Colonoscopic screening of first-degree relatives of patients with large adenomas: increased risk of colorectal tumors

BACKGROUND & AIMS: The risk of developing colorectal neoplasia is not well established among family members of individuals with large adenomas, and screening strategies remain under debate in this population. This study aimed at quantifying the risk of colorectal adenomas and cancers using colonoscopic screening in first-degree relatives of patients with large adenomas. METHODS: This case-control study was performed in 18 endoscopic units of French nonuniversity hospitals. A colonoscopy was offered to first-degree relatives of 306 index cases with adenomas > or =10 mm if they were alive, aged 40-75 years, and could be contacted by the index case. Among them, 168 were examined and matched for age, sex, and geographical area with 2 controls (n = 307). Controls were randomly selected from 1362 consecutive patients aged 40-75 years having undergone a colonoscopy for minor symptoms. RESULTS: The prevalence of large adenomas and cancers was 8.4% and 4.2%, in relatives and controls, respectively. Odds ratios (ORs) associated with a history of large adenomas in relatives were 2.27 (95% confidence interval [CI], 1.01-5.09) for cancers or large adenomas, 1.21 (95% CI, 0.68-2.15) for small adenomas, and 1.56 (95% CI, 0.96-2.53) for all colorectal neoplasia. The risk of large adenomas and cancers was higher in relatives of index cases younger than 60 years (OR, 3.82; 95% CI, 0.92-15.87) and when the index case had large distal adenomas (OR, 3.14; 95% CI, 1.27-7.73). CONCLUSIONS: First-degree relatives of patients with large adenomas are at increased risk of developing colorectal cancers or large adenomas. This result has implications for screening in this high-risk population.     

Increased prevalence of colorectal adenomas in women with breast cancer

BACKGROUND: The frequency of colorectal adenomas and carcinomas was investigated in a large cohort of women with breast cancer in comparison with matched controls, since data on the occurrence of second tumors in women with breast cancer is controversial. DESIGN: In a cohort study, 188 consecutive women (median age 57 years) with primary breast cancer and 376 age-matched women who served as controls were examined by total colonoscopy. Breast cancer patients and controls were compared for the frequency of colorectal adenomas and carcinomas. RESULTS: Women with breast cancer showed a higher risk of colorectal adenomas than controls (14.9 vs. 9.3%, p=0.047, OR 1.7, 95% CI 1.0-2.9). This increased prevalence resulted primarily from an increased prevalence in the age group 65-85 (31 vs. 10%, p=0.004, OR 3.8, 95% CI 1.6-9.3). Colorectal carcinomas were found infrequently in both groups (2 in each group). Women with breast cancer receiving anti-estrogen therapy showed a trend towards a lower risk of adenomas compared to women without anti-estrogen therapy (3.7 vs. 17.2%, p=0.053, OR 0.16, 95% CI 0.0-1.1). CONCLUSIONS: Women with breast cancer above the age of 65 years have an increased risk of colorectal adenomas compared to women without breast cancer. Women with a diagnosis of breast cancer should especially be encouraged to participate in colorectal cancer-screening programs which, in most countries, call for screening of all average-risk individuals over the age of 50 years.     

Incidence and recurrence rates of colorectal adenomas in first-degree asymptomatic relatives of patients with colon cancer

OBJECTIVES: Subjects with one first-degree relative affected with colorectal cancer are considered to be at increased risk of colorectal adenomas. We compared the recurrence and incidence rates of colorectal adenomas among subjects with one first-degree relative with colorectal cancer and those without family history. METHODS: A series of consecutive asymptomatic subjects successfully underwent a colonoscopy, were found to have either normal results or at least one adenoma, provided a detailed family history, and were offered a second colonoscopy 3 yr later; 190 out of 436 subjects accepted, 134/172 with one or more adenomas and 56/264 with no abnormalities at the initial examination. A first-degree family history was reported by 43/134 and 26/56, respectively. RESULTS: By multivariate analysis, the presence of adenomas at follow-up examination was significantly associated with a positive family history of colorectal cancer in both subgroups, those with a previously resected adenoma (odds ratio = 2.23, 95% CI = 1.04-4.79) and those without (odds ratio = 8.95, CI = 1.29-62.22). CONCLUSION: A history of one first-degree relative with colorectal cancer is associated with a significant increase in 3-yr cumulative incidence and recurrence rates of adenomas.     

Endoscopic screening of relatives of patients with colorectal cancer

Background—The risk of colorectal cancer ishigher among relatives of those affected. The neoplastic yield reportedfrom screening such individuals varies enormously between studies anddepends on the age and strength of the family history of those screened.
Aims—To ascertain the neoplastic yield ofendoscopic screening of first degree relatives of patients withcolorectal cancer by age and familial risk.
Subjects—A total of 330 individuals with a familyhistory of colorectal cancer.
Method—Endoscopic screening conducted accordingto a protocol.
Results—Adenomas were found in 12%, and adenomaslarger than 1 cm in 8%, of "high risk" individuals screenedprimarily by colonoscopy. Of those with neoplasia, 26% had lesions ator proximal to the splenic flexure. Neoplasia was found in 9.5% ofindividuals at lower familial risk, screened primarily by 60 cmflexible sigmoidoscopy, 4% of whom had neoplasia larger than 1 cm insize or cancer. Neoplastic yield was greatest in the fourth and fifthdecades in those at highest risk, but increased with age in those atlower risk.
Conclusions—For individuals with two or morefirst degree relatives, or relatives who have developed colorectalcancer at a young age, colonoscopy appears to be the only satisfactorymethod of screening, but 60 cm flexible sigmoidoscopy may be useful in those at lower levels of risk.

Keywords:colorectal cancer; endoscopic screening; colonoscopy; sigmoidoscopy; familial risk

     

Patients with iron deficiency anemia have an increased prevalence of gallstones

We determined the frequency of gallstones (GS) in iron deficiency anemia (IDA) patients and evaluated factors that could affect GS formation—like lipid levels and gallbladder (GB) motilities of the patients. One hundred and eleven IDA patients (88 females, 23 males; median age, 42) and 81 healthy controls (68 females, 13 males; median age, 42) were included into our study. The clinical findings of all IDA patients were recorded down; biochemical values and body mass index (BMI) were determined; and abdominal ultrasonography was performed. In addition, GB emptying was monitored by ultrasound at 30-min intervals for 2 h after a mixed meal in randomly chosen, age-matched 25 IDA patients and 26 controls. Fasting volume (FV), residual volume (RV), and ejection fraction (EF) for all GBs were determined. The frequency of GS plus cholecystectomy was significantly higher in IDA patients (15 cases, 13.5%) than in the control group (five cases, 6.2%, p = 0.048). IDA patients with GS plus cholecystectomy were older than those without GS plus cholecystectomy (p < 0.001). FV and EF did not differ between IDA and control groups (p > 0.05). On the other hand, RV was significantly higher in IDA group than in controls (p = 0.035). The frequency of GS in IDA patients was significantly higher than in controls. The increased prevalence of GS in IDA might be explained with impaired GB motility.     

Selenoprotein levels in patients with colorectal adenomas and cancer

OBJECTIVES: Selenium is a trace mineral that, as a constituent of certain selenoproteins, acts as an antioxidant. Results of studies addressing a cancer protective effect of selenium have been controversial. The present study measured selenoprotein-P, extracellular glutathione peroxidase, and plasma selenium in patients with colon cancer and adenomatous colon polyps to determine whether patients who develop colorectal adenomas or cancer are selenium deficient. METHODS: Patients who presented to an endoscopy center for colonoscopy or who were referred to our institution with a newly diagnosed colorectal cancer were offered enrollment in the trial. Each patient underwent phlebotomy, usually immediately after colonoscopy. In all, 103 patients were enrolled in the study. Of these, 33 patients were found to have colorectal cancer, 35 adenomatous colon polyps, and 17 normal examinations. A total of 18 patients had other diagnoses and were not included in the study group. RESULTS: The mean age for the colorectal cancer group was 69 yr, for the adenomatous colon polyp group 62 yr, and for the normal group was 56 yr. The adenomatous colon polyp and normal groups were predominantly female. Based on one way analysis of variance tests, there was no significant difference in selenoprotein-P or plasma selenium levels or extracellular glutathione peroxidase activity among the three groups (p = 0.28, 0.098, and 0.35 respectively). CONCLUSIONS: The present data suggest that patients with adenomatous colon polyps and those with colorectal cancer are not selenium deficient.     

Should relatives of patients with colorectal cancer be screened?

PURPOSE: The objective of our investigation was to attempt to address the controversial issue concerning index screening and surveillance of relatives of patients with colorectal cancer and to identify those areas of research that should be considered in future studies. METHODS: Relevant literature was reviewed concerning the screening of asymptomatic first-degree relatives of patients with colorectal cancer not associated with the rare autosomal dominant inherited colorectal cancer syndromes. RESULTS: The data reviewed suggest that there is an increased risk of colorectal neoplasia in this population and a significantly higher yield of adenomas and carcinomas when colonoscopy is used for index screening. However, significant variability in study design and screening protocols and inconsistencies in data presentation make clinical interpretation and data analysis confusing and difficult. CONCLUSIONS: There is a critical need for standardization in future studies. Furthermore, as there are no studies that document decreased overall mortality from colorectal cancer in first-degree relatives as a result of screening, the decision as to whether to screen this population needs to be based on future prospective controlled trials.     

Polyethylene glycol and prevalence of colorectal adenomas

BACKGROUND AND AIM: Dietary polyethylene glycol (PEG) is extraordinarily potent in the chemoprevention of experimental colon carcinogenesis. PEG is used to treat constipation in France and in the USA. French laxatives include Forlax (PEG4000), Movicol and Transipeg (PEG3350), and Idrocol (pluronic F68). This study tests the hypothesis that use of a PEG-based laxative might reduce the prevalence of colorectal tumors. METHODS: In this population-based study, consecutive patients attending for routine total colonoscopy were enrolled during four months by the gastroenterologists of Indre-et-Loire. They were asked if they had previously taken a laxative or a NSAID. Age, gender, previous polyps, family history of colorectal cancer, constipation, digestive symptoms were also recorded. Tumors found during colonoscopy were categorized histologically. RESULTS: Records from 1165 patients fulfilled the inclusion criteria, 607 women and 498 men, mean age 58.3. Among those, 813 had no tumor, 329 had adenomas, and 23 had carcinomas. In a univariate analysis, older age, male gender, lack of digestive symptom, and previous polyps were more common in patients with colorectal tumors. In contrast, previous Forlax intake was more common in tumor-free patients (odds ratio (OR) any use/no use, 0.52; 95% confidence interval, 0.27-0.94). More people used Forlax, which contains a higher dose of PEG than the other PEG-laxatives, whose ORs were smaller than one, but did not reach significance. In multivariate analysis, older age and male gender were associated with higher risk, and NSAIDs use with lower risk, of colorectal tumors. CONCLUSION: Forlax users had a halved risk of colorectal tumors in univariate analysis, which suggests that PEG may prevent carcinogenesis.     

Sarcopenia is associated with an increased risk of advanced colorectal neoplasia

Background/aims

Although sarcopenia is associated with an increased risk for mortality after the curative resection of colorectal cancer, its influence on the development of advanced colonic neoplasia remains unclear.

Methods

This study included 1270 subjects aged 40 years or older evaluated with first-time screening colonoscopy at Seoul National University Boramae Health Care Center from January 2010 to February 2015. Skeletal muscle mass was measured with a body composition analyzer (direct segmental multifrequency bioelectrical impedance analysis method). Multiple logistic regression analysis was performed to determine whether sarcopenia is associated with advanced colorectal neoplasia.

Results

Of 1270 subjects, 139 (10.9%) were categorized into the sarcopenia group and 1131 (89.1%) into the non-sarcopenia group. In the non-sarcopenia group, 55 subjects (4.9%) had advanced colorectal neoplasia. However, in the sarcopenia group, 19 subjects (13.7%) had advanced colorectal neoplasia, including 1 subject with invasive colorectal cancer (0.7%). In addition, subjects with sarcopenia had a higher prevalence of advanced adenoma (P < 0.001) than those without sarcopenia. According to the multiple logistic regression analysis adjusted for variable confounders, age (odds ratio 1.062, 95% confidence interval 1.032–1.093; P < 0.001), male sex (odds ratio 1.749, 95% confidence interval 1.008–3.036; P = 0.047), and sarcopenia (odds ratio 2.347, 95% confidence interval 1.311–4.202; P = 0.004) were associated with an advanced colorectal neoplasia.

Conclusion

Sarcopenia is associated with an increased risk of advanced colorectal neoplasia.

     

Colonoscopic screening examination of relatives of patients with colorectal cancer. I. A comparison with an endoscopically screened normal population.

First-degree relatives (n = 206) of patients operated on for colorectal cancer (CRC) (n = 181) were offered a colonoscopic screening examination; 169 relatives (82%) attended. The findings were compared with those in a normal population sample with no CRC in first-degree relatives (n = 308), aged 50-59 years, who had been screened by means of flexible sigmoidoscopy. Three carcinomas and 176 polyps were found in 56 of 95 male relatives (57%) and 34 of 74 female relatives (46%). The adenoma prevalence rate was 37 (39%) and 26 (35%) for male and female relatives, respectively. In the 50- to 59-year age group, the adenoma prevalence rates for both sexes collectively and for women separately were significantly higher among relatives than among the population without CRC relatives. Hyperplastic polyps were larger, whereas adenomas were similar in size among relatives compared with the normal population. Colonoscopy may be a suitable method of choice for screening first-degree relatives of patients with CRC.