Polyps With Advanced Neoplasia Are Smaller in the Right Than in the Left Colon: Implications for Colorectal Cancer Screening

Samir Gupta, Bijal A. Balasubramanian, Tommy Fu, Robert M. Genta, Don C. Rockey, Richard Lash

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Background &Aims:Colonoscopy is consistently associated with reduced left-sided, but not right-sided, colorectal cancer (CRC) incidence and mortality. This might be because polyps with advanced pathology are smaller and more easily missed in the right vs left colon. We explored this postulate by evaluating the relationship among size, location, and histology of polyps from a large nationwide sample.Methods:We conducted a cross-sectional study of 233,414 polyps from 142,686 patients (47% women; mean age, 60 years), which were reviewed by Miraca Life Sciences in 2009. We assessed polyp histology, location, and size of largest fragment submitted. We compared size distribution of right vs left polyps with high-grade dysplasia (HGD) or adenocarcinoma as well as any advanced neoplasia.Results:The average size of right-sided polyps was smaller than that of left-sided polyps with HGD or adenocarcinoma (8.2 vs 12.4 mm, respectively); the same was true for polyps with advanced neoplasia (7.6 vs 11.1 mm, respectively) (P < .001). Most right-sided polyps with HGD, adenocarcinoma, or any advanced neoplasia were ≤9 mm, whereas most left-sided polyps with these findings were >9 mm. Polyps with advanced pathology were 5-fold more likely to be <6 mm in the right vs left colon: odds ratio, 5.27; 95% confidence interval, 4.06-6.82 for HGD or adenocarcinoma; odds ratio, 4.89; 95% confidence interval, 4.34-5.51 for advanced neoplasia.Conclusions:Polyps with features of HGD, adenocarcinoma, or advanced neoplasia were significantly smaller in the right vs left colon. Strategies to prevent right-sided CRC require more accurate detection of small, advanced polyps.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
Volume10
Issue number12
DOIs
StatePublished - Dec 2012

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Polyps
Early Detection of Cancer
Colorectal Neoplasms
Colon
Neoplasms
Adenocarcinoma
Histology
Odds Ratio
Confidence Intervals
Pathology
Biological Science Disciplines
Colonoscopy
Cross-Sectional Studies
Mortality

Keywords

  • Colon Cancer Screening
  • Colorectal Neoplasms
  • Early Detection.
  • Epidemiology

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Polyps With Advanced Neoplasia Are Smaller in the Right Than in the Left Colon : Implications for Colorectal Cancer Screening. / Gupta, Samir; Balasubramanian, Bijal A.; Fu, Tommy; Genta, Robert M.; Rockey, Don C.; Lash, Richard.

In: Clinical Gastroenterology and Hepatology, Vol. 10, No. 12, 12.2012.

Research output: Contribution to journalArticle

Gupta, Samir ; Balasubramanian, Bijal A. ; Fu, Tommy ; Genta, Robert M. ; Rockey, Don C. ; Lash, Richard. / Polyps With Advanced Neoplasia Are Smaller in the Right Than in the Left Colon : Implications for Colorectal Cancer Screening. In: Clinical Gastroenterology and Hepatology. 2012 ; Vol. 10, No. 12.
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AB - Background &Aims:Colonoscopy is consistently associated with reduced left-sided, but not right-sided, colorectal cancer (CRC) incidence and mortality. This might be because polyps with advanced pathology are smaller and more easily missed in the right vs left colon. We explored this postulate by evaluating the relationship among size, location, and histology of polyps from a large nationwide sample.Methods:We conducted a cross-sectional study of 233,414 polyps from 142,686 patients (47% women; mean age, 60 years), which were reviewed by Miraca Life Sciences in 2009. We assessed polyp histology, location, and size of largest fragment submitted. We compared size distribution of right vs left polyps with high-grade dysplasia (HGD) or adenocarcinoma as well as any advanced neoplasia.Results:The average size of right-sided polyps was smaller than that of left-sided polyps with HGD or adenocarcinoma (8.2 vs 12.4 mm, respectively); the same was true for polyps with advanced neoplasia (7.6 vs 11.1 mm, respectively) (P < .001). Most right-sided polyps with HGD, adenocarcinoma, or any advanced neoplasia were ≤9 mm, whereas most left-sided polyps with these findings were >9 mm. Polyps with advanced pathology were 5-fold more likely to be <6 mm in the right vs left colon: odds ratio, 5.27; 95% confidence interval, 4.06-6.82 for HGD or adenocarcinoma; odds ratio, 4.89; 95% confidence interval, 4.34-5.51 for advanced neoplasia.Conclusions:Polyps with features of HGD, adenocarcinoma, or advanced neoplasia were significantly smaller in the right vs left colon. Strategies to prevent right-sided CRC require more accurate detection of small, advanced polyps.

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