Association Between Cigarette Smoking and Alcohol Consumption and Sessile Serrated Polyps in Subjects 30 to 49 Years Old

Detection of high-risk polyps at screening colonoscopy indicates risk for liver and biliary cancer death

BACKGROUND

Hepatobiliary cancers share risk factors with colorectal cancer (CRC), but there are no combined screening programs for these conditions.

AIMS

The aim of this study was to assess whether patients with high-risk colonic polyps are more likely to die from liver related tumors than patients with a negative colonoscopy.

METHODS

In this retrospective analysis of mortality data, Austrian screening participants were included. The absolute risk for hepatobiliary cancer death was calculated using the cumulative incidence method. We aimed to identify an association with time to death of hepatobiliary cancer by Cox proportional hazards model.

RESULTS

343,838 colonoscopies performed between 01/2007 and 12/2020 were included in the analysis, of which 17,678 (5.14%) revealed high-risk polyps. Overall hepatobiliary cancer mortality was more than twice as high in patients with high risk polyps (cumulative incidence 0.39%, 95% CI 0.37-0.41%) compared to patients with a negative colonoscopy (cumulative incidence 0.17%, 95% CI 0.17-0.17%). When adjusting for age and sex, having high-risk polyps at screening colonoscopy was significantly associated with hepatobiliary cancer death (HR 1.83, 95% CI 1.29- 2.59, p < 0.001).

CONCLUSIONS

Patients with certain colonic polyp characteristics are at increased risk for mortality of liver malignancies. Further studies are needed to determine whether a structured additional screening for liver diseases and consecutive malignancies might be beneficial in these patients.

Healthy lifestyle and the risk of conventional adenomas and serrated polyps: Findings from a large colonoscopy screening population

Evidence on the link between healthy lifestyle and colorectal cancer (CRC) precursors is limited. Our study aimed to examine and compare the associations of healthy lifestyle with CRC precursors in adenoma (AD)-carcinoma and serrated pathways. A total of 24 480 participants including 6309 ADs, 1343 serrated polyps (SPs), and 16 828 polyp-free controls were included. A healthy lifestyle score (HLS) was constructed based on five lifestyle factors including cigarette smoking, alcohol drinking, physical activity, diet and body weight, and categorized into least, slightly, moderately and most healthy. Multivariable logistic regressions were used to estimate odds ratio (OR) and 95% confidence interval (CI). Inverse dose-response associations between the HLS and risk of ADs were observed (OR per 1 score increment for ADs: 0.82 [95% CI 0.79-0.84]; for SPs: 0.73 [95% CI 0.69-0.78]), and the association with SPs was more evident than with ADs (OR 0.90, 95% CI 0.85-0.96). Compared to participants with the least healthy lifestyle, those with the most healthy lifestyle had 47% lower risk of ADs (OR 0.53, 95% CI 0.47-0.59) and 70% lower risk of SPs (OR 0.30, 95% CI 0.23-0.39), respectively. These inverse associations were consistent across lesion stage and anatomic subsite and not modified by any stratification factors. The risk advancement periods for the most vs the least healthy lifestyle were -9.49 years for ADs and -20.69 years for SPs. Our findings help confirm the preventive role of healthy lifestyle in colorectal carcinogenesis.

Patient, Physician, and Procedure Characteristics Are Independently Predictive of Polyp Detection Rates in Clinical Practice

BACKGROUND

Variability in colon polyp detection impacts patient outcomes. However, the relative influence of physician, patient, and procedure-specific factors on polyp detection is unclear. Therefore, determining how these factors contribute to adenoma and sessile serrated polyp (SSP) detection is important to contextualize measures of colonoscopy quality such as adenoma detection rate and patient outcomes.

AIMS

To determine the relative contribution of physician, patient, and procedure-specific factors in total polyp, adenoma, and SSP detection rates.

METHODS

We performed a retrospective study of patients undergoing screening colonoscopy and used a two-level generalized linear mixed regression model to identify factors associated with polyp detection.

RESULTS

7799 average risk screening colonoscopies were performed between July 2016 and October 2017. The patient factor most strongly associated with increased risk of adenoma and sessile serrated polyp detection was white race (OR 1.21, 95% CI 1.05-1.39 and OR 3.17, 95% CI 2.34-4.30, respectively). Adenomatous (OR 1.92, 95% CI 1.04-3.57) and sessile serrated polyps (OR 5.56, 95% CI 1.37-20.0) were more likely to be found during procedures performed with anesthesia care as compared to those with moderate sedation. Physician with a luminal gastrointestinal focus had increased odds of adenoma detection (OR 1.61, 95% CI 1.02-2.50).

CONCLUSIONS

In a multi-level model accounting for clustering effects, we identified patient, provider and procedural factors independently influence adenoma and sessile serrated polyp detection. Our findings suggest that to compare polyp detection rates between endoscopists, even at the same institution, risk adjustment by characteristics of the patient population and practice is necessary.

Colorectal Polyp Prevalence According to Alcohol Consumption, Smoking and Obesity

This study aimed to analyze colorectal polyp prevalence associated with health behavior. Data from 1180 Korean men (young adult (YA), aged 40-49; middle age (MA) aged 50-59; old aged (OA), aged 60-79 years) were collected. Health behavior included alcohol consumption, smoking status, and obesity. Obesity was determined using body mass index (BMI) and waist circumference (WC). Odds ratio (OR) was calculated by logistic regression. The prevalence of polyps increased for current smokers by 2.642 times in the YA group, 3.468 times in the MA group, and 3.104 times in the OA group compared to the never-smokers. The OR for WC increased in subjects with obesity by 1.514 in the MA and 1.451 in the OA group compared to normal. The prevalence of three or more polyps increased with WC obesity by 2.3 times in YA, 2.2 times in MA, and 1.9 times in OA compared to normal WC. Therefore, smoking cessation and obesity management may reduce the risk of colorectal polyps.

Risk Factors Associated With Young-Onset Colorectal Adenomas and Cancer: A Systematic Review and Meta-Analysis of Observational Research

The risk of young-onset colorectal adenomas and cancer (yCRAC) in adults less than 50 years of age is increasing. We conducted a systematic review and meta-analysis of epidemiologic studies to identify lifestyle and clinical risk factors associated with yCRAC risk. We searched Medline, EMBASE, and Cochrane Database of Systematic Reviews for studies which: used an epidemiologic study design, involved individuals with yCRAC, evaluated at least 1 lifestyle or clinical factor, and applied multivariable regression approaches. We critically appraised the quality of included studies and calculated pooled measures of association (e.g. odds ratio [OR]) and 95% confidence intervals (CI) using random-effects models. We identified 499 articles in our search with 9 included in a narrative synthesis and 6 included in a meta-analysis. We found in the pooled analysis that smoking and alcohol consumption were lifestyle factors associated with yCRAC, as were clinical factors including obesity elevated blood glucose, elevated blood pressure, and elevated triglycerides. We identified lifestyle and clinical risk factors associated with risk of yCRAC, which have potential implications for informing preventive efforts and modifying screening to target at-risk populations.

Terminology, Molecular Features, Epidemiology, and Management of Serrated Colorectal Neoplasia

In addition to the adenoma to carcinoma sequence, colorectal carcinogenesis can occur via the serrated pathway. Studies have focused on clarification of categories and molecular features of serrated polyps, as well as endoscopic detection and risk assessment. Guidelines from the World Health Organization propose assigning serrated polyps to categories of hyperplastic polyps, traditional serrated adenomas, and sessile serrated lesions (SSLs). Traditional serrated adenomas and SSLs are precursors to colorectal cancer. The serrated pathway is characterized by mutations in RAS and RAF, disruptions to the Wnt signaling pathway, and widespread methylation of CpG islands. Epidemiology studies of serrated polyps have been hampered by inconsistencies in terminology and reporting, but the prevalence of serrated class polyps is 20%-40% in average-risk individuals; most serrated polyps detected are hyperplastic. SSLs, the most common premalignant serrated subtype, and are found in up to 15% of average-risk patients by high-detecting endoscopists. Variations in rate of endoscopic detection of serrated polyps indicate the need for careful examination, with adequate bowel preparation and sufficient withdrawal times. Risk factors for SSLs include white race, family history of colorectal cancer, smoking, and alcohol intake. Patients with serrated polyps, particularly SSLs and traditional serrated adenomas, have an increased risk of synchronous and metachronous advanced neoplasia. Surveillance guidelines vary among countries, but SSLs and proximal hyperplastic polyps require special attention in assignment of surveillance interval-especially in light of concerns regarding incomplete detection and resection.