Skip to main content
SpringerLink
Log in

Clinicopathological Features of Colon Polyps from African-Americans

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

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.

Results

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%).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin. 2007;57:43–66.

    Article  PubMed  Google Scholar 

  2. Lipkin M, Higgins P. Biological markers of cell proliferation and differentiation in human gastrointestinal diseases. Adv Cancer Res. 1988;50:1–24.

    Article  CAS  PubMed  Google Scholar 

  3. Kinzler KW, Vogelstein B. Lessons from hereditary colorectal cancer. Cell. 1996;87:159–170.

    Article  CAS  PubMed  Google Scholar 

  4. 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.

    Article  CAS  PubMed  Google Scholar 

  5. Helwig EB. The evolution of adenomas of the large intestine and their relation to carcinoma. Gynecol Obstet. 1947;84:36–49.

    CAS  Google Scholar 

  6. Neugut AI, Jacobson JS, De Vivo I. Epidemiology of colorectal adenomatous polyps. Cancer Epidemiol Biomarkers Prev. 1993;2:159–176.

    CAS  PubMed  Google Scholar 

  7. Coode PE, Chan KW, Chan YT. Polyps and diverticula of the large intestine: a necropsy survey in Hong Kong. Gut. 1985;26:1045–1048.

    Article  CAS  PubMed  Google Scholar 

  8. 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.

    PubMed  Google Scholar 

  9. Weston AP, Campbell DR. Diminutive colonic polyps: histopathology, spatial distribution, concomitant significant lesions, and treatment complications. Am J Gastroenterol. 1995;90:24–28.

    CAS  PubMed  Google Scholar 

  10. Villavicencio RT, Rex DK. Colonic adenomas: prevalence and incidence rates, growth rates, and miss rates at colonoscopy. Semin Gastrointest Dis. 2000;11:185–193.

    CAS  PubMed  Google Scholar 

  11. Patel K, Hoffman NE. The anatomical distribution of colorectal polyps at colonoscopy. J Clin Gastroenterol. 2001;33:222–225.

    Article  CAS  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. Lieberman DA, Smith FW. Frequency of isolated proximal colonic polyps among patients referred for colonoscopy. Arch Intern Med. 1988;148:473–475.

    Article  CAS  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. Colucci PM, Yale SH, Rall CJ. Colorectal polyps. Clin Med Res. 2003;1:261–262.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  CAS  PubMed  Google Scholar 

  18. Stemmermann GN, Yatani R. Diverticulosis and polyps of the large intestine. A necropsy study of Hawaii Japanese. Cancer. 1973;31:1260–1270.

    Article  CAS  PubMed  Google Scholar 

  19. Vatn MH, Stalsberg H. The prevalence of polyps of the large intestine in Oslo: an autopsy study. Cancer. 1982;49:819–825.

    Article  CAS  PubMed  Google Scholar 

  20. 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.

    Article  CAS  PubMed  Google Scholar 

  21. 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.

    CAS  PubMed  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. 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.

    CAS  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Liu HH, Wu MC, Peng Y, Wu MS. Prevalence of advanced colonic polyps in asymptomatic Chinese. World J Gastroenterol. 2005;11:4731–4734.

    PubMed  Google Scholar 

  26. Rex DK, Khan AM, Shah P, Newton J, Cummings OW. Screening colonoscopy in asymptomatic average-risk African Americans. Gastrointest Endosc. 2000;51:524–527.

    Article  CAS  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. Cucino C, Buchner AM, Sonnenberg A. Continued rightward shift of colorectal cancer. Dis Colon Rectum. 2002;45:1035–1040.

    Article  PubMed  Google Scholar 

  29. 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.

    PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. Loeve F, Boer R, Zauber AG, et al. National polyp study data: evidence for regression of adenomas. Int J Cancer. 2004;111:633–639.

    Article  CAS  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

  36. Haghighi P, Nasr K, Mohallatee EA, et al. Colorectal polyps and carcinoma in southern Iran. Cancer. 1977;39:274–278.

    Article  CAS  PubMed  Google Scholar 

  37. 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.

    Article  CAS  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    PubMed  Google Scholar 

  40. 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.

    PubMed  Google Scholar 

  41. Bombi JA. Polyps of the colon in Barcelona, Spain. An autopsy study. Cancer. 1988;61:1472–1476.

    Article  CAS  PubMed  Google Scholar 

  42. Khan A, Shrier I, Gordon PH. The changed histologic paradigm of colorectal polyps. Surg Endosc. 2002;16:436–440.

    Article  CAS  PubMed  Google Scholar 

  43. Granqvist S, Gabrielsson N, Sundelin P. Diminutive colonic polyps—clinical significance and management. Endoscopy. 1979;11:36–42.

    Article  CAS  PubMed  Google Scholar 

  44. Isbister WH. Colorectal polyps: an endoscopic experience. Aust N Z J Surg. 1986;56:717–722.

    Article  CAS  PubMed  Google Scholar 

  45. Williams AR, Balasooriya BA, Day DW. Polyps and cancer of the large bowel: a necropsy study in Liverpool. Gut. 1982;23:835–842.

    Article  CAS  PubMed  Google Scholar 

  46. 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.

    Article  CAS  PubMed  Google Scholar 

  47. 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.

    Google Scholar 

  48. 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.

  49. Hyman NH, Anderson P, Blasyk H. Hyperplastic polyposis and the risk of colorectal cancer. Dis Colon Rectum. 2004;47:2101–2104.

    Article  PubMed  Google Scholar 

  50. 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.

    Article  PubMed  Google Scholar 

  51. 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.

    Article  CAS  PubMed  Google Scholar 

  52. Jass JR. Serrated adenoma of the colorectum and the DNA-methylator phenotype. Nat Clin Pract Oncol. 2005;2:398–405.

    Article  CAS  PubMed  Google Scholar 

  53. 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.

    Article  PubMed  Google Scholar 

  54. 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.

    Article  PubMed  Google Scholar 

  55. 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.

    PubMed  Google Scholar 

  56. 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.

    Article  PubMed  Google Scholar 

  57. Wegener M, Borsch G, Schmidt G. Colorectal adenomas. Distribution, incidence of malignant transformation, and rate of recurrence. Dis Colon Rectum. 1986;29:383–387.

    Article  CAS  PubMed  Google Scholar 

  58. 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.

    CAS  PubMed  Google Scholar 

  59. 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.

    PubMed  Google Scholar 

  60. 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.

    Article  CAS  PubMed  Google Scholar 

  61. 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.

    Article  PubMed  Google Scholar 

  62. Eide TJ, Stalsberg H. Polyps of the large intestine in northern Norway. Cancer. 1978;42:2839–2848.

    Article  CAS  PubMed  Google Scholar 

  63. Tedesco FJ, Hendrix JC, Pickens CA, Brady PG, Mills LR. Diminutive polyps: histopathology, spatial distribution, and clinical significance. Gastrointest Endosc. 1982;28:1–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by Grant #CA102681, funded by the National Cancer Institute, NIH, GCRC, and Marcia Johnson award from Howard University.

Author information

Authors and Affiliations

  1. Department of Medicine and Cancer Center, Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA

    Mehdi Nouraie, Fatemeh Hosseinkhah, Behrouz Zamanifekri, Duane T. Smoot & Hassan Ashktorab

  2. Department of Pathology, Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA

    Hassan Brim

Authors
  1. Mehdi Nouraie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fatemeh Hosseinkhah
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hassan Brim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Behrouz Zamanifekri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Duane T. Smoot
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hassan Ashktorab
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hassan Ashktorab.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nouraie, M., Hosseinkhah, F., Brim, H. et al. Clinicopathological Features of Colon Polyps from African-Americans. Dig Dis Sci 55, 1442–1449 (2010). https://doi.org/10.1007/s10620-010-1133-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-010-1133-5

Keywords

Search

Navigation