Clinicopathologic Characteristics of Colorectal Adenomas in Population Before the Age of 50: The Kasid Prospective Multicenter Study

Clinicopathologic Characteristics of Colorectal Adenomas in Population Before the Age of 50: The Kasid Prospective Multicenter Study Jung-Ae Jung, Hyun Soo Kim, Young-Ho Kim, Won Ho Kim, Tae Il Kim, Hyo Jong Kim, Suk-Kyun Yang, Seung Jae Myung, Jeong Sik Byeon, Moon Sung Lee, IL Kwon Jung, Moon Kwan Chung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Dong Soo Han, Jae Suk Song Background: The current practice of removing adenomatous polyp is based on the belief that this will prevent colorectal cancer. Clinicopathologic charateristics of colon adenomas in the population before the age of 50 is uncertain. Methods: A prospective study was conducted from July 2003 to June 2004. Of the total 17,200 patients performed colonoscopy at 12 tertiary medical centers, the case group was composed of 7,913 patients younger than 50. Colonoscopic polypectomy for adenoma was done in 5,845 patients including 3,051 younger patients. Advanced colorectal adenoma was defined as an adenoma that was 11 mm or more in diameter, a villous adenoma, an adenoma with high grade dysplasia, or invasive cancer. In patients with more than one neoplastic lesion, the classification was based on the most advanced lesion. We compared their characteristics of adenoma and colonoscopic indications as clinical risk factors for adenoma according to the age. Results: In patients before the age of 50, the most common indication of colonoscopy was asymptomatic screening (32.6%), and another major indications were bowel habit change (23.9%), positive stool occult blood or hematochezia (9.1%), referred cases from primary clinic (3.7%), iron deficiency anemia (2.9%) and surveillance for inflammatory bowel disease (IBD) (1.3%). The proportion of adenoma removed by colonoscopic polypectomy was 38.6% (3,051/7,913) in younger patients and 30.1% (2,794/9,287) in older patients (p ! 0.0001), while the detection rate of advanced adenoma was significantly lower in younger patients than older patients (3.7% vs. 7.2%, p ! 0.0001). The distribution of adenoma was shifted to the right colon (p Z 0.016) with ageing. The risk factors for advanced adenoma as colonoscopic indications in younger population were surveillance for IBD (OR 3.17, 95% CI 1.68-5.60) and referred cases from primary clinic (OR 1.66, 95% CI 1.03-2.58). Conclusion: This study documents colon polyp requiring polypectomy in younger patients has a characteristic of higher proportion of adenoma than in older patients, despite of the lower detection rate of advanced adenoma. Also, in this younger population, the colonoscopic polypectomy should be the first consideration in polyps with IBD patients or referred patients from primary clinic. W1114 Men with Prostate Cancer Are Predisposed to Colon Cancer: Half a Million US Veterans’ Case Control Study Vikas Khurana, Hanmanth R. Bejjanki, Jeffrey A. Goldstein, Gloria Caldito, Charlton Fort, Ruby Kochhar Background: Prostate and colorectal cancers share some common risk factors including age, family history and a diet high in fat. For both cancers the screening for general population starts at age 50. Several studies were done to evaluate the association between them, however the results have been conflicting and inconclusive. Aim: To study the association between prostate and colorectal cancers and to evaluate the effect of prostate cancer diagnosis on the risk for colorectal cancer. Design: VISN 16 data warehouse, which contains clinical and demographic information about all veterans (O1.4 million patients) cared for at the 10 VA Medical Centers in 4 states comprising the South Central VA health Care Network in the mid-south region of the US, was queried from Oct 1998 to June 2004. Patients with prostate cancer were identified using ICD-9 (185) codes and patients with colorectal cancers were identified using ICD-9 (153 & 154) codes. Retrospective case control design was used. Multiple logistic regression analysis was used with calculation of odds ratios and 95% confidence intervals were used universally. Statistical analysis was performed using SAS software version 9.0 (Chicago, IL). Results: We analyzed 443,774 male patients from our database. The mean age of the selected group was 62.5(S.D. G 14.5). There were 26,087 (5.88%) prostate cancer and 5423 (1.22%) colorectal cancer patients in the study group. There was a significant increase in the incidence of colon cancer in patients diagnosed with prostate cancer compared to patients without prostate cancer (Odds Ratio 1.79, 95% CI 1.65 to 1.93 p-value ! 0.0001) after the data was controlled for the above covariates. Discussion: The increased incidence of colon cancer in patients with prostate cancers may be due to several risk factors that are common to both prostate and colon cancers. The data should be evaluated with caution given the limitations of the population, the database and the design of the study. Some factors known to increase the risk of colorectal cancers like family history, diet and inflammatory bowel disease were not incorporated into the study. Conclusion: Our data suggest that prostate cancer is a significant risk factor for colorectal cancer. Patients with prostate cancer may be considered for more aggressive screening for colorectal cancer.