Clinicopathological Features of Colon Polyps from African-Americans
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Background and Aims
Among the ethnic groups, the age-standardized incidence rate of colorectal cancer (CRC) is highest among African-Americans. The majority of CRC arise from preexisting adenoma. It is shown that 30% of the US adult population has adenomas. The potential risk of malignant transformation in adenomas differs by specific pathologic and clinical characteristics that we aimed to study in AAs.
Materials and Methods
All pathologic reports (150,000) in Howard University Hospital from 1959 to 2006 were reviewed manually. Those pathology reports compatible with the colorectal polyps were carefully reviewed and selected by a GI pathologist. All cases with cancer were then excluded from the list. Data were then entered into Microsoft Excel and checked for missing data and duplications. Differences in right-side and left-side polyps for sex, histology, and clinical symptoms were assessed by Chi-2 test.
A total number of 5,013 colorectal polyps were diagnosed in this period that include 47% male, with mean age (SD) of 63 (12). Half of the cases were diagnosed in 2001–2006. Tubular adenoma was the most frequent pathology (73%). The highest frequency of right-sided polyps was observed in the 1990s (56%). Left-sided polyps were younger (p < 0.0001), more hyperplasic (23 vs. 5%; p < 0.0001), and more frequent in female (56 vs. 52%; p = 0.02) compared to right-sided polyps. The frequency of right-sided adenoma significantly increases from 18% in the 1960s to 51% in the period of 2001–2006 (p < 0.0001). The most frequent symptom in both sides was GI bleeding (21%).
There was a ratio of 8:1 for neoplastic to hyperplastic polyps in our study, which is more than what has been reported in Caucasians (7:1). Our data shows a shift in polyps from the left side to the right side of the colon in recent years. This data is consistent with the lack of a reduction in the incidence of colon cancer in African-Americans. Screening is thus very important in AA to reduce the incidence of colon cancer.
- Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66. CrossRef
- Lipkin M, Higgins P. Biological markers of cell proliferation and differentiation in human gastrointestinal diseases. Adv Cancer Res. 1988;50:1–24. CrossRef
- Kinzler KW, Vogelstein B. Lessons from hereditary colorectal cancer. Cell. 1996;87:159–170. CrossRef
- Winawer SJ, Zauber AG, O’Brien MJ, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med. 1993;328:901–906. CrossRef
- Helwig EB. The evolution of adenomas of the large intestine and their relation to carcinoma. Gynecol Obstet. 1947;84:36–49.
- Neugut AI, Jacobson JS, De Vivo I. Epidemiology of colorectal adenomatous polyps. Cancer Epidemiol Biomarkers Prev. 1993;2:159–176.
- Coode PE, Chan KW, Chan YT. Polyps and diverticula of the large intestine: a necropsy survey in Hong Kong. Gut. 1985;26:1045–1048. CrossRef
- Tony J, Harish K, Ramachandran TM, Sunilkumar K, Thomas V. Profile of colonic polyps in a southern Indian population. Indian J Gastroenterol. 2007;26:127–129.
- Weston AP, Campbell DR. Diminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications. Am J Gastroenterol. 1995;90:24–28.
- Villavicencio RT, Rex DK. Colonic adenomas: prevalence and incidence rates, growth rates, and miss rates at colonoscopy. Semin Gastrointest Dis. 2000;11:185–193.
- Patel K, Hoffman NE. The anatomical distribution of colorectal polyps at colonoscopy. J Clin Gastroenterol. 2001;33:222–225. CrossRef
- Olsen HW, Lawrence WA, Snook CW, Mutch WM. Review of recurrent polyps and cancer in 500 patients with initial colonoscopy for polyps. Dis Colon Rectum. 1988;31:222–227. CrossRef
- Lieberman DA, Smith FW. Frequency of isolated proximal colonic polyps among patients referred for colonoscopy. Arch Intern Med. 1988;148:473–475. CrossRef
- Lieberman DA, Holub J, Eisen G, Kraemer D, Morris CD. Prevalence of polyps greater than 9 mm in a consortium of diverse clinical practice settings in the United States. Clin Gastroenterol Hepatol. 2005;3:798–805. CrossRef
- Hoff G, Vatn M. Epidemiology of polyps in the rectum and sigmoid colon. Endoscopic evaluation of size and localization of polyps. Scand J Gastroenterol. 1985;20:356–360. CrossRef
- Colucci PM, Yale SH, Rall CJ. Colorectal polyps. Clin Med Res. 2003;1:261–262. CrossRef
- Sato E, Ouchi A, Sasano N, Ishidate T. Polyps and diverticulosis of large bowel in autopsy population of Akita prefecture, compared with Miyagi. High risk for colorectal cancer in Japan. Cancer. 1976;37:1316–1321. CrossRef
- Stemmermann GN, Yatani R. Diverticulosis and polyps of the large intestine. A necropsy study of Hawaii Japanese. Cancer. 1973;31:1260–1270. CrossRef
- Vatn MH, Stalsberg H. The prevalence of polyps of the large intestine in Oslo: an autopsy study. Cancer. 1982;49:819–825. CrossRef
- Paspatis GA, Papanikolaou N, Zois E, Michalodimitrakis E. Prevalence of polyps and diverticulosis of the large bowel in the Cretan population. An autopsy study. Int J Colorectal Dis. 2001;16:257–261. CrossRef
- Johnson DA, Gurney MS, Volpe RJ, et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol. 1990;85:969–974.
- Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. Veterans affairs cooperative study group 380. N Engl J Med. 2000;343:162–168. CrossRef
- Rex DK, Lehman GA, Ulbright TM, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol. 1993;88:825–831.
- Johnson H Jr, Margolis I, Wise L. Site-specific distribution of large-bowel adenomatous polyps. Emphasis on ethnic differences. Dis Colon Rectum. 1988;31:258–260. CrossRef
- Liu HH, Wu MC, Peng Y, Wu MS. Prevalence of advanced colonic polyps in asymptomatic Chinese. World J Gastroenterol. 2005;11:4731–4734.
- Rex DK, Khan AM, Shah P, Newton J, Cummings OW. Screening colonoscopy in asymptomatic average-risk African Americans. Gastrointest Endosc. 2000;51:524–527. CrossRef
- Cress RD, Morris C, Ellison GL, Goodman MT. Secular changes in colorectal cancer incidence by subsite, stage at diagnosis, and race/ethnicity, 1992–2001. Cancer. 2006;107:1142–1152. CrossRef
- Cucino C, Buchner AM, Sonnenberg A. Continued rightward shift of colorectal cancer. Dis Colon Rectum. 2002;45:1035–1040. CrossRef
- Shavers VL. Racial/ethnic variation in the anatomic subsite location of in situ and invasive cancers of the colon. J Natl Med Assoc. 2007;99:733–748.
- Wu X, Chen VW, Martin J, et al. Subsite-specific colorectal cancer incidence rates and stage distributions among Asians and Pacific Islanders in the United States, 1995 to 1999. Cancer Epidemiol Biomarkers Prev. 2004;13:1215–1222. CrossRef
- Lieberman DA, Holub J, Eisen G, Kraemer D, Morris CD. Utilization of colonoscopy in the United States: results from a national consortium. Gastrointest Endosc. 2005;62:875–883. CrossRef
- Amonkar MM, Hunt TL, Zhou Z, Jin X. Surveillance patterns and polyp recurrence following diagnosis and excision of colorectal polyps in a Medicare population. Cancer Epidemiol Biomarkers Prev. 2005;14:417–421. CrossRef
- Yood MU, Oliveria S, Boyer JG, Wells K, Stang P, Johnson CC. Colon polyp recurrence in a managed care population. Arch Intern Med. 2003;163:422–426. CrossRef
- Loeve F, Boer R, Zauber AG, et al. National polyp study data: evidence for regression of adenomas. Int J Cancer. 2004;111:633–639. CrossRef
- Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-society Task Force on Colorectal Cancer and the American Cancer Society. CA Cancer J Clin. 2006;56:143–159. quiz 184–145. CrossRef
- Haghighi P, Nasr K, Mohallatee EA, et al. Colorectal polyps and carcinoma in southern Iran. Cancer. 1977;39:274–278. CrossRef
- Ansari R, Mahdavinia M, Sadjadi A, et al. Incidence and age distribution of colorectal cancer in Iran: results of a population-based cancer registry. Cancer Lett. 2006;240:143–147. CrossRef
- Francois F, Park J, Bini EJ. Colon pathology detected after a positive screening flexible sigmoidoscopy: a prospective study in an ethnically diverse cohort. Am J Gastroenterol. 2006;101:823–830. CrossRef
- Thornton JG, Morris AM, Thornton JD, Flowers CR, McCashland TM. Racial variation in colorectal polyp and tumor location. J Natl Med Assoc. 2007;99:723–728.
- O’Brien MJ, Winawer SJ, Zauber AG, et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology. 1990;98:371–379.
- Bombi JA. Polyps of the colon in Barcelona, Spain. An autopsy study. Cancer. 1988;61:1472–1476. CrossRef
- Khan A, Shrier I, Gordon PH. The changed histologic paradigm of colorectal polyps. Surg Endosc. 2002;16:436–440. CrossRef
- Granqvist S, Gabrielsson N, Sundelin P. Diminutive colonic polyps—clinical significance and management. Endoscopy. 1979;11:36–42. CrossRef
- Isbister WH. Colorectal polyps: an endoscopic experience. Aust N Z J Surg. 1986;56:717–722. CrossRef
- Williams AR, Balasooriya BA, Day DW. Polyps and cancer of the large bowel: a necropsy study in Liverpool. Gut. 1982;23:835–842. CrossRef
- Jass JR, Young PJ, Robinson EM. Predictors of presence, multiplicity, size and dysplasia of colorectal adenomas. A necropsy study in New Zealand. Gut. 1992;33:1508–1514. CrossRef
- Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2006.
- DeNavas-Walt C, Bernadette D. Proctor, Jessica Smith, US Census Bureau, Current Population Reports, P60-233. Income, Poverty, and Health Insurance Coverage in the United States: 2006, US Government Printing Office, Washington, DC, 2007.
- Hyman NH, Anderson P, Blasyk H. Hyperplastic polyposis and the risk of colorectal cancer. Dis Colon Rectum. 2004;47:2101–2104. CrossRef
- Yano T, Sano Y, Iwasaki J, et al. Distribution and prevalence of colorectal hyperplastic polyps using magnifying pan-mucosal chromoendoscopy and its relationship with synchronous colorectal cancer: prospective study. J Gastroenterol Hepatol. 2005;20:1572–1577. CrossRef
- Wynter CV, Walsh MD, Higuchi T, Leggett BA, Young J, Jass JR. Methylation patterns define two types of hyperplastic polyp associated with colorectal cancer. Gut. 2004;53:573–580. CrossRef
- Jass JR. Serrated adenoma of the colorectum and the DNA-methylator phenotype. Nat Clin Pract Oncol. 2005;2:398–405. CrossRef
- Sandmeier D, Seelentag W, Bouzourene H. Serrated polyps of the colorectum: is sessile serrated adenoma distinguishable from hyperplastic polyp in a daily practice? Virchows Arch. 2007;450:613–618. CrossRef
- Snover DC, Jass JR, Fenoglio-Preiser C, Batts KP. Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept. Am J Clin Pathol. 2005;124:380–391. CrossRef
- Schoepfer A, Marbet UA. Colonoscopic findings of symptomatic patients aged 50 to 80 years suggest that work-up of tumour suspicious symptoms hardly reduces cancer-induced mortality. Swiss Med Wkly. 2005;135:679–683.
- Costantini M, Sciallero S, Giannini A, et al. Interobserver agreement in the histologic diagnosis of colorectal polyps. The experience of the Multicenter Adenoma Colorectal Study (SMAC). J Clin Epidemiol. 2003;56:209–214. CrossRef
- Wegener M, Borsch G, Schmidt G. Colorectal adenomas. Distribution, incidence of malignant transformation, and rate of recurrence. Dis Colon Rectum. 1986;29:383–387. CrossRef
- Ozick LA, Jacob L, Donelson SS, Agarwal SK. Freeman hyperplastic polyp: distribution of adenomatous polyps in African-Americans. Am J Gastroenterol. 1995;90:758–760.
- Odelowo OO, Hoque M, Begum R, Islam KK, Smoot DT. Colonoscopy for colorectal cancer screening in African-Americans. J Assoc Acad Minor Phys. 2002;13:66–68.
- Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med. 2000;343:169–174. CrossRef
- Lin OS, Gerson LB, Soon MS, Schembre DB, Kozarek RA. Risk of proximal colon neoplasia with distal hyperplastic polyps: a meta-analysis. Arch Intern Med. 2005;165:382–390. CrossRef
- Eide TJ, Stalsberg H. Polyps of the large intestine in northern Norway. Cancer. 1978;42:2839–2848. CrossRef
- Tedesco FJ, Hendrix JC, Pickens CA, Brady PG, Mills LR. Diminutive polyps: histopathology, spatial distribution, and clinical significance. Gastrointest Endosc. 1982;28:1–5. CrossRef
- Clinicopathological Features of Colon Polyps from African-Americans
Digestive Diseases and Sciences
Volume 55, Issue 5 , pp 1442-1449
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine and Cancer Center, Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA
- 2. Department of Pathology, Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA