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The association between colorectal sessile serrated adenomas/polyps and subsequent advanced colorectal neoplasia

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Abstract

Purpose

Colorectal cancer (CRC) screening guidelines recommend increased surveillance of individuals with sessile serrated adenomas/polyps (SSA/Ps), but there is uncertainty about the risk associated with SSA/Ps. We aimed to determine the association between SSA/Ps and subsequent advanced colorectal neoplasia.

Methods

This case–control study included Kaiser Permanente Washington (KPWA) members who received an index colonoscopy between 1/1/1998 and 12/31/2007, and had hyperplastic polyps (HPs) or SSA/Ps but no conventional adenomas according to study pathologist histologic review. Subsequent pathology reports and biopsies through 1/1/2013 were reviewed for advanced colorectal neoplasia. We linked to the Seattle-Puget Sound Surveillance Epidemiology and End Results (SEER) registry to identify additional CRC cases. We used generalized estimating equations with a logit link to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for advanced colorectal neoplasia, comparing those with SSA/Ps to those with HPs.

Results

There were 161 individuals with index SSA/Ps, 548 with HPs, and 918 subsequent endoscopies included in analyses. Of those with index SSA/Ps, 19 had subsequent advanced colorectal neoplasia; 39 with HPs had subsequent advanced colorectal neoplasia. Compared to those with HPs, those with SSA/Ps were not statistically significantly more likely to have subsequent advanced colorectal neoplasia (adjusted OR 1.79; CI 0.98–3.28). Polyp size ≥ 10 mm, right colon location, and the presence of multiple serrated polyps were also not associated with advanced colorectal neoplasia.

Conclusions

Our results suggest that there is not a strong association between SSA/Ps and subsequent advanced colorectal neoplasia during the 5 years following SSA/P removal.

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Acknowledgments

This research was supported in part by the National Institutes of Health, National Cancer Institute (Grant No. R01 CA168338).

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Authors and Affiliations

  1. Kaiser Permanente Colorado Institute for Health Research, 2550 S. Parker Rd, Aurora, CO, USA

    Andrea N. Burnett-Hartman

  2. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Andrea N. Burnett-Hartman, Xinwei Hua, Rachel C. Malen, Sheetal Hardikar & Polly A. Newcomb

  3. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA

    Jessica Chubak, Rebecca Ziebell, Aruna Kamineni & Lee-Ching Zhu

  4. University of Washington, School of Public Health, Seattle, WA, USA

    Jessica Chubak, Xinwei Hua & Polly A. Newcomb

  5. University of Washington, School of Medicine, Seattle, WA, USA

    Melissa P. Upton

  6. Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Sheetal Hardikar

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  1. Andrea N. Burnett-Hartman
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  2. Jessica Chubak
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Correspondence to Andrea N. Burnett-Hartman.

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This study was conducted in accordance with the ethical standards of the institutional review boards at Kaiser Permanente Washington, the Fred Hutchinson Cancer Research Center, and with the 1964 Helsinki declaration and its later amendments.

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Burnett-Hartman, A.N., Chubak, J., Hua, X. et al. The association between colorectal sessile serrated adenomas/polyps and subsequent advanced colorectal neoplasia. Cancer Causes Control 30, 979–987 (2019). https://doi.org/10.1007/s10552-019-01205-y

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