Brian A Sullivan1,2, Thomas S Redding3, Xuejun Qin3,4, Ziad F Gellad3,5, Elizabeth R Hauser3,5,4, Meghan C O'Leary3, Christina D Williams3,6, Laura W Musselwhite3,7, David Weiss8, Ashton N Madison3, David Lieberman9,10, Dawn Provenzale3,5. 1. Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA. brian.sullivan3@va.gov. 2. Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. brian.sullivan3@va.gov. 3. Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA. 4. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA. 5. Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. 6. Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. 7. Department of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, NC, USA. 8. Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, MD, USA. 9. Portland Veteran Affairs Medical Center, Portland, OR, USA. 10. Oregon Health and Science University, Portland, OR, USA.
Abstract
BACKGROUND: Colorectal cancer (CRC) screening guidelines recommend frequent colonoscopies and consideration of genetic testing in individuals with ≥10 cumulative adenomas. However, it is unclear how these guidelines apply to routine practice. AIMS: We estimated the proportion of participants found to have ≥10 cumulative adenomas in a screening population and described their outcomes of advanced neoplasia (AN), CRC, and extra-colonic malignancy. METHODS: We performed a secondary analysis of VA CSP#380, which includes 3121 veterans aged 50-75 who were followed up to 10 years after screening colonoscopy. We calculated the cumulative risk of ≥10 cumulative adenomas by Kaplan-Meier method. We compared baseline risk factors in those with and without ≥10 cumulative adenomas as well as the risk for AN (adenoma ≥1 cm, villous adenoma or high-grade dysplasia, or CRC) and extra-colonic malignancy by multivariate logistic regression. RESULTS: The cumulative risk of ≥10 cumulative adenomas over 10.5 years was 6.51% (95% CI 4.38%-9.62%). Age 60-69 or 70-75 at baseline colonoscopy was the only factors associated with the finding of ≥10 cumulative adenomas. Compared to those with 0-9 cumulative adenomas, participants with ≥10 cumulative adenomas were more likely to have had AN (OR 17.03; 95% CI 9.41-30.84), including CRC (OR 7.00; 95% CI 2.84-17.28), but not extra-colonic malignancies. CONCLUSIONS: Approximately 6.5% of participants in this screening population were found to have ≥10 cumulative adenomas over 10.5 years, which was uncommon before age 60. These participants were found to have AN and CRC significantly more often compared to those with lower cumulative adenomas.
BACKGROUND: Colorectal cancer (CRC) screening guidelines recommend frequent colonoscopies and consideration of genetic testing in individuals with ≥10 cumulative adenomas. However, it is unclear how these guidelines apply to routine practice. AIMS: We estimated the proportion of participants found to have ≥10 cumulative adenomas in a screening population and described their outcomes of advanced neoplasia (AN), CRC, and extra-colonic malignancy. METHODS: We performed a secondary analysis of VA CSP#380, which includes 3121 veterans aged 50-75 who were followed up to 10 years after screening colonoscopy. We calculated the cumulative risk of ≥10 cumulative adenomas by Kaplan-Meier method. We compared baseline risk factors in those with and without ≥10 cumulative adenomas as well as the risk for AN (adenoma ≥1 cm, villous adenoma or high-grade dysplasia, or CRC) and extra-colonic malignancy by multivariate logistic regression. RESULTS: The cumulative risk of ≥10 cumulative adenomas over 10.5 years was 6.51% (95% CI 4.38%-9.62%). Age 60-69 or 70-75 at baseline colonoscopy was the only factors associated with the finding of ≥10 cumulative adenomas. Compared to those with 0-9 cumulative adenomas, participants with ≥10 cumulative adenomas were more likely to have had AN (OR 17.03; 95% CI 9.41-30.84), including CRC (OR 7.00; 95% CI 2.84-17.28), but not extra-colonic malignancies. CONCLUSIONS: Approximately 6.5% of participants in this screening population were found to have ≥10 cumulative adenomas over 10.5 years, which was uncommon before age 60. These participants were found to have AN and CRC significantly more often compared to those with lower cumulative adenomas.
Authors: Ashley Earles; Lin Liu; Ranier Bustamante; Pat Coke; Julie Lynch; Karen Messer; María Elena Martínez; James D Murphy; Christina D Williams; Deborah A Fisher; Dawn T Provenzale; Andrew J Gawron; Tonya Kaltenbach; Samir Gupta Journal: JCO Clin Cancer Inform Date: 2018-12
Authors: Mary E Reid; James R Marshall; Denise Roe; Michael Lebowitz; David Alberts; Achyut K Battacharyya; Maria Elena Martinez Journal: Cancer Epidemiol Biomarkers Prev Date: 2003-10 Impact factor: 4.254