, preventing DNA replication, accelerating tumor cells apoptosis, inhibiting intra-tumor angiogenesis and epithelial-mesenchymal transition (EMT), increasing tumor-infiltrating lymphocytes and CD68+ tumor-associated macrophages, and enhancing T cells cytotoxic activity. It is well-known that metformin can improve overall survival and CRC-specific survival among patients with diabetes and CRC. Interestingly, metformin decreases the incidence of colonic adenoma in patients with acromegaly and reduces the incidence of inflammatory bowel disease (IBD) among patients with diabetes, which can indirectly lower the risk of CRC. Results of phase II clinical trials have revealed that metformin can enhance the anti-cancer effects of chemotherapeutic agents, such as 5-Fluorouracil (5-FU) and irinotecan on refractory CRC. Furthermore, metformin decreases the risk of new polyps and adenomas in patients without diabetes. Regarding the results of previous preclinical and clinical studies, it is rational to assess the effect of metformin in normoglycemic patients with CRC and expand its clinical application for treating CRC or preventing it in a high-risk population.

Management of high and low risk malignant polyps: a population-wide analysis.

The management of malignant polyps is a treatment dilemma in selecting between polypectomy and colorectal resection. To assist clinicians, guidelines have been developed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to provide treatment recommendations. This study compared management strategy based on the ACPGBI risk categorization for malignant polyps. Univariable and multivariable statistical analysis was undertaken to assess the factors predicting management strategy. A population-wide analysis was performed of 1646 malignant polyps and the factors that predicted their management strategy, from Queensland, Australia, from 2011 to 2019. Overall, 31.55% of patients with very low or low risk disease proceeded to resection. Of those with high or very high risk disease, 36.69% did not proceed to resection. In very low and low risk polyps, age (P=0.003) and polyp location (P < 0.001) were significantly different between the colorectal resection group and the polypectomy alone group. In those with very high or high risk polyps age (P < 0.001), type of facility (public or private) for the colonoscopy (P=0.037), right colonic polyps compared to left colonic polyps (P=0.015) and rectal polyps (P < 0.001) and mismatch repair mutations present (P=0.027) were predictive of resection in high risk disease using a multivariable model. Over 30% of patients with very low and low risk malignant polyps proceeded to resection, against the advice of guidelines. Furthermore, over 35% of patients with very high or high risk malignant polyps did not proceed to resection. Education strategies may improve management decision choices. Furthermore, improvements in data collation will improve the understanding of management choices in the future.

Large café-au-lait spots on a 5-year-old boy

Large café-au-lait spots on a 5-year-old boy