TY - JOUR
T1 - Polyps With Advanced Neoplasia Are Smaller in the Right Than in the Left Colon
T2 - Implications for Colorectal Cancer Screening
AU - Gupta, Samir
AU - Balasubramanian, Bijal A.
AU - Fu, Tommy
AU - Genta, Robert M.
AU - Rockey, Don C.
AU - Lash, Richard
N1 - Funding Information:
Funding Supported by Cancer Prevention and Research Institute of Texas grant PP100039 (Samir Gupta, PI); National Institutes of Health/National Cancer Institute grant number 1U54CA163308-01 titled, “Parkland-UT Southwestern PROSPR Center: Colon cancer screening in a safety net” (Celette Sugg Skinner, PI). Also supported by National Institutes of Health grant number 1 KL2 RR024983-01 , titled, “North and Central Texas Clinical and Translational Science Initiative” (Milton Packer, MD, PI) from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research, and its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/ . Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp . None of the study sponsors had a role in study design, data collection, analysis, interpretation, or decision to publish.
PY - 2012/12
Y1 - 2012/12
N2 - 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.
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.
KW - Colon Cancer Screening
KW - Colorectal Neoplasms
KW - Early Detection.
KW - Epidemiology
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U2 - 10.1016/j.cgh.2012.07.004
DO - 10.1016/j.cgh.2012.07.004
M3 - Article
C2 - 22835574
AN - SCOPUS:84869436512
SN - 1542-3565
VL - 10
SP - 1395-1401.e2
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 12
ER -