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Ten or More Cumulative Lifetime Adenomas Are Associated with Increased Risk for Advanced Neoplasia and Colorectal Cancer

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Abstract

Background

Colorectal cancer (CRC) screening guidelines recommend frequent colonoscopies and consideration of genetic testing in individuals with ≥10 cumulative adenomas. However, it is unclear how these guidelines apply to routine practice.

Aims

We estimated the proportion of participants found to have ≥10 cumulative adenomas in a screening population and described their outcomes of advanced neoplasia (AN), CRC, and extra-colonic malignancy.

Methods

We performed a secondary analysis of VA CSP#380, which includes 3121 veterans aged 50–75 who were followed up to 10 years after screening colonoscopy. We calculated the cumulative risk of ≥10 cumulative adenomas by Kaplan–Meier method. We compared baseline risk factors in those with and without ≥10 cumulative adenomas as well as the risk for AN (adenoma ≥1 cm, villous adenoma or high-grade dysplasia, or CRC) and extra-colonic malignancy by multivariate logistic regression.

Results

The cumulative risk of ≥10 cumulative adenomas over 10.5 years was 6.51% (95% CI 4.38%–9.62%). Age 60–69 or 70–75 at baseline colonoscopy was the only factors associated with the finding of ≥10 cumulative adenomas. Compared to those with 0–9 cumulative adenomas, participants with ≥10 cumulative adenomas were more likely to have had AN (OR 17.03; 95% CI 9.41–30.84), including CRC (OR 7.00; 95% CI 2.84–17.28), but not extra-colonic malignancies.

Conclusions

Approximately 6.5% of participants in this screening population were found to have ≥10 cumulative adenomas over 10.5 years, which was uncommon before age 60. These participants were found to have AN and CRC significantly more often compared to those with lower cumulative adenomas.

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Abbreviations

CRC:

Colorectal cancer

AN:

Advanced neoplasia

KM:

Kaplan–Meier

OR:

Odds ratio

CI:

Confidence interval

CSP:

Cooperative Studies Program

VA:

Department of Veteran Affairs

BMI:

Body mass index

NSAID:

Nonsteroidal anti-inflammatory drug

Sd:

Standard deviation

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Acknowledgments

The authors wish to acknowledge the 3,121 veteran participants of CSP#380 as well as the original CSP#380 site investigators and former team members, Rebecca McNeil and Lawrence Whitey. The authors also wish to acknowledge Veterans Affairs Cooperative Studies Program Director, Grant Huang, PhD, MPH and Veterans Affairs Office of Research and Development Chief Research and Development Officer, Timothy O’Leary, MD, for their support of this research.

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Authors and Affiliations

  1. Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA

    Brian A. Sullivan, Thomas S. Redding IV, Xuejun Qin, Ziad F. Gellad, Elizabeth R. Hauser, Meghan C. O’Leary, Christina D. Williams, Laura W. Musselwhite, Ashton N. Madison & Dawn Provenzale

  2. Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Brian A. Sullivan, Ziad F. Gellad, Elizabeth R. Hauser & Dawn Provenzale

  3. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Xuejun Qin & Elizabeth R. Hauser

  4. Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Christina D. Williams

  5. Department of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, NC, USA

    Laura W. Musselwhite

  6. Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, MD, USA

    David Weiss

  7. Portland Veteran Affairs Medical Center, Portland, OR, USA

    David Lieberman

  8. Oregon Health and Science University, Portland, OR, USA

    David Lieberman

Authors
  1. Brian A. Sullivan
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  2. Thomas S. Redding IV
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  3. Xuejun Qin
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  4. Ziad F. Gellad
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  5. Elizabeth R. Hauser
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  6. Meghan C. O’Leary
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  7. Christina D. Williams
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  8. Laura W. Musselwhite
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  9. David Weiss
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  10. Ashton N. Madison
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  11. David Lieberman
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  12. Dawn Provenzale
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Contributions

BS, DP, ERH, and ZFG contributed to study concept and design; BS, TR, MCO, LM, and AM were involved in acquisition of data; BS, TR, DHA, XQ, DP, and ERH contributed to analysis and interpretation of data; BS, EHR, ZFG, and DP were involved in drafting of manuscript; CW, LM, DW, and DL contributed to critical revision of the manuscript for important intellectual content; TR, DHA, XQ, and ERH were involved in statistical analysis; : EHR, DL, and DP obtained funding; MCO and AM contributed to administrative, technical, or material support; and ERH, DL, and DP were involved in study supervision.

Corresponding author

Correspondence to Brian A. Sullivan.

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No authors have any potential conflicts to disclose.

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The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the government of the USA.

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Grant Support: This work was funded by the US Department of Veteran Affairs Cooperative Studies Program.

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Sullivan, B.A., Redding, T.S., Qin, X. et al. Ten or More Cumulative Lifetime Adenomas Are Associated with Increased Risk for Advanced Neoplasia and Colorectal Cancer. Dig Dis Sci 67, 2526–2534 (2022). https://doi.org/10.1007/s10620-021-07069-0

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  • DOI: https://doi.org/10.1007/s10620-021-07069-0

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