Select group of patients might benefit from early colonoscopic screening for colorectal cancer
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and Other Interventional Techniques
Select group of patients might benefit from early colonoscopic screening for colorectal cancer Mohammad Bilal1 · Shailendra Singh2 · Thanh‑Truc Le1 · Yamam Al‑Saadi3 · Praveen Guturu1 Received: 29 March 2019 / Accepted: 4 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Recently, the American Cancer Society made a qualified recommendation to start colorectal cancer (CRC) screening at 45 years of age in all average-risk individuals. In this study, our primary aim is to calculate the prevalence and also evaluate the predictors of increased prevalence of detected adenomas in the 40–49-year-old individuals undergoing colonoscopy. Methods A retrospective cross-sectional study was performed using our endoscopy database. Study subjects included all 40–49-year-old patients undergoing their first colonoscopy at our institution from January 1, 2010 to September 30, 2017. Exclusion criteria included patients who underwent colonoscopy for overt gastrointestinal bleeding, inflammatory bowel disease, a history of familial adenomatous polyposis, hereditary non-polyposis CRC. Univariate analysis and multivariate analysis were performed to identify factors associated with increased adenoma detection rate (ADR). Results A total of 2059 patients were included in the study, and 317 of these patients had family history (FH) of CRC. Patients with FH of CRC had significantly higher ADR (27.8% vs. 19.7%, p = 0.001) as compared to those without FH of CRC. There was no significant difference in ADR in patients between 40–44 years and 45–49 years of age (17.7% vs. 21.4%, p = 0.058). On a multivariate analysis while adjusting for multiple patient and procedural variables, FH of CRC, male sex, BMI > 30 kg/m2, chronic kidney disease, and age were associated with high ADR. Conclusions Our study shows that in addition to FH of CRC, age, male sex, BMI, and CKD are independent predictors of increased ADR in patients between 40 and 49 years of age. Keywords Adenoma detection rate · Colonoscopy · Colon cancer · Early-onset colon cancer Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer among adults in the USA and the second leading cause of cancer-related deaths [1]. Prior reports have shown that colonoscopy with polypectomy of adenomatous polyps is effective in preventing CRC [2]. One estimate suggests that more than half (53%) of these deaths could have * Praveen Guturu [email protected] 1
Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
2
Division of Gastroenterology, Charleston Area Medical Center, West Virginia University, 3110 MacCorkle Avenue SE, Charleston, WV 25304, USA
3
Department of Internal Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
been prevented if all adults over the age of 50 underwent routine CRC screening [3]. Despite the decrease in incidence of CRC overall, which is prim
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