Sammy Au1, Vladimir Marquez2, Fergal Donnellan2, Baljinder S Salh2, Michael Nimmo3, Karen J Goddard4, Majid Alsahafi5, Nazira Chatur2. 1. Department of Pathology and Laboratory Medicine, Vancouver General Hospital, 3203-910 W 10 Avenue, Vancouver, BC, V5Z 4E3, Canada. sammyau@alumni.ubc.ca. 2. Division of Gastroenterology, Department of Medicine, Vancouver General Hospital, 5153-2775 Laurel St, Vancouver, BC, V5Z 1M9, Canada. 3. Department of Pathology and Laboratory Medicine, Vancouver General Hospital, 135C-910 W 10 Avenue, Vancouver, BC, V5Z 4E3, Canada. 4. Department of Radiation Oncology, British Columbia Cancer Agency, 600 W 10 Ave, Vancouver, BC, V5Z 4E6, Canada. 5. Department of Medicine, King Abdulaziz University, PO Box 80200, Jeddah, 21589, Saudi Arabia.
Abstract
BACKGROUND: Cancer survivors treated with abdominal or pelvic radiation therapy (RT) for childhood cancer have an increased risk of colorectal cancer. However, clinical guidelines are inconsistent on recommendations regarding the early initiation of screening in these patients due to the lack of supporting evidence that these patients pass through a pre-invasive phase, in which adenomatous polyps can be detected and removed. AIMS: To determine the prevalence of adenomatous polyps in cancer survivors treated with RT for childhood cancer; the prevalence in average-risk patients aged 17-49; and the prevalence in average-risk patients aged 50-75. METHODS: We conducted a retrospective study comparing the prevalence of adenomatous polyps among three patient groups: childhood cancer survivors aged 17-49 with prior RT who underwent colonoscopy screening from 2006 to 2017; age- and gender-matched patients in the average-risk population; and average-risk patients aged 50-75. RESULTS: One hundred and forty-five patients were included in the study. The proportion of patients with adenomatous polyps in the cancer survivor group was significantly higher than that in the age- and gender-matched average-risk group (58.6 vs 17.2%, p = 0.00) and higher than the average-risk group aged 50-75 (58.6 vs 27.6%, p = 0.009). The prevalence of adenomas with high-risk features was higher in the survivor group compared to patients aged 50-75 (20.7 vs 3.5%, p = 0.015). CONCLUSIONS: Cancer survivors treated with RT for childhood cancer have a higher prevalence of adenomatous polyps compared to the average-risk population. These findings support the early initiation of colonoscopy screening 10 years after radiation therapy, even in patients who have received RT doses below 30 Gy.
BACKGROUND:Cancer survivors treated with abdominal or pelvic radiation therapy (RT) for childhood cancer have an increased risk of colorectal cancer. However, clinical guidelines are inconsistent on recommendations regarding the early initiation of screening in these patients due to the lack of supporting evidence that these patients pass through a pre-invasive phase, in which adenomatous polyps can be detected and removed. AIMS: To determine the prevalence of adenomatous polyps in cancer survivors treated with RT for childhood cancer; the prevalence in average-risk patients aged 17-49; and the prevalence in average-risk patients aged 50-75. METHODS: We conducted a retrospective study comparing the prevalence of adenomatous polyps among three patient groups: childhood cancer survivors aged 17-49 with prior RT who underwent colonoscopy screening from 2006 to 2017; age- and gender-matched patients in the average-risk population; and average-risk patients aged 50-75. RESULTS: One hundred and forty-five patients were included in the study. The proportion of patients with adenomatous polyps in the cancer survivor group was significantly higher than that in the age- and gender-matched average-risk group (58.6 vs 17.2%, p = 0.00) and higher than the average-risk group aged 50-75 (58.6 vs 27.6%, p = 0.009). The prevalence of adenomas with high-risk features was higher in the survivor group compared to patients aged 50-75 (20.7 vs 3.5%, p = 0.015). CONCLUSIONS:Cancer survivors treated with RT for childhood cancer have a higher prevalence of adenomatous polyps compared to the average-risk population. These findings support the early initiation of colonoscopy screening 10 years after radiation therapy, even in patients who have received RT doses below 30 Gy.
Entities:
Keywords:
Cancer survivor; Colorectal polyp; Radiation therapy; Screening colonoscopy
Authors: Tara O Henderson; Kevin C Oeffinger; John Whitton; Wendy Leisenring; Joseph Neglia; Anna Meadows; Catherine Crotty; David T Rubin; Lisa Diller; Peter Inskip; Susan A Smith; Marilyn Stovall; Louis S Constine; Sue Hammond; Greg T Armstrong; Leslie L Robison; Paul C Nathan Journal: Ann Intern Med Date: 2012-06-05 Impact factor: 25.391
Authors: Michael Schaapveld; Berthe M P Aleman; Anna M van Eggermond; Cécile P M Janus; Augustinus D G Krol; Richard W M van der Maazen; Judith Roesink; John M M Raemaekers; Jan Paul de Boer; Josée M Zijlstra; Gustaaf W van Imhoff; Eefke J Petersen; Philip M P Poortmans; Max Beijert; Marnix L Lybeert; Ina Mulder; Otto Visser; Marieke W J Louwman; Inge M Krul; Pieternella J Lugtenburg; Flora E van Leeuwen Journal: N Engl J Med Date: 2015-12-24 Impact factor: 91.245
Authors: Patricia E Daly; Sara Samiee; Maria Cino; Robert Gryfe; Aaron Pollett; Andrea Ng; Louis S Constine; David C Hodgson Journal: Gut Date: 2016-07-13 Impact factor: 23.059
Authors: Ann G Zauber; Sidney J Winawer; Michael J O'Brien; Iris Lansdorp-Vogelaar; Marjolein van Ballegooijen; Benjamin F Hankey; Weiji Shi; John H Bond; Melvin Schapiro; Joel F Panish; Edward T Stewart; Jerome D Waye Journal: N Engl J Med Date: 2012-02-23 Impact factor: 91.245
Authors: Graça M Dores; Catherine Metayer; Rochelle E Curtis; Charles F Lynch; E Aileen Clarke; Bengt Glimelius; Hans Storm; Eero Pukkala; Flora E van Leeuwen; Eric J Holowaty; Michael Andersson; Tom Wiklund; Timo Joensuu; Mars B van't Veer; Marilyn Stovall; Mary Gospodarowicz; Lois B Travis Journal: J Clin Oncol Date: 2002-08-15 Impact factor: 44.544
Authors: Jop C Teepen; Suzanne L de Vroom; Flora E van Leeuwen; Wim J Tissing; Leontien C Kremer; Cécile M Ronckers Journal: Cancer Treat Rev Date: 2015-12-17 Impact factor: 12.111
Authors: Mylène Bassal; Ann C Mertens; Leslie Taylor; Joseph P Neglia; Brian S Greffe; Sue Hammond; Cécile M Ronckers; Debra L Friedman; Marilyn Stovall; Yutaka Y Yasui; Leslie L Robison; Anna T Meadows; Nina S Kadan-Lottick Journal: J Clin Oncol Date: 2006-01-20 Impact factor: 50.717
Authors: Debra L Friedman; John Whitton; Wendy Leisenring; Ann C Mertens; Sue Hammond; Marilyn Stovall; Sarah S Donaldson; Anna T Meadows; Leslie L Robison; Joseph P Neglia Journal: J Natl Cancer Inst Date: 2010-07-15 Impact factor: 11.816
Authors: Berbel L M Ykema; Lisanne S Rigter; Manon C W Spaander; Leon M G Moons; Tanya M Bisseling; Berthe M P Aleman; Evelien Dekker; Wieke H M Verbeek; Ernst J Kuipers; Jan Paul de Boer; Pieternella J Lugtenburg; Cecile P M Janus; Eefke J Petersen; Judith M Roesink; Richard W M van der Maazen; Gerrit A Meijer; Michael Schaapveld; Flora E van Leeuwen; Beatriz Carvalho; Petur Snaebjornsson; Monique E van Leerdam Journal: Dig Endosc Date: 2021-06-08 Impact factor: 6.337