Adenoma

Taller adults may have higher risk for colorectal cancer, adenoma

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Greater adult-attained height correlated with increased risk for colorectal cancer and adenoma, according to a meta-analysis published in Cancer, Epidemiology, Biomarkers & Prevention.

Researchers from Johns Hopkins School of Medicine arrived at the finding after adjusting for demographic, socioeconomic, behavioral and other known risk factors.

Quote from Gerard E. Mullin, MD.

“Tallness is an overlooked risk factor for several adverse health conditions and is not on the radar for doctors to bear in mind when evaluating health maintenance and prevention. Those who are considered tall for their culture should be considered for earlier screening for colorectal adenomas than the general population,” Gerard E. Mullin, MD, associate professor of medicine and director of Johns Hopkins Hospital Integrative GI Nutrition Services at The Johns Hopkins School of Medicine, told Healio.

Background

Mullin and colleagues pursued the research because the influence of anthropometric characteristics on colorectal neoplasia biology was unclear.

“We knew that there were modifiable factors such as smoking, alcohol use and processed meat consumption that raised the risk for digestive tract cancers that are not considered by doctors in screening for colon cancer, but what about nonmodifiable factors?” Mullin said. “We knew that certain conditions with excessive body size and tallness, such as acromegaly and Klinefelter syndrome, raised risk for colon cancer — but what about basketball players and athletes?”

Mullin said the thought first occurred to him years ago when he was at a New York Yankees baseball game and their 36-year-old outfielder, Darryl Strawberry, was taken out of a playoff game due to advanced colon cancer.

“That was the first time I had heard of a young person with advanced colon cancer,” Mullin said. “I saw him at a vegan restaurant in Miami in 2019 and he looked healthy and fit. It wasn’t his diet. I wondered if it was his height and began to look for a link in the literature and was struck that there were positive studies on many digestive tract cancers. So, we focused on a possible line of colon cancer and attained tallness.”

Methodology

Mullin and colleagues searched MEDLINE, EMBASE, the Cochrane Library and Web of Science for studies on the association between adult-attained height and colorectal cancer or adenoma. They identified 47 observational studies involving 280,644 colorectal cancer and 14,139 colorectal adenoma cases. The researchers also gathered original data from the Johns Hopkins Colon Biofilm study, which enrolled 1,459 adults who received outpatient colonoscopies.

Researchers estimated HRs and ORs of colorectal cancer/adenoma with increased height using random-effects meta-analysis.

Key findings

Thirty-three studies had data for colorectal cancer incidence per 10 cm increase in height — 19 yielded an HR of 1.14 (95% CI, 1.11-1.17) and 14 an OR of 1.09 (95% CI, 1.05-1.13).

In addition, 26 studies had data comparing colorectal cancer incidence between individuals within the highest vs. the lowest height percentile — 19 showed an HR of 1.24 (95% CI, 1.19-1.3) and seven an OR of 1.07 (95% CI, 0.92-1.25). Four studies had data assessing colorectal adenoma incidence per 10 cm increase in height, showing an overall OR of 1.06 (95% CI, 1-1.12).

Mullin told Healio that the positive adenoma data surprised researchers.

“Most of all that the apparent magnitude of risk was comparable to the risk of frequent processed red meat consumption, cigarette smoking or moderate alcohol consumption,” Mullin said. “We controlled for many of the risk factors for adenoma and colon cancer, such as family history, inflammatory bowel disease and even diet, and found attained height as an independent risk factor.”

Implications

As a result of their findings, Mullin and colleagues recommended that height be considered a risk factor for colorectal cancer screening. They added that more research is necessary to define the tallness risk parameters that can translate the finding into the clinical care setting.

Mullin suggested research into the use of DNA stool testing for neoplasia in tall individuals, testing their positivity with age-matched controls.

“It also would be interesting to see if there is a factorial interaction of attained height with the aforementioned modifiable factors, such as diet, and/or nonmodifiable ones, such as genetic,” Mullin said.

AI-assisted colonoscopy increases adenoma detection rate

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Artificial intelligence-assisted colonoscopy reduced the colorectal neoplasia miss rate by nearly twofold compared with colonoscopy alone, according to research published in Gastroenterology.

“Miss rate of colorectal neoplasia remains the most relevant cause of post-colonoscopy colorectal cancer that occurs with a 10-year incidence of 1% after a screening/surveillance colonoscopy,” Michael B. Wallace, MD, PhD, professor of gastroenterology and hepatology at the Mayo Clinic Jacksonville, and colleagues wrote. “Artificial intelligence by means of deep learning had been successfully implemented in colonoscopy due to its speed and accuracy in detecting colorectal lesions. … Preliminary cross-over studies with investigational devices showed a significant reduction of the adenoma miss rate (AMR) when using artificial intelligence. However, interpretation of these data was limited by single-study setting, need of a second monitor for the output of artificial intelligence and use of tip-hood based colonoscopy.”

Adenoma miss rate among patients who underwent: AI-assisted colonoscopy followed by standard colonoscopy; 15.5% VS Standard colonoscopy followed

In a randomized controlled trial, Wallace and colleagues compared the adenoma detection rate (ADR) in 230 participants ( 45 years) at average risk for CRC who underwent screening or surveillance colonoscopy. Participants received two same-day colonoscopies: A test group underwent white-light colonoscopy with AI followed by standard white-light colonoscopy without AI (n = 116) and a control group underwent white-light colonoscopy without AI followed by white-light colonoscopy with AI (n = 114). Additional studied endpoints included the AMR, polyp miss rate and the mean number of adenomas and carcinomas detected. Researchers noted use of regulatory-approved computer-aided detection during this study (GI Genius, Medtronic).

According to study results, the AMR was 15.5% in the AI-first group and 32.4% in the control group (adjusted OR = 0.38; 95% CI, 0.23-0.62). Compared with the control group, patients who underwent AI-assisted colonoscopy first had a lower AMR for lesions less than or equal to 5 mm (15.9% vs. 35.8%; OR = 0.34; 95% CI, 0.21-0.55) and nonpolypoid lesions (16.8% vs. 45.8%; OR = 0.24; 95% CI, 0.13-0.43). AMR also was lower in both the proximal colon (18.3% vs. 32.5%; OR = 0.46; 95% CI, 0.26-0.78) and distal colon (10.8% vs. 32.1%; OR = 0.25; 95% CI, 0.11-0.57).

Further investigation yielded a lower mean number of adenomas detected at second colonoscopy in the AI-first group compared with the control group (0.33±0.63 vs. 0.70±0.97; P < 0.001) with false negative rates of 6.8% and 29.6%, respectively. There was no difference in the rate of adverse events between groups.

“We showed a 50% reduction in miss rate of colorectal neoplasia when using the same AI device that had shown a substantial increase in ADR in two previous randomized controlled trials, indirectly substantiating that the ADR increase in the previous studies was specifically driven by a substantial reduction of the miss rate risk,” Wallace and colleagues concluded.

Assessment of volumetric growth rates of small colorectal polyps with CT colonography: a longitudinal study of natural history.

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Summary

Background

The clinical relevance and in-vivo growth rates of small (6—9 mm) colorectal polyps are not well established. We aimed to assess the behaviour of such polyps with CT colonography assessments.

Methods

In this longitudinal study, we enrolled asymptomatic adults undergoing routine colorectal cancer screening with CT colonography at two medical centres in the USA. Experienced investigators (PJP, DHK, JLH) measured volumes and maximum linear sizes of polyps in vivo with CT colonography scans at baseline and surveillance follow-up. We defined progression, stability, and regression on the basis of a 20% volumetric change per year from baseline (20% or more growth classed as progression, 20% growth to −20% reduction classed as stable, and −20% or more reduction classed as regression). We compared findings with histological subgroups confirmed after colonoscopy when indicated. This study is registered withClinicalTrials.gov, number NCT00204867.

Findings

Between April, 2004, and June, 2012, we screened 22 006 asymptomatic adults and included 243 adults (mean age 57·4 years [SD 7·1] and median age 56 years [IQR 52—61]; 106 [37%] women), with 306 small colorectal polyps. The mean surveillance interval was 2·3 years (SD 1·4; range 1—7 years; median 2·0 years [IQR 1·1—2·3]). 68 (22%) of 306 polyps progressed, 153 (50%) were stable, and 85 (28%) regressed, including an apparent resolution in 32 (10%) polyps. We established immediate histology in 131 lesions on colonoscopy after final CT colonography. 21 (91%) of 23 proven advanced adenomas progressed, compared with 31 (37%) of 84 proven non-advanced adenomas, and 15 (8%) of 198 other lesions (p<0·0001). The odds ratio for a growing polyp at CT colonography surveillance to become an advanced adenoma was 15·6 (95% CI 7·6—31·7) compared with 6—9 mm polyps detected and removed at initial CT colonography screening (without surveillance). Mean polyp volume change was a 77% increase per year for 23 proven advanced adenomas and a 16% increase per year for 84 proven non-advanced adenomas, but a 13% decrease per year for all proven non-neoplastic or unresected polyps (p<0·0001). An absolute polyp volume of more than 180 mm3 at surveillance CT colonography identified proven advanced neoplasia (including one delayed cancer) with a sensitivity of 92% (22 of 24 polyps), specificity of 94% (266 of 282 polyps), positive-predictive value of 58% (22 of 38 polyps), and negative-predictive value of 99% (266 of 268 polyps). Only 16 (6%) of the 6—9 mm polyps exceeded 10 mm at follow-up.

Interpretation

Volumetric growth assessment of small colorectal polyps could be a useful biomarker for determination of clinical importance. Advanced adenomas show more rapid growth than non-advanced adenomas, whereas most other small polyps remain stable or regress. Our findings might allow for less invasive surveillance strategies, reserving polypectomy for lesions that show substantial growth. Further research is needed to provide more information regarding the ultimate fate of unresected small polyps without significant growth.

Source: Lancet