Cost–benefit analysis of screening colonoscopy in 40- to 50-year-old first-degree relatives of patients with colorectal cancer

Background and aims As shown previously, 40- to 50-year-old first-degree relatives of patients with colorectal cancer (CRC) have significantly more colorectal adenomas than controls of the same age. Screening colonoscopy of these persons at risk between 40 and 50 years might be cost beneficial.Methods We prepared a detailed cost–benefit analysis of screening colonoscopy and possible repeat endoscopies according to current expenditures for endoscopic procedures in Germany. Since screening colonoscopy is generally offered and reimbursed from 55 years on in Germany, we analysed the period between 45 and 55 years, taking an annual interest rate of 5% into account. Costs were analysed based on the results of a former study [11] depending on various participation rates in a general screening programme.Findings Based on the available 1994 figure of about €20,000 for diagnosis and treatment of one cancer case, screening colonoscopy is cost beneficial when participation is high. Under a more realistic assumption of currently about €40,000 per cancer case, screening colonoscopy is cost beneficial in any case.Interpretation Our data support that systematic screening colonoscopy in first-degree relatives of patients with CRC by the age of 45 years most likely demonstrates an economic benefit.     

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.     

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.     

prevalence of colorectal neoplasms in young,average risk individuals: A turning tide between East and West

AIM To determine the prevalence of colorectal neoplasia in average risk persons 40-59 years of age in Israel and to compare the results with other populations. METHODS We reviewed the results of asymptomatic average-risk subjects, aged 40 to 59 years, undergoing their first screening colonoscopy between April 1994 and January 2014. The detection rates of adenoma, advanced adenoma(AA) and colorectal cancer(CRC) were determined in the 40's and 50's age groups by gender. The prevalence of lesions was compared between age groups. After meticulous review of the literature, these results were compared to published studies addressing the prevalence of colorectal neoplasia in similar patient groups, in a variety of geographical locations.RESULTS We included first screening colonoscopy results of 1750 individuals. The prevalence of adenomas, AA and CRC was 8.3%, 1.0% and 0.2% in the 40-49 age group and 13.7%, 2.4% and 0.2% in the 50-59 age group, respectively. Age-dependent differences in adenoma and AA rates were significant only among men(p 0.005). Literature review disclosed 17 relevant studies. As expected, in both Asian and Western populations, the risks for overall adenoma and advanced adenoma was significantly higher in the 50's age group as compared to the 40's age group in a similar fashion. The result of the current study were similar to previous studies on Western populations. A substantially higher rate of adenoma, was observed in studies conducted among Asian populations in both age groups.CONCLUSION The higher rate of colorectal neoplasia in Asian populations requires further investigation and reconsideration as to the starting age of screening in that population.     

Risk factors for colorectal adenomas among immediate family members of patients with colorectal cancer in Taiwan: a case-control study

OBJECTIVES: The incidence of colorectal cancer or adenoma among first-degree relatives of patients with colorectal cancer is significantly high. However, a well defined screening and surveillance consensus has not been developed for these families in Taiwan. We conducted this study to evaluate the colorectal adenoma prevalence pattern in screened immediate family members in Taiwan, and to derive implications for future screening programs. METHODS: A total of 234 immediate family members (aged 51.6 +/- 21.5 yr) of 186 patients with colorectal cancer were offered a colonoscopy. Each relative examined was then paired with two control subjects for age, sex, and symptoms. The prevalence of colorectal adenomas was then compared using multiple logistic regression analysis. RESULTS: The estimated risk of developing adenomas among immediate family members of patients with colorectal cancer was significantly increased (OR = 2.33; 95% CI, 1.43-3.78; p < 0.001). This trend was more striking for men (OR = 2.46; 95% CI, 1.40-4.31; p = 0.001). Immediate family members were at an increased risk for high-risk adenomas (> or = 1.0 cm, with a villous component, and/or with severe dysplasia) (OR = 4.5; 95% CI, 1.91-10.60; p = 0.002), and developed adenomas at an earlier age than did controls. Individuals with index cancer relatives diagnosed at < 50 yr of age or male relatives posed a higher risk of developing colorectal adenomas. CONCLUSIONS: The prevalence of colorectal adenoma in persons with a colorectal cancer family history in Taiwan is similar to that reported in Western countries. This high-risk population should be offered a screening colonoscopy beginning at 40 yr of age.     

Colonoscopic screening for neoplasms in asymptomatic first-degree relatives of colon cancer patients

Individuals with a family history of colorectal cancer are believed to be at an increased risk of developing colorectal neoplasia. To estimate this risk and the potential yield of screening colonoscopy in this population, we recruited and prospectively colonoscoped 181 asymptomatic first-degree relatives (FDR) of colorectal cancer patients and 83 asymptomatic controls (without a family history of colorectal cancer). The mean ages for the FDR and control groups were 48.2 ± 12.5 and 54.8 ± 11.0, respectively. Adenomatous polyps were detected in 14.4 percent of FDRs and 8.4 percent of controls. Although 92 percent of our FDRs had only one FDR afflicted with colon cancer, those subjects with two or more afflicted FDRs had an even higher risk of developing colonic adenomas (23.8 percent) than those with only one afflicted FDR (13.1 percent). A greater proportion of adenomas was found to be beyond the reach of flexible sigmoidoscopy in the FDR group than in the controls (48 percent vs.25 percent, respectively). Logistic regression analysis revealed that age, male sex, and FDR status were independent risk factors for the presence of colonic adenomatous polyps (RR=2.32, 2.86, and 3.49, respectively;P <0.001). Those at greatest risk for harboring an asymptomatic colonic adenoma are male FDRs over the age of 50 (40 percent ts.20 percent for age-matched male controls). Based on probability curves, males with one FDR afflicted with colon cancer appear to have an increased risk of developing a colonic adenoma beginning at 40 years of age. Our results document, for the first time, an increased prevalence of colonoscopically detectable adenomas in asymptomatic first-degree relatives of colon cancer patients, as compared with asymptomatic controls, and support the use of colonoscopy as a routine screening tool in this high-risk group.Read at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992.Funded in part by the Aaron Diamond Foundation Colon Cancer Program of Columbia University and the Jean and Louis Dreyfus Foundation.     

Screening colonoscopy among persons 50 to 60 years of age with and without familial risk of colorectal cancer - a prospective multicenter trial

BACKGROUND: In Germany screening colonoscopy was introduced into the National program on colorectal cancer prevention in Oktober 2002. The prevalence of neoplasia in patients with and without familiar risk was determined together with patient satisfaction with screening colonoscopy. Methods: Asymptomatic subjects from 50 to 60 years underwent screening colonoscopy and were stratified in two groups with and without familiar risk (first-degree relatives with CRC) in a multicenter trial among German gastroenterologists. Advanced neoplasia was defined as an adenoma at least 1 cm in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. After recovery from sedation all subjects were asked if they would agree to a control colonoscopy and the pain score was recorded on a scale from 0 to 6. Results: A total of 557 subjects (322 at average risk and 235 with familiar risk) underwent screening colonoscopy. The prevalence of advanced neoplasia in subjects without/with familiar risk was not significantly different in persons from 50 to 54 years (9 vs. 15 %) in contrast to persons from 55 to 60 years (10 vs. 22 %, p = 0.004) where the relative risk was doubled. Compared to younger patients, the prevalence of all neoplasia (including small adenomas) was significantly different only for older patients with familiar risk (44 vs. 23 %, p < 0.0001). The mean value of the pain-score was 0.76 + 1.0. Subjects examined without medication had significantly higher pain scores than subjects under medication. Colonoscopy performed under disoprivan resulted in similar pain-scores compared to midazolam at dosages > 5 mg. All patients agreed to a control colonoscopy. CONCLUSION: Screening colonoscopy is an effective and well-accepted method. The high prevalence of advanced neoplasia even in persons from 50 to 54 years suggests that screening should start at the age of 50.     

A Scoring System for the Strength of a Family History of Colorectal Cancer

BACKGROUND Family history of colorectal cancer is associated with an increased risk for the disease, although there are many combinations of family history that are hard to correlate with risk status. A scoring system for family history of colorectal cancer was designed to make risk more readily quantifiable.METHODS A colonoscopy database was used to test the following points system: each first-degree relative with colorectal cancer = 3 points; each second-degree relative with colorectal cancer = 1 point. Families with one or more first-degree relative affected under 50 years of age = an extra 3 points. Families with one or more second-degree relative affected under 50 years of age = an extra 1 point. Families with multiple relatives on the same side of the family = an extra 3 points (first-degree relatives), 1 point (second-degree relatives), or 2 points (first-degree and second-degree relatives). Points were added and categories defined as follows: low risk, 1 to 4 points; medium risk, 5 to 7 points; high risk, 8 to 10 points; very high risk, >10 points. A control group of average-risk patients having screening colonoscopy was used. Categories were compared in number of adenomas, hyperplastic polyps, and cancers.RESULTS The records of 992 patients were used to test the system. Mean adenomas per patient per group were 0.4 for controls, 1.0 for low risk, 1.0 for medium risk, 1.7 for high risk, and 1.7 for very high risk. Cancers per group were 2 of 196 for controls, 8 of 513 for low risk, 3 of 171 for medium risk, 3 of 84 for high risk, and 1 of 28 for very high risk. The score categories were combined to produce revised risk levels of low (score 1 to 7) and high (>7). Average adenomas per patient in the revised categories were 0.4 (control), 1.0 (low risk), and 1.7 (high risk). The odds ratio of having one to two adenomas was 1.73 (1.19–2.50, 95% confidence limits) in the low-risk group and 2.39 (1.41–4.01) in the high-risk group. Odds ratios for having three or more adenomas were 5.70 (2.44–13.32) in the low-risk group and 10.35 (3.97–26.97) in the high-risk group.CONCLUSION In the two-category system proposed here of quantifying familial risk of colorectal cancer, patients having less than 8 points were at low risk and those with 8 or more were at high risk. Surveillance and chemoprevention protocols can be designed through use of these risk categories. A scoring system for family history of colorectal cancer can make risk assessment easier and facilitate both collaborative studies and patient triage into appropriate screening programs.Reprints are not available.Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004.     

Colonoscopic screening of persons with suspected risk factors for colon cancer. I. Family history

A family history of colorectal cancer is believed to place persons at increased risk for development of the disease. It is unclear, however, how "strong" a family history must be to increase this risk or to make colonoscopic screening appropriate. We performed initial colonoscopy in 154 asymptomatic subjects whose only suspected risk factor was one or two first-degree relatives with colorectal cancer; 48 of these subjects also had affected second- and third-degree relatives. We found 45 adenomas in 28 subjects (18%). One subject had a 3-cm villous adenoma. In 6 subjects, the most advanced findings were tubular adenomas 5-9 mm in diameter; in 21 subjects, we found only tubular adenomas that were 2-4 mm in diameter. The prevalence of adenomas increased significantly with age of subjects (p less than 0.01). Although the overall prevalence of colorectal neoplasms in our group was no greater than might be expected in the general population, subjects with two first-degree relatives tended to have more diminutive adenomas than those with one such relative. Our findings suggest that colonoscopy is not an appropriate first step in screening persons with one affected first-degree relative. For those with more complex family histories, more data are needed--particularly on the prevalence of advanced neoplasms--to determine whether a screening technique that is less costly and less invasive than colonoscopy may be adequate.     

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.     

Prevalence of adenomas among young individuals at average risk for colorectal cancer

OBJECTIVES: We evaluated the prevalence and characteristics of adenomas in a young population not genetically predisposed for the development of colorectal cancer (CRC). METHODS: The databases of the Dutch Hereditary Colorectal Cancer Registry were used. The study population included patients (n = 444) who had regular endoscopy until mutation analysis revealed they did not carry the (Adenomatous Polyposis Coli (APC)/Mismatch Repair) gene defect identified in their family. RESULTS: At first colonoscopy (n = 342; 50% males, mean age 37 yr) a total of 19 adenomas (10 males, mean age 50 yr, range 24-91 yr) and two CRCs (2 males, age 49 and 72 yr) were identified, and at first sigmoidoscopy (n = 102; 53% males, mean age 29 yr) three adenomas (2 males, age 8, 40, and 41 yr) were found. A second colonoscopy was performed in 14 patients with, and in 162 patients without an adenoma. Three of 14 patients (21%) developed a new adenoma (all >50 yr) and 8 of 162 (5%) patients developed their first adenoma during follow-up. In the colonoscopy group, the cumulative proportion of patients free of adenomas at age 50 yr was 86%. Of all adenomas diagnosed during colonoscopy (n = 49), 65% were located distal from the flexura lienalis. Of the adenomas detected during all endoscopies (n = 53), 9.8% were > or =7 mm, 7.5% showed high-grade dysplasia, and 7.5% showed tubulovillous features. CONCLUSIONS: On the basis of our findings during colonoscopy we conclude that the risk of developing adenomas/CRC in young individuals without genetic risk factors is low. Adenoma surveillance programs should focus on young individuals with a positive family (or personal) history for adenomas/CRC, or on individuals >50 yr.     

Colorectal cancer screening: Results of a 5-year program in asymptomatic subjects at increased risk

BACKGROUND AND AIMS: The province of Ferrara has one of the highest incidences of colorectal cancer (CRC) in Italy. In January 2000, we set up a colonoscopy screening program focussing on first-degree relatives of CRC patients. We now report the results 5 years after the beginning of the project. SCREENEES AND METHODS: In October 1999, we started a campaign stressing the usefulness of colonoscopy for the first-degree relatives of CRC patients. Subjects included in the screening program were aged between 45 and 75 years with at least one first-degree relative affected by CRC. They were invited to an interview where a physician suggested colonoscopy as a screening option. RESULTS: In 5 years, 776 subjects were interviewed and 733 (94.4%) agreed to an endoscopic examination (M/F:375/401; mean age 55 years): 562 colonoscopies were performed. Adenomas and cancers were found in 122 (21.7%) and 12 (2.1%) subjects, respectively. Histological examination in 181 persons with lesions (32.8%) showed (most serious lesion quoted) 47 hyperplastic polyps (26% of all lesions), 2 serrated adenomas (1.1%), 68 tubular adenomas (48%), 24 tubulovillous adenomas (13.3%), 9 adenomas with high grade dysplasia (5%) and 12 adenocarcinomas (6.6%). The majority of the cancers were at an early stage (8 Dukes A and 3 Dukes B). Sedation was used in only 42 colonoscopies (7.5%). CONCLUSIONS: A colonoscopy-based screening in this selected high-risk population is feasible. Even without sedation subjects readily agreed to the endoscopic procedure. We identified a significant number of advanced neoplasms and cancers at an early stage suggesting that this could be a useful tool in early identification of CRC.     

Risk of colorectal adenomas in patients with a family history of colorectal cancer: some implications for screening programmes.

BACKGROUND AND AIMS: Most colorectal cancers (CRC) arise in colorectal adenomas. A case-control study was conducted to see whether a family history of CRC is associated with a higher prevalence of colorectal adenomas. SUBJECTS: Subjects were drawn from all patients who underwent colonoscopy at the Royal Brisbane Hospital between 1980-1982 and 1985, and included 141 cases with colorectal adenomas diagnosed at colonoscopy and 882 controls who were free of polyps at colonoscopy. METHODS: The prevalence of family history of CRC was compared between patients with adenomas and negative colonoscopy controls. RESULTS: Overall, patients with one first degree relative with CRC were at no greater risk for adenomas at colonoscopy than patients with no family history (odds ratio (OR) = 0.8, 95% confidence intervals (CI) = 0.4, 1.5). Patients with two or more affected first degree relatives had a more than doubled risk for adenomas (OR = 2.3, 95% CI = 0.5, 8.2), and were also more likely to carry moderately or severely dysplastic adenomas (OR = 14.1, 95% CI = 2.0, 62.9). CONCLUSIONS: These findings are consistent with the hypothesis that some families, in addition to those with familial adenomatous polyposis, have an increased susceptibility to develop colorectal adenomas, and that adenomas in such families may have a greater tendency to undergo malignant transformation.     

伺机性筛查新模式在结直肠肿瘤患者一级亲属中的探索性研究

目的探究结直肠病房筛查新模式在结直肠肿瘤患者一级亲属筛查的有效性。 方法采用结直肠肿瘤风险问卷评分、粪便潜血免疫化学检测（FIT）以及粪便多靶点FIT-DNA检测对2019年10月至2021年7月在中国医学科学院肿瘤医院结直肠外科就诊的结直肠癌及进展期腺瘤患者的一级亲属进行检测，根据检测结果将一级亲属进行筛查风险分层以及肠镜检查推荐分类，分析不同分层分类后一级亲属的肠镜依从率与病变检出率。 结果共250名受试者被纳入本研究。总体人群肠镜依从率为38.0%（95/250），肠镜病变检出率为9.5%（9/95）；高风险人群（A类推荐人群）肠镜依从率为78.9%（15/19），肠镜病变检出率为26.7%（4/15）；中风险人群（B类推荐人群）肠镜依从率为61.2%（30/49），肠镜病变检出率为16.7%（5/30）；低风险人群（C类推荐人群）肠镜依从率为27.5%（50/182），肠镜病变检出率为0（0/50）。 结论三种筛查方法联合使用可以高效精准地区分一级亲属的筛查风险，此方案是一个可以在病房开展的有效可行的结直肠肿瘤患者一级亲属人群的伺机性筛查新模式。     

Colonoscopic screening examination of relatives of patients with colorectal cancer. II. Relations between tumour characteristics and the presence of polyps.

Colonoscopy was offered to 206 first-degree relatives of 181 patients operated on for colorectal cancer (CRC). Findings of polyps in relatives correlated with Dukes staging, extent of dedifferentiation and localization of tumour in the operated patient, and type of family relationship. Adenomas in relatives and Dukes staging of carcinoma in the patients were inversely related. Relatives of patients with Dukes stage A tumour had more than twice as many adenomas as and a higher prevalence of multiple adenomas than relatives of patients with advanced cancer at the time of operation. If the patient had polyp(s) in addition to tumour, the number of adenomas per relative was almost doubled. Hyperplastic polyps in relatives were associated with poorly differentiated carcinoma in their related patients. These results support the theory that not all CRC are derived from polyps and that adenoma-derived CRC may have a better prognosis than 'de novo' CRC. An adenoma prevalence risk table is also presented.     

Screening Colonoscopy for Colorectal Cancer in Asymptomatic People: A Meta-Analysis

Objective The preferred method for screening asymptomatic people for colorectal cancer (CRC) is colonoscopy, according to the new American guidelines. The aim of our study was to perform a meta-analysis of the prospective cohorts using total colonoscopy for screening this population for CRC. We looked for the diagnostic yield of the procedure as well as for its safety in a screening setting. Methods We included papers with more than 500 participants and only those reporting diagnostic yield of adenoma (and/or advanced adenoma) and CRC. Nested analysis were performed for secondary endpoints of complications and CRC stages when this information was available. All analyses were performed with StatDirect Statistical software, version 2.6.1 (). Results Our search yielded ten studies of screening colonoscopy conducted in asymptomatic people that met our inclusion criteria, with a total of 68,324 participants. Colonoscopy was complete and reached the cecum in 97% of the procedures. Colorectal cancer was found in 0.78% of the participants (95% confidence interval 0.13–2.97%). Stage I or II were found in 77% of the patients with CRC. Advanced adenoma was found in 5% of the cases (95% confidence interval 4–6%). Complications were rare and described in five cohorts. Perforation developed in 0.01% of the cases (95% confidence interval 0.006–0.02%) and bleeding in 0.05% (95% confidence interval 0.02–0.09%). Conclusions Our findings support the notion that colonoscopy is feasible and a suitable method for screening for CRC in asymptomatic people.     

Moderate Alcohol Consumption Protects Against Colorectal Adenomas in Smokers

Background Although some studies have shown an association between alcohol consumption and colorectal adenomas, the effect of moderate alcohol consumption is not well defined, nor is the interaction between alcohol and smoking. Aim To investigate the relationship between different levels of alcohol consumption and colorectal adenomas and to determine whether smoking modifies this relationship. Methods Eligible patients who underwent a complete colonoscopy were included (179 cases and 466 controls). Alcohol consumption was obtained from a lifestyle questionnaire. Patients were divided into three groups: (1) Abstainers: 0 drinks/week; (2) Moderate drinkers: > 0 to <7 drinks/week; (3) Heavy drinkers: > 7 drinks/week. Odds ratios (OR) were calculated using logistic regression, controlling for gender, age, body mass index, use of non-steroidal anti-inflammatory medications. Results were stratified by the number of years smoked. Results The proportion of patients with adenomas was 29.6% in abstainers, 22.1% in moderate drinkers, and 36.7% in heavy drinkers. The relationship between alcohol consumption and colorectal adenomas varied significantly by smoking history. For individuals who had never smoked, heavy drinkers were at significantly increased odds of having an adenoma compared to moderate drinkers (OR 3.08; 95% CI: 1.50–6.32), while no difference was seen for abstainers (OR 0.99; 95% CI: 0.52–1.89). Similarly, among individuals who had smoked 1–14 years, heavy drinkers were at increased odds of having an adenoma compared to moderate drinkers (OR 2.61; 95% CI: 1.04–6.51), and no difference was seen for abstainers (OR 1.02; 95% CI: 0.33–3.10). Somewhat unexpectedly, among individuals who had smoked for 15 or more years, abstainers were at increased odds of having an adenoma compared to moderate drinkers (OR 2.04; 95% CI: 0.91–4.59), while heavy drinkers were not at increased odds of having an adenoma (OR 0.73; 95% CI: 0.27–1.97). Conclusions Consumption of less than seven alcohol drinks per week does not increase the risk of having a colorectal adenoma. We found evidence in this study that moderate alcohol consumption among long-term smokers may potentially decrease the risk of an adenoma compared to abstainers.     

Screening of first degree relatives of patients operated for colorectal cancer: evaluation of fecal calprotectin vs. hemoccult II.

Fecal calprotectin (CPT) is elevated in the majority of patients with known colorectal cancer (CRC), but the specificity is not clarified. AIM: To evaluate if a CPT test (PhiCal ELISA) was more sensitive than Hemoccult II test in detecting colorectal neoplasia, and to obtain reference values in subjects with normal colonoscopy. To evaluate a possible relation between number and extent of dysplasia of adenomas in first degree relatives of patients with CRC and the stage of the carcinoma in the index casus. Further to study the prevalence of CRC and adenomas in the first degree relatives of patients operated for CRC. METHOD: In a multicenter study, 253 first degree relatives of patients with CRC, aged 50-75 years (mean age 60 years) underwent colonoscopy after having delivered stool samples and three Hemoccult II slides. RESULTS: In 237 first degree relatives from 148 patients with CRC, polyps were found in 118 (50%). Seventy three (31%) had adenomas and 17 had adenomas > or =10 mm. Five had asymptomatic cancers. The specificity of fecal CPT for adenomas at cut off levels 15 mg/l. The sensitivity of Hemoccult II for adenomas was 8%, and 4/5 of patients with carcinoma had negative Hemoccult II. The specificity for adenomas was 95%. CONCLUSION: Fecal CPT test was more sensitive than Hemoccult II in detecting colorectal neoplasia but the specificity was lower. In a high risk group like first degree relatives of patients with CRC, there are good reasons to consider fecal CPT as a first test in selecting patients for endoscopy.     

Risk of Colorectal Adenomas in Women with Prior Breast Cancer

Background and Aims

Longer life expectancy in patients with prior breast cancer may increase their risk of developing other primary cancers, including colorectal cancer (CRC). Whether the risk of developing CRC in this patient population is higher in comparison to those with no prior cancer remains unclear. The purpose of this study was to compare the prevalence of colorectal adenomas and any CRC in breast cancer survivors with those who have no history of prior cancer and assess any difference with use of antiestrogen therapy.

Methods

We compared the prevalence of colorectal cancer and adenomas in breast cancer survivors with that of a group of matched controls. Eligible survivors were ??85?years of age; had initially been diagnosed with stage 0, I, II, or III breast cancer; had completed all cancer treatments with the exception of adjuvant antiestrogen therapy; and had no evidence of recurrence on follow-up. We used the screening colonoscopy database at our institution to identify age-, sex-, and race-matched controls with no history of cancer.

Results

We identified 302 study-eligible breast cancer survivors and 302 matched controls. No colorectal cancers were found in either group. Forty-one breast cancer survivors and 30 controls had tubular adenomas; four survivors and three controls had villous adenoma; and eight survivors and ten controls had advanced adenoma. Multivariate regression analysis revealed that adjuvant antiestrogen therapy was not significantly associated with an increased risk of advanced adenoma.

Conclusions

The prevalence of colorectal adenomas in breast cancer survivors and controls was similar. Breast cancer survivors, including those receiving adjuvant antiestrogen therapies may follow the colorectal screening guidelines used for average-risk population.     

Clinical impact of colonoscopy for patients with early gastric cancer treated by endoscopic submucosal dissection: A matched case–control study

BackgroundGastric cancer frequently occurs synchronously with colorectal cancer (CRC).AimsThe aim of the present study was to assess the value of colonoscopy in patients with primariy early gastric cancer (EGC) indicated for endoscopic submucosal dissection (ESD) and to identify predictors for the risk of high-risk adenomas.MethodsA total of 130 patients with EGC, who underwent both colonoscopy and gastric ESD, and 260 controls matched for age and sex, who underwent a colonoscopy as part of our institutional health check-up program.The prevalence of high-risk adenomas in EGC patients vs. controls was evaluated.ResultsHigh-risk adenomas were found in 43 (33%) EGC patients and 37 (14%) controls (P < 0.01). Multivariate analysis showed the presence of EGC was significantly associated with high-risk adenoma [odds ratio (OR) 2.8, 95% confidence interval (CI): 1.7–4.9]. Among EGC patients, high serum CEA level (OR 2.4, 95% CI: 1.2–5.0) was an independent predictor for high-risk adenoma.ConclusionsPatients with EGC had a significant risk for colorectal cancer. When endoscopists detected an early gastric cancer indicated for ESD, colonoscopy should be considered for EGC patients with high serum CEA levels.