1
|
Kędzia-Berut R, Berut M, Włodarczyk M, Włodarczyk J, Dziki Ł, Dziki A, Mik M. Colorectal Cancer: Is it Still a Disease of the Elderly? POLISH JOURNAL OF SURGERY 2023; 96:41-45. [PMID: 38348978 DOI: 10.5604/01.3001.0054.0956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
<b><br>Introduction:</b> Colorectal cancer is becoming an increasingly significant health issue, being one of the more commonly diagnosed malignancies. Colorectal tumors account for 10% of all malignant cancers in women and 12% in men. Incidence is higher in the male population, especially among younger individuals. It is commonly believed that colorectal cancer is predominantly associated with advanced age. However, colorectal surgeons, who specialize in the treatment of this type of cancer, are observing a growing number of cases among middle-aged and younger individuals.</br> <b><br>Aim:</b> The aim of our study was to investigate whether colorectal cancer still predominantly affects elderly individuals, how frequently it is diagnosed in younger patients, and whether the location of tumors in the intestines of younger patients aligns with data from elderly individuals.</br> <b><br>Materials and methods:</b> The study was conducted retrospectively and included a cohort of 1771 patients who underwent surgical procedures due to colorectal cancer between 2012 and 2015 at the Department of General and Colorectal Surgery at the Medical University of Łódź and between 2014 and 2017 at the Department of General Surgery with a Division of Surgical Oncology at the District Health Center in Brzeziny. Data were analyzed regarding the frequency of colorectal cancer occurrence by age, tumor location in different age groups, and disease stage according to age. Age groups included <40 years, 41-50 years, 51-70 years, and >70 years.</br> <b><br>Results:</b> The study encompassed a total of 1771 patients, with 988 (55.79%) being males and 783 (44.21%) females. The mean age of the patients was 65.27 11.12 years. The highest number of cases was observed in the age range of 60-70 years and 70-80 years. It was found that colorectal tumors in males more frequently occurred on the left side of the colon and rectum, while in females, they were more commonly located on the right side of the colon, which was statistically significant (P = 0.007). Younger age groups of patients (<40 years, 40-50 years) had a similar male-to-female ratio, whereas in age groups above 50 years, males significantly outnumbered females (P = 0.049). The study revealed that in the group of patients below 40 years of age, an advanced stage of colorectal cancer was significantly more common; stage D occurred over twice as often as in the 51-70 age group and over three times as often as in the >70 age group.</br> <b><br>Conclusions:</b> The incidence of colorectal cancer in Poland is steadily increasing, with a growing number of diagnoses in younger individuals. Research findings demonstrate that males, especially those in younger age groups, are at a higher risk of developing colorectal cancer. A higher disease stage is more frequently observed in younger patients, possibly due to delayed diagnosis and symptomatic treatment. Screening programs should be adjusted to the changing age groups at higher risk. Our study underlines the need to raise public awareness regarding colorectal cancer, particularly among the younger population.</br>.
Collapse
Affiliation(s)
- Renata Kędzia-Berut
- Department of General and Colorectal Surgery, Military Medical Academy Memorial Teaching Hospital, Lodz, Poland
| | - Maciej Berut
- Department of General Surgery with Subdivision of Oncological Surgery, District Health Center in Brzeziny, Poland
| | - Marcin Włodarczyk
- Department of General and Cancer Surgery, Central Clinical Hospital of the Medical University of Lodz, Poland
| | - Jakub Włodarczyk
- Department of General and Cancer Surgery, Central Clinical Hospital of the Medical University of Lodz, Poland
| | - Łukasz Dziki
- Department of General and Cancer Surgery, Central Clinical Hospital of the Medical University of Lodz, Poland
| | - Adam Dziki
- Department of General and Colorectal Surgery, Military Medical Academy Memorial Teaching Hospital, Lodz, Poland
| | - Michał Mik
- Department of General and Colorectal Surgery, Military Medical Academy Memorial Teaching Hospital, Lodz, Poland
| |
Collapse
|
2
|
Wang S, Yang Z, Sha F, Qi X, He Z, Szeto CH, Yang Z, Tang J. Prevalence of incidental colorectal cancer and polyps in autopsies of different populations: a systematic review with meta-regression analysis. Eur J Epidemiol 2023; 38:939-955. [PMID: 37634229 DOI: 10.1007/s10654-023-01041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023]
Abstract
The colorectal cancer (CRC) and polyps incidentally found in autopsies represent the lesions that have not actually caused problems throughout the lifetime and thus may not need to be removed during screening. This study aimed to investigate the prevalence of incidental CRC (iCRC) and polyps in autopsies of different populations. A systematic search was performed on 19 August 2022 to identify autopsy studies that provided data on prevalence of iCRC, adenomatous polyps, hyperplastic polyps, and/or all polyps combined. The prevalence was pooled with the random-effects model. Subgroup and multivariable meta-regression analyses were conducted to investigate the heterogeneity. Forty-three eligible studies including 59,656 autopsies were identified, with 94% conducted before 1990 when CRC screening was uncommon or not available. The pooled prevalence was 0.7% (95% confidence interval [CI], 0.3-1.2%) for iCRC, 18.4% (95% CI, 13.3-24.1%) for adenomatous polyps, 16.4% (95% CI, 8.7-25.9%) for hyperplastic polyps, 26.3% (95% CI, 15.4-38.8%) for all polyps combined, and 29.9% (95% CI, 14.8-47.6%) for iCRC plus polyps. The prevalence of iCRC was higher (1.2%) in white-predominant populations but lower (0.4%) after excluding low-quality studies. Multivariable analyses showed that the prevalence of polyps was higher in white-predominant populations and higher-quality studies, increased with age, and showed a downward trend from "before 1975" through "after 1985". In conclusion, the prevalence of iCRC in autopsies was not low, considering the average lifetime risk of CRC, while incidental polyps were common. Both varied greatly in different populations. These findings may have implications when weighing the benefits and harms of screening.
Collapse
Affiliation(s)
- Shuting Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhirong Yang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Feng Sha
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Zhonghu He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chun-Ho Szeto
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zuyao Yang
- JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Jinling Tang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| |
Collapse
|
3
|
Smoking-induced microbial dysbiosis in health and disease. Clin Sci (Lond) 2022; 136:1371-1387. [PMID: 36156126 PMCID: PMC9527826 DOI: 10.1042/cs20220175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/09/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022]
Abstract
Smoking is associated with an increased risk of cancer, pulmonary and cardiovascular diseases, but the precise mechanisms by which such risk is mediated remain poorly understood. Additionally, smoking can impact the oral, nasal, oropharyngeal, lung and gut microbiome composition, function, and secreted molecule repertoire. Microbiome changes induced by smoking can bear direct consequences on smoking-related illnesses. Moreover, smoking-associated dysbiosis may modulate weight gain development following smoking cessation. Here, we review the implications of cigarette smoking on microbiome community structure and function. In addition, we highlight the potential impacts of microbial dysbiosis on smoking-related diseases. We discuss challenges in studying host–microbiome interactions in the context of smoking, such as the correlations with smoking-related disease severity versus causation and mechanism. In all, understanding the microbiome’s role in the pathophysiology of smoking-related diseases may promote the development of rational therapies for smoking- and smoking cessation-related disorders, as well as assist in smoking abstinence.
Collapse
|
4
|
Cigarette Smoking Associated with Colorectal Cancer Survival: A Nationwide, Population-Based Cohort Study. J Clin Med 2022; 11:jcm11040913. [PMID: 35207186 PMCID: PMC8879005 DOI: 10.3390/jcm11040913] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
We investigate whether cigarette smoking is associated with survival in patients with colorectal cancer (CRC) through a nationwide population-based cohort study in Taiwan. The Taiwan Cancer Registry and National Health Insurance Research Database were used to identify data from patients with CRC from 2011 to 2017. Tobacco use was evaluated based on the smoking status, intensity, and duration before cancer diagnosis. A total of 18,816 patients was included. A Kaplan–Meier survival analysis indicated smoking to be significantly associated with the CRC mortality risk (log-rank p = 0.0001). A multivariable Cox model indicated that smoking patients had a 1.11-fold higher mortality risk (HR = 1.11, 95% CI = 1.05–1.19) than nonsmoking patients did. This increased risk was also present in patients with CRC who smoked 11–20 cigarettes per day (HR = 1.16; 95% CI = 1.07–1.26) or smoked for >30 years (HR = 1.14; 95% CI = 1.04–1.25). Stratified analyses of sex and cancer subsites indicated that the effects of smoking were higher in male patients and in those with colon cancer. Our results indicate that cigarette smoking is significantly associated with poor survival in patients with CRC. An integrated smoking cessation campaign is warranted to prevent CRC mortality.
Collapse
|
5
|
Dimou N, Yarmolinsky J, Bouras E, Tsilidis KK, Martin RM, Lewis SJ, Gram IT, Bakker MF, Brenner H, Figueiredo JC, Fortner RT, Gruber SB, van Guelpen B, Hsu L, Kaaks R, Kweon SS, Lin Y, Lindor NM, Newcomb PA, Sánchez MJ, Severi G, Tindle HA, Tumino R, Weiderpass E, Gunter MJ, Murphy N. Causal Effects of Lifetime Smoking on Breast and Colorectal Cancer Risk: Mendelian Randomization Study. Cancer Epidemiol Biomarkers Prev 2021; 30:953-964. [PMID: 33653810 PMCID: PMC7611442 DOI: 10.1158/1055-9965.epi-20-1218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/02/2020] [Accepted: 02/23/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Observational evidence has shown that smoking is a risk factor for breast and colorectal cancer. We used Mendelian randomization (MR) to examine causal associations between smoking and risks of breast and colorectal cancer. METHODS Genome-Wide Association Study summary data were used to identify genetic variants associated with lifetime amount of smoking (n = 126 variants) and ever having smoked regularly (n = 112 variants). Using two-sample MR, we examined these variants in relation to incident breast (122,977 cases/105,974 controls) and colorectal cancer (52,775 cases/45,940 controls). RESULTS In inverse-variance weighted models, a genetic predisposition to higher lifetime amount of smoking was positively associated with breast cancer risk [OR per 1-SD increment: 1.13; 95% confidence interval (CI): 1.00-1.26; P = 0.04]; although heterogeneity was observed. Similar associations were found for estrogen receptor-positive and estrogen receptor-negative tumors. Higher lifetime amount of smoking was positively associated with colorectal cancer (OR per 1-SD increment, 1.21; 95% CI, 1.04-1.40; P = 0.01), colon cancer (OR, 1.31; 95% CI, 1.11-1.55; P < 0.01), and rectal cancer (OR, 1.36; 95% CI, 1.07-1.73; P = 0.01). Ever having smoked regularly was not associated with risks of breast (OR, 1.01; 95% CI, 0.90-1.14; P = 0.85) or colorectal cancer (OR, 0.97; 95% CI, 0.86-1.10; P = 0.68). CONCLUSIONS These findings are consistent with prior observational evidence and support a causal role of higher lifetime smoking amount in the development of breast and colorectal cancer. IMPACT The results from this comprehensive MR analysis indicate that lifetime smoking is a causal risk factor for these common malignancies.
Collapse
Affiliation(s)
- Niki Dimou
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
| | - James Yarmolinsky
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Emmanouil Bouras
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom
| | - Richard M Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Inger T Gram
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jane C Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stephen B Gruber
- Center for Precision Medicine, City of Hope National Medical Center, Duarte, California
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology Unit, Umea University, Umea, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå Sweden
| | - Li Hsu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Member of the German Center for Lung Research (DZL), Translational Lung Research Center (TLRC), Heidelberg, Germany
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea
- Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yi Lin
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Noralane M Lindor
- Department of Health Science Research, Mayo Clinic, Scottsdale, Arizona
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- School of Public Health, University of Washington, Seattle, Washington
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Gianluca Severi
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Villejuif, France
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
| | - Hilary A Tindle
- General Internal Medicine, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7) Ragusa, Ragusa, Italy
| | - Elisabete Weiderpass
- Office of the Director, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
| | - Neil Murphy
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
6
|
Li J, Xu HL, Yao BD, Li WX, Fang H, Xu DL, Zhang ZF. Environmental tobacco smoke and cancer risk, a prospective cohort study in a Chinese population. ENVIRONMENTAL RESEARCH 2020; 191:110015. [PMID: 32818497 DOI: 10.1016/j.envres.2020.110015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 05/30/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
Few prospective cohort studies have investigated associations between environmental tobacco smoke (ETS) and other cancer sites, in addition to lung cancer. We assessed these associations in a population-based prospective cohort study started from 2008 to 2011 with average of 9.1 years of follow-up, in Minhang district, Shanghai, China. The study included a total of 23,415 participants (8388 men, 15,027 women) and 205,515 person-years. Epidemiological data were collected by a standardized questionnaire including ETS exposure. Newly diagnosed patients with primary cancers and deaths were identified by record linkage system with the Shanghai Cancer Registry and Shanghai Vital Statistics. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models, adjusting for potential confounders. During the study period, a total of 1462 patients with diagnoses of primary cancers were identified. Among all participants and non-smokers, ETS was associated with an increased risk of all smoking-related cancers (all: adjusted HR: 1.23, 95% CI: 1.05-1.43 and non-smokers: 1.24, 1.02-1.49), lung cancer (1.29, 0.98-1.71 and 1.27, 0.91-1.77), and stomach cancer (1.86, 1.21-2.85 and 1.75, 1.05-2.91), respectively. Furthermore, associations for lung and stomach cancers were the strongest among non-smoking females. The joint effects of both ETS and active smoking were strongest for all cancers, all smoking-related cancers, lung cancer, and stomach cancer. No clear interactions were observed. These results suggest that ETS exposure may increase the risk of smoking-related cancers in a Chinese population. Further studies on the relationship between ETS exposure and specific cancer sites are warranted to replicate our findings.
Collapse
Affiliation(s)
- Jun Li
- Department of Non-Communicable Diseases Prevention and Control, Shanghai Minhang Center for Disease Control and Prevention, Shanghai, 201101, China; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, 90095, USA
| | - Hui-Lin Xu
- Department of Non-Communicable Diseases Prevention and Control, Shanghai Minhang Center for Disease Control and Prevention, Shanghai, 201101, China
| | - Bao-Dong Yao
- Department of Non-Communicable Diseases Prevention and Control, Shanghai Minhang Center for Disease Control and Prevention, Shanghai, 201101, China
| | - Wei-Xi Li
- Department of Non-Communicable Diseases Prevention and Control, Shanghai Minhang Center for Disease Control and Prevention, Shanghai, 201101, China
| | - Hong Fang
- Department of Non-Communicable Diseases Prevention and Control, Shanghai Minhang Center for Disease Control and Prevention, Shanghai, 201101, China
| | - Dong-Li Xu
- Department of Non-Communicable Diseases Prevention and Control, Shanghai Minhang Center for Disease Control and Prevention, Shanghai, 201101, China.
| | - Zuo-Feng Zhang
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, 90095, USA.
| |
Collapse
|
7
|
Akter S, Islam Z, Mizoue T, Sawada N, Ihira H, Tsugane S, Koyanagi YN, Ito H, Wang C, Tamakoshi A, Wada K, Nagata C, Tanaka K, Kitamura Y, Utada M, Ozasa K, Sugawara Y, Tsuji I, Shimazu T, Matsuo K, Naito M, Tanaka K, Inoue M. Smoking and colorectal cancer: A pooled analysis of 10 population-based cohort studies in Japan. Int J Cancer 2020; 148:654-664. [PMID: 32761607 DOI: 10.1002/ijc.33248] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/28/2020] [Accepted: 07/24/2020] [Indexed: 01/23/2023]
Abstract
Smoking has been consistently associated with the risk of colorectal cancer (CRC) in Western populations; however, evidence is limited and inconsistent in Asian people. To assess the association of smoking status, smoking intensity and smoking cessation with colorectal risk in the Japanese population, we performed a pooled analysis of 10 population-based cohort studies. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox's proportional hazards model and then pooled using a random-effects model. Among 363 409 participants followed up for 2 666 004 person-years, 9232 incident CRCs were identified. In men, compared with never smokers, ever smokers showed higher risk of CRC. The HRs (95% CI) were 1.19 (1.10-1.29) for CRC, 1.19 (1.09-1.30) for colon cancer, 1.28 (1.13-1.46) for distal colon cancer and 1.21 (1.07-1.36) for rectal cancer. Smoking was associated with risk of CRC in a dose-response manner. In women, compared with never smokers, ever smokers showed increased risk of distal colon cancer (1.47 [1.19-1.82]). There was no evidence of a significant gender difference in the association of smoking and CRC risk. Our results confirm that smoking is associated with an increased risk of CRC, both overall and subsites, in Japanese men and distal colon cancer in Japanese women.
Collapse
Affiliation(s)
- Shamima Akter
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Zobida Islam
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Hikaru Ihira
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Yuriko N Koyanagi
- Division of Cancer Information and Control, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hidemi Ito
- Division of Cancer Information and Control, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan.,Department of Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chaochen Wang
- Department of Public Health, Aichi Medical University School of Medicine, Aichi, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Keiko Wada
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kenta Tanaka
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuri Kitamura
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mai Utada
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Kotaro Ozasa
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Yumi Sugawara
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Mariko Naito
- Department of Oral Epidemiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| |
Collapse
|
8
|
Gram IT, Park SY, Wilkens LR, Haiman CA, Le Marchand L. Smoking-Related Risks of Colorectal Cancer by Anatomical Subsite and Sex. Am J Epidemiol 2020; 189:543-553. [PMID: 31971226 PMCID: PMC7368133 DOI: 10.1093/aje/kwaa005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study was to examine whether the increased risk of colorectal cancer due to cigarette smoking differed by anatomical subsite or sex. We analyzed data from 188,052 participants aged 45-75 years (45% men) who were enrolled in the Multiethnic Cohort Study in 1993-1996. During a mean follow-up period of 16.7 years, we identified 4,879 incident cases of invasive colorectal adenocarcinoma. In multivariate Cox regression models, as compared with never smokers of the same sex, male ever smokers had a 39% higher risk (hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.16, 1.67) of cancer of the left (distal or descending) colon but not of the right (proximal or ascending) colon (HR = 1.03, 95% CI: 0.89, 1.18), while female ever smokers had a 20% higher risk (HR = 1.20, 95% CI: 1.06, 1.36) of cancer of the right colon but not of the left colon (HR = 0.96, 95% CI: 0.80, 1.15). Compared with male smokers, female smokers had a greater increase in risk of rectal cancer with number of pack-years of smoking (P for heterogeneity = 0.03). Our results suggest that male smokers are at increased risk of left colon cancer and female smokers are at increased risk of right colon cancer. Our study also suggests that females who smoke may have a higher risk of rectal cancer due to smoking than their male counterparts.
Collapse
Affiliation(s)
- Inger T Gram
- Department of Community Medicine, Faculty of Health Sciences, UiT–The Arctic University of Norway, Tromsø, Norway
| | - Song-Yi Park
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Lynne R Wilkens
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Loïc Le Marchand
- Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| |
Collapse
|
9
|
Jha P. The hazards of smoking and the benefits of cessation: a critical summation of the epidemiological evidence in high-income countries. eLife 2020; 9:49979. [PMID: 32207405 PMCID: PMC7093109 DOI: 10.7554/elife.49979] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
In high-income countries, the biggest cause of premature death, defined as death before 70 years, is smoking of manufactured cigarettes. Smoking-related disease was responsible for about 41 million deaths in the United States, United Kingdom and Canada, cumulatively, from 1960 to 2020. Every million cigarettes smoked leads to one death in the US and Canada, but slightly more than one death in the UK. The 21st century hazards reveal that smokers who start smoking early in adult life and do not quit lose a decade of life expectancy versus non-smokers. Cessation, particularly before age 40 years, yields large reductions in mortality risk. Up to two-thirds of deaths among smokers are avoidable at non-smoking death rates, and former smokers have about only a quarter of the excess risk of death compared to current smokers. The gap between scientific and popular understanding of smoking hazards is surprisingly large.
Collapse
Affiliation(s)
- Prabhat Jha
- Centre for Global Health Research, Dalla Lana School of Public Health and Unity Health, Toronto, University of Toronto, Ontario, Canada
| |
Collapse
|
10
|
Survival Prediction in Patients with Colorectal Cancer Using Artificial Neural Network and Cox Regression. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.81161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
11
|
Kageyama S, Takeshita T, Takeuchi K, Asakawa M, Matsumi R, Furuta M, Shibata Y, Nagai K, Ikebe M, Morita M, Masuda M, Toh Y, Kiyohara Y, Ninomiya T, Yamashita Y. Characteristics of the Salivary Microbiota in Patients With Various Digestive Tract Cancers. Front Microbiol 2019; 10:1780. [PMID: 31428073 PMCID: PMC6688131 DOI: 10.3389/fmicb.2019.01780] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/18/2019] [Indexed: 12/26/2022] Open
Abstract
The salivary microbiota is constantly swallowed and delivered to the digestive tract. These bacteria may be associated with gastrointestinal diseases. This case-control study examined the salivary microbiota in patients with digestive tract cancer (DTC) and evaluated their differential distribution based on the cancer sites. We collected saliva samples from 59 patients with cancer in any part of the digestive tract (tongue/pharynx, esophagus, stomach, and large intestine) and from 118 age- and sex-matched control subjects. There was no significant difference in periodontal status between DTC patients and control subjects (P = 0.72). We examined the bacterial diversity and composition in saliva by 16S ribosomal RNA gene sequencing. Salivary bacterial diversity in DTC patients was significantly higher than that in control subjects [number of operational taxonomic units (OTUs), P = 0.02; Shannon index, P < 0.01; Chao1, P = 0.04]. Eleven differentially abundant OTUs in DTC patients were identified using the linear discriminant analysis effect size (LEfSe) method. Based on the cancer sites, the diversity of salivary bacteria was especially higher in tongue/pharyngeal or esophageal cancer patients than in control subjects. Among the 11 differentially abundant OTUs in DTC patients, an OTU corresponding to Porphyromonas gingivalis was more abundant in the saliva of all groups of DTC patients compared to that in control subjects, and an OTU corresponding to Corynebacterium species was more abundant in all groups other than gastric cancer patients (P < 0.01). In addition, the relative abundances of OTUs corresponding to Fusobacterium nucleatum, Streptococcus parasanguinis II, and Neisseria species were significantly higher in tongue/pharyngeal cancer patients compared to their abundances in control subjects (P < 0.01). The relative abundance of an OTU corresponding to the Neisseria species was also significantly higher in gastric cancer patients and that of an OTU corresponding to Actinomyces odontolyticus was significantly higher in colorectal cancer patients (P < 0.01). These results suggest that the salivary microbiota might be associated with various digestive tract cancers.
Collapse
Affiliation(s)
- Shinya Kageyama
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Toru Takeshita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan.,OBT Research Center, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Kenji Takeuchi
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Mikari Asakawa
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Rie Matsumi
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Michiko Furuta
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Yukie Shibata
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Kiyoshi Nagai
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Masahiko Ikebe
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Masaru Morita
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Muneyuki Masuda
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yutaka Kiyohara
- Hisayama Research Institute for Lifestyle Diseases, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihisa Yamashita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| |
Collapse
|
12
|
The value of four imaging modalities in diagnosing lymph node involvement in rectal cancer: an overview and adjusted indirect comparison. Clin Exp Med 2019; 19:225-234. [PMID: 30900099 DOI: 10.1007/s10238-019-00552-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/12/2019] [Indexed: 12/28/2022]
Abstract
Several systematic reviews have investigated the accuracy of imaging modalities for lymph node involvement of rectal cancer, but there are considerable differences in conclusions. This overview aimed to assess the methodological and reporting quality of systematic reviews that evaluated the diagnostic value of imaging modalities for lymph node involvement in patients with rectal cancer and to compare the diagnostic value of different modalities for lymph node involvement. The PubMed, EMBASE, Cochrane Library and Chinese Biomedicine Literature were searched to identify relevant systematic reviews. The methodological quality was assessed using the AMSTAR checklist, and the reporting quality was assessed using PRISMA-DTA checklist. The indirect comparison was conducted to compare the accuracy of different imaging modalities. Seven systematic reviews involving 353 primary studies were included. The median (Range) AMSTAR scores were 6.0 (4.0-9.0); the median (Range) PRISMA-DTA scores were 18.0 (11.0-23.0). Sensitivity of MRI [0.69 (95% CI 0.63, 0.77)] was significantly higher than that of ERUS [0.57 (95% CI 0.53, 0.62)]. Specificity of ERUS [0.80 (95% CI 0.77, 0.83)] was significantly higher than that of CT [0.72 (95% CI 0.67, 0.78)]. Positive likelihood ratio of EUS [3.04 (95% CI 2.75, 3.36)] was significantly higher than that of CT [2.21 (95% CI 1.69, 2.90)]. EUS had better diagnostic value than CT and ERUS in the diagnosis of lymph node involvement. Compared with CT and ERUS, MRI was more sensitive. EUS and MRI had comparable diagnostic accuracy, but no modality was proved to be particularly accurate.
Collapse
|
13
|
Alshareef SH, Alsobaie NA, Aldeheshi SA, Alturki ST, Zevallos JC, Barengo NC. Association between Race and Cancer-Related Mortality among Patients with Colorectal Cancer in the United States: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020240. [PMID: 30654462 PMCID: PMC6352187 DOI: 10.3390/ijerph16020240] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/04/2019] [Accepted: 01/14/2019] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) is the third most common cause of mortality in the United States (US). Differences in CRC mortality according to race have been extensively studied; however, much more understanding with regard to tumor characteristics’ effect on mortality is needed. The objective was to investigate the association between race and mortality among CRC patients in the US during 2007–2014. A retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) Program, which collects cancer statistics through selected population-based cancer registries during in the US, was conducted. The outcome variable was CRC-related mortality in adult patients (≥18 years old) during 2007–2014. The independent variable was race of white, black, Asian/Pacific Islander (API), and American Indian/Alaska Native (others). The covariates were, age, sex, marital status, health insurance, tumor stage at diagnosis, and tumor size and grade. Bivariate analysis was performed to identify possible confounders (chi-square tests). Unadjusted and adjusted logistic regression models were used to study the association between race and CRC-specific mortality. The final number of participants consisted of 70,392 patients. Blacks had a 32% higher risk of death compared to whites (adjusted odds ratio (OR) 1.32; 95% confidence interval (CI) 1.22–1.43). Corresponding OR for others were 1.41 (95% CI 1.10–1.84). API had nonsignificant adjusted odds of mortality compared to whites (0.95; 95% CI 0.87–1.03). In conclusion, we observed a significant increased risk of mortality in black and American Indian/Alaska Native patients with CRC compared to white patients.
Collapse
Affiliation(s)
- Sayaf H Alshareef
- College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh 13317, Saudi Arabia.
| | - Nasser A Alsobaie
- College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh 13317, Saudi Arabia.
| | - Salman A Aldeheshi
- College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh 13317, Saudi Arabia.
| | - Sultan T Alturki
- College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh 13317, Saudi Arabia.
| | - Juan Carlos Zevallos
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA.
| | - Noël C Barengo
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA.
| |
Collapse
|
14
|
Novais RB, Barbosa AAL, Intelizano PM, Bin FC, Castro KDM, Formiga FB, Manzione TS, Batista CFL. Comparative study between amputation of the rectum in the classic Lloyd-Davies position and in ventral decubitus. ACTA ACUST UNITED AC 2018; 45:e1643. [PMID: 30365691 DOI: 10.1590/0100-6991e-20181643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to evaluate the benefits and disadvantages of the ventral decubitus position compared with that of Lloyd-Davies in patients submitted to abdominoperineal amputation of the rectum. METHODS we conducted a retrospective study of 56 patients submitted to abdominoperineal amputation of the rectum due to distal rectal and anal canal neoplasms, treated at the Central Hospital of the Santa Casa de Misericórdia in São Paulo between 2008 and 2017. RESULTS patients' mean age was 63.08 years, 48.2% of them women and 51.8%, men. Adenocarcinoma was the histological type, in 94.6% of cases, and squamous cell carcinoma, in 5.4%. The position of Lloyd-Davies was adopted in 66.1% of the procedures, and the ventral position, in 33.9%. At the time of surgery, four patients had synchronous metastases: hepatic (one case), pulmonary (one case) and simultaneous liver and lung (two cases). Neoadjuvant treatment was performed in 85.7% of the patients. Late postoperative complications occurred in 13 patients operated in the classic position and in one patient operated on in the ventral decubitus position. The overall survival time for the group operated in the classic position was on average 45.7 months, while in the group operated on in the ventral decubitus position it was 15.5 months. CONCLUSION the ventral position group presented less need for intraoperative intravenous volume infusion and fewer postoperative complications, whereas the Lloyd-Davies group had better surgical and anesthetic times. Relapse, disease-free time, and overall survival should be evaluated at a longer follow-up time.
Collapse
Affiliation(s)
- Rodrigo Barbosa Novais
- Santa Casa de Misericórdia, Departamento de Cirurgia, Disciplina de Coloproctologia, São Paulo, SP, Brasil
| | | | | | - Fang Chia Bin
- Santa Casa de Misericórdia, Departamento de Cirurgia, Disciplina de Coloproctologia, São Paulo, SP, Brasil
| | - Karina Dagre Magri Castro
- Santa Casa de Misericórdia, Departamento de Cirurgia, Disciplina de Coloproctologia, São Paulo, SP, Brasil
| | - Fernanda Bellotti Formiga
- Santa Casa de Misericórdia, Departamento de Cirurgia, Disciplina de Coloproctologia, São Paulo, SP, Brasil
| | - Thiago Silveira Manzione
- Santa Casa de Misericórdia, Departamento de Cirurgia, Disciplina de Coloproctologia, São Paulo, SP, Brasil
| | | |
Collapse
|
15
|
Wang X, Gao Y, Li J, Wu J, Wang B, Ma X, Tian J, Shen M, Wang J. Diagnostic accuracy of endoscopic ultrasound, computed tomography, magnetic resonance imaging, and endorectal ultrasonography for detecting lymph node involvement in patients with rectal cancer: A protocol for an overview of systematic reviews. Medicine (Baltimore) 2018; 97:e12899. [PMID: 30412090 PMCID: PMC6221605 DOI: 10.1097/md.0000000000012899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Rectal cancer is one of the most common tumors and is the leading cause of cancer-related deaths in developed countries. Lymph node involvement remains the strongest prognostic factor associated with a worse prognosis in patients with rectal cancer. Several systematic reviews have investigated the accuracy of endoscopic ultrasound, computed tomography, magnetic resonance imaging, and endorectal ultrasonography for lymph node involvement of rectal cancer and compared the diagnostic accuracy of different imaging techniques, but there are considerable differences in conclusions. This study aims to assess the methodological quality and reporting quality of systematic reviews and to determine which diagnostic imaging techniques is the optimal modality for the diagnosis of lymph node involvement in patients with rectal cancer. METHODS We will search PubMed, EMBASE, Cochrane Library, and Chinese Biomedicine Literature to identify relevant studies from inception to June 2018. We will include systematic reviews that evaluated the accuracy of diagnostic imaging techniques for lymph node involvement. The methodological quality will be assessed using AMASAR checklist, and the reporting quality will be assessed using PRISMA-DTA checklist. The pairwise meta-analysis and indirect comparisons will be performed using STATA V.12.0. RESULTS The results of this overview will be submitted to a peer-reviewed journal for publication. CONCLUSION This overview will provide comprehensive evidence of different diagnostic imaging techniques for detecting lymph node involvement in patients with rectal cancer. ETHICS AND DISSEMINATION Ethics approval and patient consent are not required as this study is an overview based on published systematic reviews. PROSPERO REGISTRATION NUMBER CRD42018104906.
Collapse
Affiliation(s)
- Xin Wang
- Department of Ultrasound Medicine, Second Hospital of Lanzhou University
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University
| | - Jipin Li
- The Second Clinical Medical College of Lanzhou University, Lanzhou
| | - Jiarui Wu
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing
| | - Bo Wang
- Department of Nursing, Rehabilitation Center Hospital of Gansu Province
| | - Xueni Ma
- The Second Clinical Medical College of Lanzhou University, Lanzhou
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University
| | - Minghui Shen
- Department of Clinical Laboratory, Second Hospital of Lanzhou University
| | | |
Collapse
|
16
|
Hur SJ, Jo C, Yoon Y, Jeong JY, Lee KT. Controversy on the correlation of red and processed meat consumption with colorectal cancer risk: an Asian perspective. Crit Rev Food Sci Nutr 2018; 59:3526-3537. [PMID: 29999423 DOI: 10.1080/10408398.2018.1495615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study aimed to investigate the relationship between meat intake and colorectal cancer risk from an Asian, particularly Korean, perspective. A report by the International Agency for Research on Cancer (IARC) published in 2015 concluded that intake of processed and red meat increases the risk of developing colorectal cancer. We conducted an in-depth analysis of prospective, retrospective, case-control and cohort studies, systematic review articles, and IARC monograph reports, which revealed that the IARC/WHO report weighted the results of studies based in Western countries more and that the correlation between intake of processed meat products and colorectal cancer incidence in Asians is not clearly supported. Among 73 epidemiological studies, approximately 76% were conducted in Western countries, whereas only 15% of studies were conducted in Asia. Furthermore, most studies conducted in Asia showed that processed meat consumption is not related to the onset of cancer. Moreover, there have been no reports showing significant correlation between various factors that directly or indirectly affect colorectal cancer incidence, including processed meat products types, raw meat types, or cooking methods. Further epidemiological studies taking each country's food culture into consideration are required to reliably elucidate the effects of processed meat product intake, especially on cancer incidence.
Collapse
Affiliation(s)
- Sun Jin Hur
- Department of Animal Science and Technology, Chung-Ang University, Anseong, Korea
| | - Cheorun Jo
- Department of Agricultural Biotechnology, Center for Food and Bioconvergence, Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, Korea
| | - Yohan Yoon
- Department of Food and Nutrition, Sookmyung Womens' University, Seoul, Korea
| | - Jong Youn Jeong
- School of Food Biotechnology & Nutrition, Kyungsung University, Busan, Korea
| | - Keun Taik Lee
- Department of Food Processing and Distribution, Gangneung-Wonju National University, Gangneung, Korea
| |
Collapse
|
17
|
Jung YS, Kim NH, Yang HJ, Park SK, Park JH, Park DI, Sohn CI. The impact of passive smoking on the risk of colorectal neoplasia in never, former, and current smokers. J Gastroenterol Hepatol 2018; 33:1023-1030. [PMID: 29048137 DOI: 10.1111/jgh.14023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM Active smoking is well known to be a risk factor for colorectal neoplasia (CRN). However, it remains unclear whether passive smoking is also related to the risk of CRN. This study investigated the effect of passive smoking on the risk of CRN in never, former, and current smokers. METHODS A cross-sectional study was performed on asymptomatic examinees who underwent colonoscopy as part of a health check-up. RESULTS Of 136 707 participants, 33 052 (24.2%) were never passive smokers, and 103 655 (75.8%) were ever passive smokers. The mean age of the study population was 41.0 years. The proportion of never, former, and current smokers was 56.9%, 21.4%, and 24.8%, respectively, and the proportion of overall CRN and advanced CRN (ACRN) was 15.4% and 1.7%, respectively. Ever passive smoke exposure was associated with an increased risk of overall CRN in never smokers (adjusted odds ratio [AOR] 1.08; 95% confidence interval [CI] 1.02-1.13) and former smokers (AOR 1.08; 95% CI 1.00-1.17) but not in current smokers (AOR 1.02; 95% CI 0.94-1.11). Additionally, it significantly increased the risk of ACRN among never smokers (AOR 1.17; 95% CI 1.01-1.35) and tended to increase the risk of ACRN among former smokers (AOR 1.26; 95% CI 0.99-1.61). Moreover, the risk of CRN increased with increasing frequency and duration of passive smoking in never and former smokers. CONCLUSIONS Passive smoking was an independent risk factor for CRN in never and former smokers. Never and former smokers who are highly exposed to passive smoke as well as current smokers should be given priority for colonoscopy.
Collapse
Affiliation(s)
- Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam Hee Kim
- Preventive Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Joon Yang
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Adamowicz K, Zaucha R. Evaluation of the Impact of Cancer Treatment on the Adoption and Consolidation of Pro-Health Attitudes in the Field of Cancer in Treated Patients with Colon Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:309-316. [PMID: 27640993 DOI: 10.1007/s13187-016-1112-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Colorectal cancer is the second most common cause of cancer deaths worldwide. Although progress in the development of new drugs over the last two decades has expanded treatment options for this disease, many significant problems relating to their optimization remain to be solved. Data on the cancer knowledge and the healthy behavior and lifestyle in patients with colorectal cancer in Poland is missing. We analyzed the course and results of treatment of first-line chemotherapy in 165 patients diagnosed with colorectal cancer treated between May 2010 and December 2013. The respondent's knowledge in the field of cancer and their lifestyle before and after the treatment were rated. The results were compared with a control group. Mean age was 60.89 ± 8.69 years, median 59 years. The general knowledge about cancer and the level of healthy lifestyle before treatment were low. After treatment, both the knowledge about cancer and the level of healthy lifestyle increased compared to the control group. There was a clear relationship between the level of knowledge about cancer and the willingness to adopt attitudes and healthy behavior by patients. In our analysis, the overall quality of life in patients treated with first-line palliative chemotherapy of colorectal cancer did not change during treatment. Our results indicate the need to implement an educational program on cancer prevention in treated patients, and the analysis of quality of life and other factors than treatment effect remains controversial.
Collapse
Affiliation(s)
- Krzysztof Adamowicz
- Regional Hospital in Wejherowo, Jagalskiego Street 10, 84-200, Wejherowo, Pomerania, Poland.
| | - Renata Zaucha
- Depatment of Oncology and Radiotherapy, Medical University of Gdansk, 7 Debinki St., 80-211, Gdansk,, Poland
| |
Collapse
|
19
|
Khatatbeh MM, Jadallah KA, AL Bashtawy M, Hamaydeh SA, Gharaibeh MA, Kanaan NB, Alsmadi BM. Factors Associated with Colorectal Cancer Among Jordanians: a Case- Control Study. Asian Pac J Cancer Prev 2018; 19:577-581. [PMID: 29481028 PMCID: PMC5980953 DOI: 10.22034/apjcp.2018.19.2.577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: In recent years, the incidence of colorectal cancer (CRC) in Jordan has been on the rise. We aimed to determine associations with lifestyle factors, demographic and clinical variables. Methods: This case-control study included 102 patients diagnosed with CRC and 198 age and gender matched healthy subjects as controls. Cases were purposefully sampled; however, the control group were selected by simple random sampling of a cross-section of the population in Northern Jordan. Participating cases and controls completed an anonymous questionnaire inquiring about their demographic characteristics, lifestyle factors, and clinical variables. Data about the medical history and diagnosis of participating cases were obtained from the cases themselves and confirmed by reviewing their medical records. Results: In the cross tabulation analysis, the Chi square test showed that diabetes and hypertension were significantly associated with CRC (P <0.05). Additionally, regression modeling revealed that age ≥ 45 years (OR=10.93), positive family history for CRC (OR=5.53), physical inactivity (OR=7.4), cigarette smoking (OR=3.71), and having other types of cancer (OR=13.61) were all associated with increased risk of CRC. Conclusions: Physical inactivity and cigarette smoking are among the top modifiable risk factors for CRC among Jordanians. Moreover, diabetes and hypertension were found to be statistically significant risk factors in univariate, but not multivariate analysis. More effective strategies for elevating awareness and prevention are required at both national and international levels. Improving screening strategies is needed for early detection of CRC in Jordan.
Collapse
Affiliation(s)
- Moawiah M Khatatbeh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
| | | | | | | | | | | | | |
Collapse
|
20
|
Chang CC, Lin PC, Lin CC, Lan YT, Lin HH, Lin CH, Yang SH, Liang WY, Chen WS, Jiang JK, Lin JK, Chang SC. Molecular and Clinicopathological Differences by Age at the Diagnosis of Colorectal Cancer. Int J Mol Sci 2017; 18:ijms18071441. [PMID: 28678173 PMCID: PMC5535932 DOI: 10.3390/ijms18071441] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 12/26/2022] Open
Abstract
We compared the clinicopathological and molecular profiles between different age groups of sporadic colorectal cancer (CRC) patients (age <50, 56-60, 60-70, 70-80, and >80); 1475 CRC patients were enrolled after excluding 30 individuals with Lynch syndrome. The mutation spectra for APC, TP53, KRAS, PIK3CA, FBXW7, BRAF, NRAS, HRAS, TGFbR, Akt1, and PTEN were analyzed using polymerase chain reaction (PCR), followed by MassArray and microsatellite (MSI-high) analysis by performing genotyping. Male patients (74.1%) were significantly predominant to females (25.9%) in the older age group (70-80, >80). There was an insignificantly linear trend between TNM staging and age-onset of CRC diagnosis. Patients aged < 50 had 58.7% diseases in the advanced stages (Stage III: 36.5% and IV: 22.2% respectively), while this decreased to 40.2% (Stage III: 26.2% and IV; 14.0% respectively) in patients >80. The distributions of mutation frequency were similar in majority of the genes studied among different age groups. Additionally, patients aged <50 had significantly higher frequency of MSI-high, PTEN, and HRAS mutations than those of other groups. Age-onset at diagnosis significantly affected overall survival (HR = 1.46; 95% CI: 1.35-1.58), but not cancer-specific survival (HR = 1.08; 95% CI: 0.99-1.18) in multivariate analysis. In conclusion, molecular and clinicopathological differences were not as significant among different age groups of CRC patients as previously suspected.
Collapse
Affiliation(s)
- Chu-Cheng Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Pei-Ching Lin
- Department of Clinical Pathology, Yang-Ming Branch, Taipei City Hospital, Taipei 11146, Taiwan.
| | - Chun-Chi Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Yuan-Tzu Lan
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Hung-Hsin Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Chien-Hsing Lin
- Division of Genomic Medicine, National Health Research Institutes, Zhunan 350, Taiwan.
| | - Shung-Haur Yang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Wen-Yi Liang
- Department of Pathology, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| | - Wei-Shone Chen
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Jeng-Kai Jiang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Jen-Kou Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Shih-Ching Chang
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| |
Collapse
|
21
|
Vargas AJ, Neuhouser ML, George SM, Thomson CA, Ho GYF, Rohan TE, Kato I, Nassir R, Hou L, Manson JE. Diet Quality and Colorectal Cancer Risk in the Women's Health Initiative Observational Study. Am J Epidemiol 2016; 184:23-32. [PMID: 27267948 DOI: 10.1093/aje/kwv304] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/29/2015] [Indexed: 02/07/2023] Open
Abstract
Diet quality index scores on Healthy Eating Index 2010 (HEI-2010), Alternative HEI-2010, alternative Mediterranean Diet Index, and the Dietary Approaches to Stop Hypertension (DASH) index have been inversely associated with all-cause and cancer-specific death. This study assessed the association between these scores and colorectal cancer (CRC) incidence as well as CRC-specific mortality in the Women's Health Initiative Observational Study (1993-2012), a US study of postmenopausal women. During an average of 12.4 years of follow-up, there were 938 cases of CRC and 238 CRC-specific deaths. We estimated multivariate hazard ratios and 95% confidence intervals for relationships between quintiles of diet scores (from baseline food frequency questionnaires) and outcomes. HEI-2010 score (hazard ratios were 0.81, 0.77, and 0.73 with P values of 0.04, 0.01, and <0.01 for quintiles 3-5 vs. quintile 1, respectively) and DASH score (hazard ratios were 0.72, 0.74, and 0.78 with P values of <0.01, <0.01, and 0.03 for quintiles 3-5 vs. quintile 1, respectively), but not other diet scores, were associated with a lower risk of CRC in adjusted models. No diet scores were significantly associated with CRC-specific mortality. Closer adherence to HEI-2010 and DASH dietary recommendations was inversely associated with risk of CRC in this large cohort of postmenopausal women.
Collapse
|
22
|
Epidemiological evidence on environmental tobacco smoke and cancers other than lung or breast. Regul Toxicol Pharmacol 2016; 80:134-63. [PMID: 27321059 DOI: 10.1016/j.yrtph.2016.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 02/07/2023]
Abstract
We reviewed 87 epidemiological studies relating environmental tobacco smoke (ETS) exposure to risk of cancer other than lung or breast in never smoking adults. This updates a 2002 review which also considered breast cancer. Meta-analysis showed no significant relationship with ETS for nasopharynx cancer, head and neck cancer, various digestive cancers (stomach, rectum, colorectal, liver, pancreas), or cancers of endometrium, ovary, bladder and brain. For some cancers (including oesophagus, colon, gall bladder and lymphoma) more limited data did not suggest a relationship. An increased cervix cancer risk (RR 1.58, 95%CI 1.29-1.93, n = 17 independent estimates), reducing to 1.29 (95%CI 1.01-1.65) after restriction to five estimates adjusting for HPV infection or sexual activity suggests a causal relationship, as do associations with nasosinus cancer observed in 2002 (no new studies since), and less so kidney cancer (RR 1.33, 95%CI 1.04-1.70, n = 6). A weaker association with total cancer (RR 1.13, 95%CI 1.03-1.35, n = 19) based on heterogeneous data is inconclusive. Inadequate confounder control, recall bias, publication bias, and occasional reports of implausibly large RRs in individual studies contribute to our conclusion that the epidemiological evidence does not convincingly demonstrate that ETS exposure causes any of the cancers studied.
Collapse
|
23
|
Yang C, Wang X, Huang CH, Yuan WJ, Chen ZH. Passive Smoking and Risk of Colorectal Cancer. Asia Pac J Public Health 2016; 28:394-403. [PMID: 27217428 DOI: 10.1177/1010539516650724] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We conducted this meta-analysis to explore the association between passive smoking and the risk of colorectal cancer. A literature search of online databases, including MEDLINE, EMBASE, the Cochrane Library, and Web of Science was performed up to June 30, 2015. A fixed-effects meta-analysis using Stata 12.0 was carried out to estimate the relative risks (RRs) and 95% confidence intervals (CIs) for the associations. Eleven articles, including 6 case-control studies and 6 cohort studies, were included in our analysis according to inclusion and exclusion criteria. The pooled RR of all studies showed a statistically significant association between passive smoking and colorectal cancer (RR = 1.14; 95% CI = 1.05-1.24). Results of subgroup analysis showed a positive association between passive smoking and rectal cancer ((RR = 1.33; 95% CI = 1.15-1.53) and that male passive smokers were at greater risks of colorectal cancer (RR = 1.73; 95% CI = 1.37-2.19) than females. Results suggested that passive smoking is associated with an increased risk of colorectal cancer.
Collapse
Affiliation(s)
- Chen Yang
- Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xin Wang
- Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Chang-hao Huang
- Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Wei-jie Yuan
- Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zi-hua Chen
- Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| |
Collapse
|
24
|
Lee SH, Hong JY, Lee JU, Lee DR. Association Between Exposure to Environmental Tobacco Smoke at the Workplace and Risk for Developing a Colorectal Adenoma: A Cross-Sectional Study. Ann Coloproctol 2016; 32:51-7. [PMID: 27218095 PMCID: PMC4865465 DOI: 10.3393/ac.2016.32.2.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 03/14/2016] [Indexed: 02/06/2023] Open
Abstract
Purpose A colorectal adenoma (CRA) is a well-defined precursor to colorectal cancer (CRC). Additionally, smoking is a potent risk factor for developing a CRA, as well as CRC. However, the association between exposure to environmental tobacco smoke (ETS) and the risk for developing a CRA has not yet been fully evaluated in epidemiologic studies. We performed a cross-sectional analysis on the association between exposure to ETS at the workplace and the risk for developing a CRA. Methods The study was conducted on subjects who had undergone a colonoscopy at a health promotion center from January 2012 to December 2012. After descriptive analyses, overall and subgroup analyses by smoking status were performed by using a multivariate logistic regression. Results Among the 1,129 participants, 300 (26.6%) were diagnosed as having CRAs. Exposure to ETS was found to be associated with CRAs in all subjects (fully adjusted odds ratio [OR], 1.95; 95% confidence interval [CI], 1.08–2.44; P = 0.001). In the subgroup analysis, exposure to ETS in former smokers increased the risk for developing a CRA (fully adjusted OR, 4.44; 95% CI, 2.07–9.51; P < 0.001). Conclusion Exposure to occupational ETS at the workplace, independent of the other factors, was associated with increased risk for developing a CRA in all subjects and in former smokers. Further retrospective studies with large sample sizes may be necessary to clarify the causal effect of this relationship.
Collapse
Affiliation(s)
- Seung-Hwa Lee
- Health Promotion Center, Seohae Hospital, Seocheon, Korea
| | - Ji-Yeon Hong
- Health Promotion Center, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| | - Jung-Un Lee
- Health Promotion Center, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| | - Dong Ryul Lee
- Health Promotion Center, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| |
Collapse
|
25
|
Patel P, De P. Trends in colorectal cancer incidence and related lifestyle risk factors in 15-49-year-olds in Canada, 1969-2010. Cancer Epidemiol 2016; 42:90-100. [PMID: 27060626 DOI: 10.1016/j.canep.2016.03.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/03/2016] [Accepted: 03/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND While the overall incidence rate of colorectal cancer (CRC) in Canada has been decreasing, some countries show an increasing incidence in those under the age of 50. We examined the trends in CRC incidence and associated lifestyle risk factors in Canadians aged 15-49. METHODS Incidence data for colorectal, colon and rectum/rectosigmoid cancers were obtained for 1969-2010 from the Canadian Cancer Registry, and trends in age-standardized incidence rates (ASIRs) were examined by Joinpoint regression for three age groups (15-29, 30-39, 40-49 years) and by sex. Trends in the prevalence of some CRC risk factors were similarly examined from national health surveys for various periods ranging from 1970 to 2012. RESULTS In both sexes combined, ASIRs rose by 6.7%/year (1997-2010) for 15-29-year-olds, 2.4%/year (1996-2010) for 30-39-year-olds, and 0.8%/year (1997-2010) for 40-49-year-olds. Similar trends were observed by sex. The rise in ASIR was more rapid for cancers of the rectum/rectosigmoid compared to colon for all age groups. Risk factor trends varied: excess weight rose substantially, vegetables and fruit consumption increased slightly, physical inactivity rates declined but remained high, alcohol consumption changed little, and smoking rates declined. Data on red/processed meat consumption were unavailable. CONCLUSION The ASIR of CRC in young Canadians has increased since about the mid-1990s. The rising prevalence of excess weight in younger generations has likely played a role in the CRC trend, but more research is needed.
Collapse
Affiliation(s)
- Parth Patel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Prithwish De
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Analytics and Informatics, Cancer Care Ontario and formerly with Canadian Cancer Society, Toronto, Canada.
| |
Collapse
|
26
|
Vargas AJ, Ashbeck EL, Wertheim BC, Wallace RB, Neuhouser ML, Thomson CA, Thompson PA. Dietary polyamine intake and colorectal cancer risk in postmenopausal women. Am J Clin Nutr 2015; 102:411-9. [PMID: 26135350 PMCID: PMC4515861 DOI: 10.3945/ajcn.114.103895] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 06/01/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Putrescine, spermidine, and spermine (i.e., polyamines) are small cationic amines synthesized by cells or acquired from the diet or gut bacteria. Polyamines are required for both normal and colorectal cancer (CRC) cell growth. OBJECTIVE We investigated the association between dietary polyamines and risk of CRC incidence and mortality. DESIGN The study was a prospective analysis in 87,602 postmenopausal women in the Women's Health Initiative Observational Study. Multivariate Cox regression was used to calculate HRs and 95% CIs. RESULTS Total dietary polyamine intake (mean ± SD: 289.2 ± 127.4 μmol/d) was not positively associated with CRC in fully adjusted models. Instead, intake ≥179.67 μmol/d was associated with reduced risk of CRC [HR (95% CI): 0.82 (0.68, 1.00), 0.81 (0.66, 0.99), 0.91 (0.74, 1.12), and 0.80 (0.62, 1.02) for quintiles 2-5, respectively, compared with quintile 1]. Reduced risk was not significant across all quintiles. Polyamines were not significantly associated with CRC-specific mortality in fully adjusted models. When stratified by risk factors for CRC, only body mass index (BMI) and fiber intake significantly modified the association between polyamine intake and CRC. In women with BMI (in kg/m²) ≤25 or fiber consumption above the median, polyamine intake was associated with significantly lower risk of CRC. CONCLUSIONS No positive association between dietary polyamines and CRC or CRC-specific mortality risk in women was observed. Instead, a protective effect of dietary polyamines was suggested in women with some CRC risk-lowering behaviors in particular. These results are consistent with emerging evidence that exogenous polyamines may be beneficial in colon health and warrant additional study.
Collapse
Affiliation(s)
| | | | | | - Robert B Wallace
- University of Iowa College of Public Health, University of Iowa, Iowa City, IA; and
| | - Marian L Neuhouser
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Cynthia A Thomson
- Departments of Nutritional Sciences, College of Public Health, The University of Arizona, Tucson, AZ; The University of Arizona Cancer Center, Tucson, AZ
| | - Patricia A Thompson
- Departments of Nutritional Sciences, Molecular and Cellular Biology, and The University of Arizona Cancer Center, Tucson, AZ
| |
Collapse
|
27
|
Ahmed S, Johnson K, Ahmed O, Iqbal N. Advances in the management of colorectal cancer: from biology to treatment. Int J Colorectal Dis 2014; 29:1031-42. [PMID: 24953060 DOI: 10.1007/s00384-014-1928-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common malignant neoplasm worldwide and the fourth leading cause of cancer-related deaths. This article reviews the epidemiology, risk factors, pathogenesis, and prognosis of CRC with special emphasis on advances in the management of CRC over the past decade. METHODS A review of the published English literature was conducted using the search engines PubMed, Medline, EMBASE, and Google Scholar. A total of 127 relevant publications were identified for further review. RESULTS Most CRC are sporadic and are due to genetic instability and multiple somatic mutations. Approximately 80% of cancers are diagnosed at the early stage and are curable. The pathologic stage at presentation is the most important predictor of outcome after resection of early stage cancer. Surgery is the primary treatment modality for localized CRC. Advances in (neo)adjuvant chemotherapy and radiation have reduced the disease recurrence and increased survival in high risk diseases. Although recent advancements in combination chemotherapy and target agents have increased the survival of incurable CRC, it is remarkable that only selected patients with advanced CRC can be cured with multimodality therapy. CONCLUSION Over the past decade, there has seen substantial progress in our understanding of and in the management of CRC.
Collapse
|
28
|
Tárraga López PJ, Albero JS, Rodríguez-Montes JA. Primary and secondary prevention of colorectal cancer. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2014; 7:33-46. [PMID: 25093007 PMCID: PMC4116379 DOI: 10.4137/cgast.s14039] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/25/2014] [Accepted: 03/02/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cancer is a worldwide problem as it will affect one in three men and one in four women during their lifetime. Colorectal cancer (CRC) is the third most frequent cancer in men, after lung and prostate cancer, and is the second most frequent cancer in women after breast cancer. It is also the third cause of death in men and women separately, and is the second most frequent cause of death by cancer if both genders are considered together. CRC represents approximately 10% of deaths by cancer. Modifiable risk factors of CRC include smoking, physical inactivity, being overweight and obesity, eating processed meat, and drinking alcohol excessively. CRC screening programs are possible only in economically developed countries. However, attention should be paid in the future to geographical areas with ageing populations and a western lifestyle.19,20 Sigmoidoscopy screening done with people aged 55–64 years has been demonstrated to reduce the incidence of CRC by 33% and mortality by CRC by 43%. OBJECTIVE To assess the effect on the incidence and mortality of CRC diet and lifestyle and to determine the effect of secondary prevention through early diagnosis of CRC. METHODOLOGY: A comprehensive search of Medline and Pubmed articles related to primary and secondary prevention of CRC and subsequently, a meta-analysis of the same blocks are performed. RESULTS 225 articles related to primary or secondary prevention of CRC were retrieved. Of these 145 were considered valid on meta-analysis: 12 on epidemiology, 56 on diet and lifestyle, and over 77 different screenings for early detection of CRC. Cancer is a worldwide problem as it will affect one in three men and one in four women during their lifetime. There is no doubt whatsoever which environmental factors, probably diet, may account for these cancer rates. Excessive alcohol consumption and cholesterol-rich diet are associated with a high risk of colon cancer. A diet poor in folic acid and vitamin B6 is also associated with a higher risk of developing colon cancer with an overexpression of p53. Eating pulses at least three times a week lowers the risk of developing colon cancer by 33%, after eating less meat, while eating brown rice at least once a week cuts the risk of CRC by 40%. These associations suggest a dose–response effect. Frequently eating cooked green vegetables, nuts, dried fruit, pulses, and brown rice has been associated with a lower risk of colorectal polyps. High calcium intake offers a protector effect against distal colon and rectal tumors as compared with the proximal colon. Higher intake of dairy products and calcium reduces the risk of colon cancer. Taking an aspirin (ASA) regularly after being diagnosed with colon cancer is associated with less risk of dying from this cancer, especially among people who have tumors with COX-2 overexpression.16 Nonetheless, these data do not contradict the data obtained on a possible genetic predisposition, even in sporadic or non-hereditary CRC. CRC is susceptible to screening because it is a serious health problem given its high incidence and its associated high morbidity/mortality. CONCLUSIONS (1) Cancer is a worldwide problem. (2) A modification of diet and lifestyle could reduce morbidity and mortality. (3) Early detection through screening improves prognosis and reduces mortality.
Collapse
Affiliation(s)
- Pedro J Tárraga López
- Integrated Management, Hospital Universitario de Albacete, Albacete, Spain. ; University of Castille-La Mancha, Albacete, Spain
| | | | | |
Collapse
|
29
|
Parajuli R, Bjerkaas E, Tverdal A, Le Marchand L, Weiderpass E, Gram IT. Smoking increases rectal cancer risk to the same extent in women as in men: results from a Norwegian cohort study. BMC Cancer 2014; 14:321. [PMID: 24884601 PMCID: PMC4024272 DOI: 10.1186/1471-2407-14-321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/01/2014] [Indexed: 11/10/2022] Open
Abstract
Background Smoking has recently been established as a risk factor for rectal cancer. We examined whether the smoking-related increase in rectal cancer differed by gender. Methods We followed 602,242 participants (49% men), aged 19 to 67 years at enrollment from four Norwegian health surveys carried out between 1972 and 2003, by linkage to Norwegian national registries through December 2007. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by fitting Cox proportional hazard models and adjusting for relevant confounders. Heterogeneity by gender in the effect of smoking and risk of rectal cancer was tested with Wald χ2. Results During a mean follow-up of 14 years, 1,336 men and 840 women developed invasive rectal cancer. Ever smokers had a significantly increased risk of rectal cancer of more than 25% for both men (HR = 1.27, 95% CI = 1.11-1.45) and women (HR = 1.28, 95% CI = 1.11-1.48) compared with gender-specific never smokers. Men smoking ≥20 pack-years had a significantly increased risk of rectal cancer of 35% (HR = 1.35, 95% CI = 1.14-1.58), whereas for women, it was 47% (HR = 1.47, 95% CI = 1.13-1.91) compared with gender-specific never smokers. For both men and women, we observed significant dose–response associations between the risk of rectal cancer for four variables [Age at smoking initiation in years (both ptrend <0.05), number of cigarettes smoked per day (both ptrend <0.0001), smoking duration in years (ptrend <0.05, <0.0001) and number of pack-years smoked (both ptrend <0.0001)]. The test for heterogeneity by gender was not significant between smoking status and the risk of rectal cancer (Wald χ2, p -value; current smokers = 0.85; former smokers = 0.87; ever smokers = 1.00). Conclusions Smoking increases the risk of rectal cancer to the same extent in women as in men.
Collapse
Affiliation(s)
| | | | | | | | | | - Inger T Gram
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Tromsø, Tromsø, Norway.
| |
Collapse
|
30
|
Lu M, Yan B, Song J, Ping W, Yue LX, Song B. Double-contrast-enhanced sonography for diagnosis of rectal lesions with pathologic correlation. JOURNAL OF ULTRASOUND IN MEDICINE 2014; 33:575-83. [PMID: 24658937 DOI: 10.7863/ultra.33.4.575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Transabdominal sonography with a gastrointestinal contrast agent has been widely used in China for investigation of digestive disorders. Double-contrast-enhanced sonography combines a gastrointestinal luminal contrast agent with an intravenous contrast agent for imaging of lesions. The purpose of this pilot study was to assess the value of double-contrast-enhanced sonography for preoperative diagnosis of rectal lesions. METHODS We conducted a prospective single-center study using double-contrast-enhanced sonography of rectal lesions. Patients were administered both rectal and intravenous contrast agents, and imaging was performed transabdominally, transanally, and transrectally. Morphologic characteristics and perfusion parameters were compared between histologically proven adenocarcinomas, adenomas, and inflammatory masses. Perfusion parameters were analyzed with time-intensity curves, measuring the contrast arrival time, time to peak, peak intensity, and area under the curve of the lesions and normal rectal tissue. RESULTS From January 2009 to September 2012, 420 patients were recruited, with 227 patients meeting inclusion/exclusion criteria and having 232 rectal lesions analyzed (172 rectal adenocarcinomas, 45 adenomas, and 15 inflammatory masses). Adenocarcinomas had variable enhancement patterns. Adenomas were all hypoenhanced in a homogeneous pattern. Inflammatory masses had a hyperenhanced rim with no central enhancement. Time-intensity curve perfusion parameters (arrival time, time to peak, peak intensity, and area under the curve) of rectal adenocarcinomas, adenomas, and inflammatory masses were significantly different compared to normal rectal tissue (P < .05). The differences in the arrival time, peak intensity, and time to peak among the different lesions were also significant (P < .05). CONCLUSIONS Double-contrast-enhanced sonographic assessment of morphologic enhancement patterns combined with vascularity parameters may help differentiate benign and malignant rectal lesions.
Collapse
Affiliation(s)
- Man Lu
- Department of Radiology, West China Hospital of Sichuan University, 37 Guo Xue Xiang 610041 Chengdu, Sichuan, China.
| | | | | | | | | | | |
Collapse
|
31
|
Procopciuc LM, Osian G. GSTM1-nullGenotype as a Risk Factor for Sporadic Colorectal Cancer in a Romanian Population. Association with theNAT2-rapid-acetylatorPhenotype and Exposure to Environmental Factors. Cancer Invest 2014; 32:53-62. [DOI: 10.3109/07357907.2013.867972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
32
|
Hoffmeister M, Jansen L, Stock C, Chang-Claude J, Brenner H. Smoking, lower gastrointestinal endoscopy, and risk for colorectal cancer. Cancer Epidemiol Biomarkers Prev 2014; 23:525-33. [PMID: 24403529 DOI: 10.1158/1055-9965.epi-13-0729-t] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lower gastrointestinal endoscopy can decrease colorectal cancer risk strongly through detection and removal of adenomas. Thus, we aimed to investigate whether utilization of lower gastrointestinal endoscopy modifies the effect of lifetime smoking exposure on colorectal cancer risk in a population-based case-control study. METHODS In this study from Southern Germany including 2,916 patients with colorectal cancer and 3,044 controls, information about lifetime smoking and other risk factors was obtained from standardized interviews. Self-reported endoscopies were validated by medical records. Multivariate logistic regression was performed to investigate associations of smoking with colorectal cancer risk after stratification by utilization of lower gastrointestinal endoscopy in the preceding 10 years. RESULTS Median age of patients and controls was 69 and 70 years, respectively. Former regular smoking was associated with increased colorectal cancer risk in the group with no previous endoscopy [adjusted OR, 1.50; 95% confidence interval (CI), 1.28-1.75], whereas no association was found in the group with preceding endoscopy (OR, 1.05; CI, 0.83-1.33; P for interaction <0.01). Lower gastrointestinal endoscopy did not modify the association of smoking and colorectal cancer risk among current smokers and among the more recent quitters. CONCLUSIONS Our results suggest that the increased risk of colorectal cancer among former regular smokers is essentially overcome by detection and removal of adenomas at lower gastrointestinal endoscopy. However, risk of colorectal cancer was increased if smoking was continued into higher adult age. IMPACT The strong protective effect of lower gastrointestinal endoscopy may be compromised by continued smoking. Smoking cessation may increase the efficacy of lower gastrointestinal endoscopy.
Collapse
Affiliation(s)
- Michael Hoffmeister
- Authors' Affiliations: Division of Clinical Epidemiology and Aging Research; Institute of Medical Biometry and Informatics, University of Heidelberg and; Unit of Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | | | | | | | | |
Collapse
|
33
|
Jian ZH, Lung CC, Huang JY, Su SY, Ho CC, Chiang YC, Liaw YP. Sex disparities in the association of lung adenocarcinoma with colorectal cancer. J Cancer 2013; 4:691-6. [PMID: 24312138 PMCID: PMC3842437 DOI: 10.7150/jca.7269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/20/2013] [Indexed: 01/29/2023] Open
Abstract
Background: Most cancers share common risk factors. It might provide evidence of shared risk factors with cancers by investigating cross-country and cross-township comparisons. Methods: The data were obtained from International Association of Cancer Registries/World Health Organization and the National Cancer Registration Program of Taiwan. Age standardized incidence rates were calculated among gastric cancer, colorectal cancer and lung adenocarcinoma in 19 countries from 1995 to 1998. The Pearson correlations were also compared among 3 types of cancers for both sexes. Results: The incidence rates of gastric and colorectal cancer throughout different countries show male dominance with a male-to-female sex ratio of around 2 and 1.5, respectively. Significant cross-country correlations in colorectal cancer (r=0.918, p<0.001), gastric cancer (r=0.985, p<0.001) and lung adenocarcinoma (r=0.685, p=0.001) were observed between men and women. There was a significant international correlation between colorectal cancer and lung adenocarcinoma in men (r=0.526, p=0.021), but not in women. In cross-township comparisons of Taiwan, there were significant correlations in colorectal cancer (r=0.451, p<0.001), gastric cancer (r=0.486, p<0.001), and lung adenocarcinoma (r=0.217, p<0.001) between men and women. There were links of lung adenocarcinoma and gastric cancer (r=0.122, p=0.024) and colorectal cancer (r=0.128, p=0.018) in women, and lung adenocarcinoma and colorectal cancer in men (r=0.276, p<0.001). Conclusions: There were associations between lung adenocarcinoma and colorectal cancer between and in both sexes in Taiwan, but not in cross-country comparisons. The results suggest that some factor, like genes, may be important as determinants for the association between lung adenocarcinoma and colorectal cancer.
Collapse
Affiliation(s)
- Zhi-Hong Jian
- 1. Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City 40201, Taiwan
| | | | | | | | | | | | | |
Collapse
|
34
|
A comparative overview of general risk factors associated with the incidence of colorectal cancer. Tumour Biol 2013; 34:2469-76. [PMID: 23832537 DOI: 10.1007/s13277-013-0876-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/16/2013] [Indexed: 12/14/2022] Open
Abstract
Cancers found in colorectal region remain largely localized to the large intestine and rectum. They are derived from the epithelium and are considered to be among the most frequently detected cancers. They are known to occur in approximately 5 % population of the Western world. After metastasis, a patient's 5-year postsurgical survival chances unfortunately fall from 90 to 10 % or even less. Adenocarcinoma, the most common cell type of colon cancer, alone constitutes 95 % of the cases. Lymphoma and squamous cell carcinoma can also be found in some cases. Because 5 % of persons are predisposed to development of colorectal cancer, this disease has often been addressed as an important public health issue. Factors that are known in particular to increase a person's risk to develop this cancer are as follows: an individual's age, dietary habits, any complaint of obesity, diabetes, previous history of cancer or intestinal polyps, personal habit of alcohol consumption and smoking, family history of colon cancer, race, sex, and ethnicity. Since the risk of colorectal cancer is increasing steadily in Kashmir, India, like in some other corners of Asia, exhaustive efforts are being made to find the association of above given and other risk factors with the development of this gastrointestinal tract cancer. Adoption of Western life style, diet mimicry, together with a habit of having physically inactive life style and consumption of red meat in particular can be blamed as being active players to a considerable extent.
Collapse
|
35
|
Hurley S, Goldberg D, Nelson DO, Lu Y, Henderson K, Bernstein L, Reynolds P. Risk of colorectal cancer associated with active smoking among female teachers. Cancer Causes Control 2013; 24:1291-304. [PMID: 23572327 PMCID: PMC3733091 DOI: 10.1007/s10552-013-0207-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 03/29/2013] [Indexed: 01/07/2023]
Abstract
PURPOSE The objective of this study was to examine the risk of colorectal cancer associated with active smoking among members of the California Teachers Study (CTS), a large cohort of female public school employees for whom highly detailed smoking information is available. METHODS The analysis was conducted among the 122,264 CTS participants who lived in California at cohort entry in 1995/1996, had no prior history of colorectal cancer, and provided detailed smoking information. 1,205 cases of invasive colorectal cancer prospectively diagnosed in 1995-2009 were identified from the California Cancer Registry, including 650 in the proximal colon, 267 in the distal colon, and 288 in the rectum. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards models, stratified by age at cohort entry, and adjusted for race/ethnicity. RESULTS Compared to never smokers, current smokers had an approximately 30% increased risk of colorectal cancer. Overall, a slightly elevated risk was also noted for former smokers. Among former smokers, risks appeared to remain elevated for up to 20 years following cessation. Risks among former and current smokers increased with greater intensity and duration of smoking. Little evidence for heterogeneity in risk was noted for colon versus rectal cancer or for different subsites within the colon. CONCLUSIONS These results provide convincing evidence that heavy and/or long-term smoking is a risk factor for cancers of the colon and rectum. Such evidence should be considered when updating screening guidelines to include targeting people with long active smoking histories.
Collapse
Affiliation(s)
- Susan Hurley
- Cancer Prevention Institute of California, Berkeley, CA 94704, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Parajuli R, Bjerkaas E, Tverdal A, Selmer R, Le Marchand L, Weiderpass E, Gram IT. The increased risk of colon cancer due to cigarette smoking may be greater in women than men. Cancer Epidemiol Biomarkers Prev 2013; 22:862-71. [PMID: 23632818 DOI: 10.1158/1055-9965.epi-12-1351] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Smoking is a recently established risk factor for colon cancer. We wanted to explore the hypothesis that women may be more susceptible to smoking-attributed colon cancer than men as one of the possible explanations for the high colon cancer risk of Norwegian women. METHODS We followed 602,242 participants aged 19 to 67 years at enrollment in 1972-2003, by linkage to national registries through December 2007. We used Cox proportional hazard models to estimate HRs and 95% confidence intervals (CI). RESULTS During a mean follow-up of 14 years, altogether 3,998 (46% women) subjects developed colon cancer. Female ever-smokers had a 19% (HR = 1.19, 95% CI = 1.09-1.32) and male ever-smokers an 8% (HR = 1.08, CI = 0.97-1.19) increased risk of colon cancer compared with never smokers. For all the four dose-response variables examined, female ever-smokers in the most exposed category of smoking initiation, (HR = 1.48, 95% CI = 1.21-1.81), of daily cigarette consumption (HR = 1.28, 95% CI = 1.06-1.55), of smoking duration (HR = 1.47, 95% CI = 1.11-1.95), and of pack-years of smoking (HR = 1.33, 95% CI = 1.11-1.57) had a significantly increased risk of more than 20% for colon cancer overall and of more than 40% for proximal colon cancer, compared with never smokers. A test for heterogeneity by gender was statistically significant only for ever smoking and risk of proximal colon cancer (Wald χ(2), P = 0.02). CONCLUSIONS Female smokers may be more susceptible to colon cancer and especially to proximal colon cancer than male smokers. IMPACT Women who smoke are more vulnerable to colon cancer than men.
Collapse
Affiliation(s)
- Ranjan Parajuli
- Department of Community Medicine, University of Tromsø, N-9037 Tromsø, Norway
| | | | | | | | | | | | | |
Collapse
|
37
|
Hansen RD, Albieri V, Tjønneland A, Overvad K, Andersen KK, Raaschou-Nielsen O. Effects of smoking and antioxidant micronutrients on risk of colorectal cancer. Clin Gastroenterol Hepatol 2013; 11:406-15.e3. [PMID: 23142208 DOI: 10.1016/j.cgh.2012.10.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 10/12/2012] [Accepted: 10/26/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Antioxidant intake has been reported to increase the risk of colorectal cancer (CRC) for smokers, yet reduce the risk for nonsmokers. We investigated the association between tobacco smoking and risk of colon or rectal cancer, and whether dietary and supplemental intake of the antioxidant vitamins A, C, E, β-carotene, selenium, zinc, and manganese affects the risk of CRC among smokers. METHODS Data on smoking habits and antioxidant intake were analyzed for 54,208 participants in the Danish Prospective Diet, Cancer and Health Study. Of these participants, 642 were diagnosed with colon cancer and 348 were diagnosed with rectal cancer. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazard models. Principal components were used to analyze intake of combinations of antioxidants. RESULTS Ever smoking increased the risk for CRC (hazard ratio, 1.19; 95% confidence interval, 1.03-1.37), especially for rectal cancer. Smoking for at least 20 years was associated with a 26% increase in risk of CRC, compared with never smokers, and smoking 20 g tobacco or more each day was associated with a 30% increase in risk. Smoking for more than 30 years, or more than 20 g tobacco each day, was associated with a 48% increase in risk of rectal cancer. We did not observe an interaction between smoking and antioxidant consumption on risk of CRC. CONCLUSIONS Tobacco smoking increases the risk for CRC. We did not observe that consumption of antioxidant micronutrients modulates the effects of smoking on CRC risk.
Collapse
|
38
|
Giuricin M, Lucchetta A, Giacomel G, de Manzini N. Epidemiology. Updates Surg 2013. [DOI: 10.1007/978-88-470-2670-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
39
|
Simon MS, Chlebowski RT, Wactawski-Wende J, Johnson KC, Muskovitz A, Kato I, Young A, Hubbell FA, Prentice RL. Estrogen plus progestin and colorectal cancer incidence and mortality. J Clin Oncol 2012; 30:3983-90. [PMID: 23008295 DOI: 10.1200/jco.2012.42.7732] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE During the intervention phase in the Women's Health Initiative (WHI) clinical trial, use of estrogen plus progestin reduced the colorectal cancer diagnosis rate, but the cancers were found at a substantially higher stage. To assess the clinical relevance of the findings, analyses of the influence of combined hormone therapy on colorectal cancer incidence and colorectal cancer mortality were conducted after extended follow-up. PATIENTS AND METHODS The WHI study was a randomized, double-blind, placebo-controlled clinical trial involving 16,608 postmenopausal women with an intact uterus who were randomly assigned to daily 0.625 mg conjugated equine estrogen plus 2.5 mg medroxyprogesterone acetate (n = 8,506) or matching placebo (n = 8,102). Colorectal cancer diagnosis rates and colorectal cancer mortality were assessed. RESULTS After a mean of 5.6 years (standard deviation [SD], 1.03 years) of intervention and 11.6 years (SD, 3.1 years) of total follow-up, fewer colorectal cancers were diagnosed in the combined hormone therapy group compared with the placebo group (diagnoses/year, 0.12% v 0.16%; hazard ratio [HR], 0.72; 95% CI, 0.56 to 0.94; P = .014). Bowel screening examinations were comparable between groups throughout. Cancers in the combined hormone therapy group more commonly had positive lymph nodes (50.5% v 28.6%; P < .001) and were at higher stage (regional or distant, 68.8% v 51.4%; P = .003). Although not statistically significant, there was a higher number of colorectal cancer deaths in the combined hormone therapy group (37 v 27 deaths; 0.04% v 0.03%; HR, 1.29; 95% CI, 0.78 to 2.11; P = .320). CONCLUSION The findings, suggestive of diagnostic delay, do not support a clinically meaningful benefit for combined hormone therapy on colorectal cancer.
Collapse
Affiliation(s)
- Michael S Simon
- Karmanos Cancer Institute, Wayne State University, Hudson Webber Cancer Research Building, 4221 HWCRC, 4100 John R, Detroit, MI 48201, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Risk factors for colon cancer in 150,912 postmenopausal women. Cancer Causes Control 2012; 23:1599-605. [DOI: 10.1007/s10552-012-0037-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 07/18/2012] [Indexed: 01/08/2023]
|
41
|
Martínez F, Fernández-Martos C, Quintana MJ, Castells A, Llombart A, Ińiguez F, Guillem V, Dasí F. APC and KRAS mutations in distal colorectal polyps are related to smoking habits in men: results of a cross-sectional study. Clin Transl Oncol 2012; 13:664-71. [PMID: 21865138 DOI: 10.1007/s12094-011-0712-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The purpose of this study was (a) to evaluate the association between cigarette smoking and the prevalence of distal colorectal polyps and adenocarcinoma and (b) to analyse genetic alterations representing different molecular pathways of the colorectal carcinogenesis. METHODS A total of 623 asymptomatic male (mean age: 53 years; 50-65) car factory workers were included. Information on smoking habits and other lifestyle factors were collected followed by a 60 cm colonoscopy. APC and KRAS mutations and microsatellite status were determined in colorectal lesions (colorectal carcinoma (CRC), hyperplastic (HP) and adenomatous polyps (AP)). Data were analysed using unconditional multiple logistic regression models. RESULTS Smokers had a higher prevalence of AP (OR 2.1; 95% CI 1.2-3.6; p<0.05) and HP (OR 5.4; 95% CI 2.6- 11.1; p<0.05). No differences in CRC were observed. There was a dose-response relationship with the number of cigarettes smoked. The risk of developing AP or HP decreased after smoking cessation, even among heavy smokers (≥20 packs/year). KRAS mutations were more prevalent among smokers AP (OR 5.6; 95% CI 1.6-20.4; p=0.007). There was a trend of positive association with APC mutations (OR 3.5; 95% CI 0.9-4.4; p=0.096). APC and KRAS mutations were found in 36% and 61% of the HP of smokers, but were absent in non-smokers (p=0.89 and 0.78, respectively). There were no differences in MSI between smokers and non-smokers. CONCLUSIONS Cigarette smoking is associated with a higher risk of developing both HP and AP and a higher prevalence of mutations in APC and KRAS.
Collapse
Affiliation(s)
- Fernando Martínez
- Department of Gastroenterology, Instituto Valenciano de Oncología, C/ Profesor Beltrán Báguena 8, Valencia, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Wei PL, Lin SY, Chang YJ. Cigarette Smoking and Colorectal Cancer: From Epidemiology to Bench. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.jecm.2011.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
43
|
Benamouzig R, Uzzan B. Identification and chemoprevention in subjects at moderate risk of colorectal cancer. Best Pract Res Clin Gastroenterol 2011; 25:631-40. [PMID: 22122777 DOI: 10.1016/j.bpg.2011.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 09/02/2011] [Indexed: 01/31/2023]
Abstract
The risk of developing colorectal cancer (CRC) depends on both genetic factors and lifestyle-related factors. Chemoprevention's true contribution is dependent on lifetime CRC risk. There are clinical situations where chemoprevention for CRC is undoubtedly useful. There are other situations where the risk of CRC seems to be only moderately increased and in these situations, the true contribution of chemoprevention is questionable. A few specific studies assessing the effect of chemopreventive agents in these situations are available. In the present article, we will try to better define these particular situations and discuss the risk quantification and the expected chemoprevention contribution.
Collapse
Affiliation(s)
- Robert Benamouzig
- Department of Gastroenterology, AP-HP, Avicenne Hospital, 125 rue de Stalingrad, Bobigny, France.
| | | |
Collapse
|
44
|
Krishnan S, Wolf JL. Colorectal cancer screening and prevention in women. ACTA ACUST UNITED AC 2011; 7:213-26. [PMID: 21410347 DOI: 10.2217/whe.11.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is the third most common cause of cancer in women. Screening for CRC increases early detection of cancer and premalignant polyps and decreases morbidity from this disease. However, adherence to the screening guidelines continues to remain inadequate both at the physician and patient levels. Several factors are of special importance to women. Presence of prior gynecological malignancies may increase the risk of CRC in women. Furthermore, new studies have shown other factors such as obesity and smoking to increase the risk of CRC in women. This article highlights issues unique to women with regards to CRC and outlines special considerations for determining screening intervals in women, identifies factors that make screening more difficult in women, and reviews studies that identify preventative strategies which, together with screening, may reduce the burden of CRC.
Collapse
Affiliation(s)
- Sandeep Krishnan
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | | |
Collapse
|
45
|
Disparities in treatment and survival of white and Native American patients with colorectal cancer: a SEER analysis. J Am Coll Surg 2011; 213:469-74. [PMID: 21723155 DOI: 10.1016/j.jamcollsurg.2011.05.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/28/2011] [Accepted: 05/31/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Minority groups with colorectal cancer have not experienced the decline in incidence and mortality that has been reported in whites. We sought to determine whether differences exist in treatment and survival between white and Native American patients with colorectal cancer because little has been written about this specific minority group. STUDY DESIGN The Surveillance Epidemiology and End Results (SEER) database for colorectal cancer was used to compare treatment and survival in whites (colon, n = 137,949; rectum, n = 46,843) and Native Americans (colon, n = 872; rectum, n = 316). Cox proportional hazards models were used to compare cancer-specific survival in Native Americans with whites, adjusted for stage, sex, age and year of diagnosis, socioeconomic status, and treatment. RESULTS Native Americans presented at younger ages than whites for both colon and rectal cancer (p < 0.001). They were diagnosed at more advanced stages of disease than whites for only colon cancer. No significant differences were detected in the proportion of patients recommended for surgery between the two groups, for either cancer at any stage (all p > 0.05). Native Americans with rectal cancer were more likely to receive radiation than whites (p < 0.001), but they received less sphincter-preserving surgery (60.0% vs 65.4%; p = 0.045). Native Americans with colon cancer fared significantly worse than whites (hazard ratio = 1.20; 95% CI = 1.08 to 1.34), but there is no difference in cancer-free survival between races for rectal cancer. CONCLUSIONS Compared with whites, Native Americans with colon cancer have worse cancer-specific survival.
Collapse
|
46
|
Simon MS, Thomson CA, Pettijohn E, Kato I, Rodabough RJ, Lane D, Hubbell FA, O'Sullivan MJ, Adams-Campbell L, Mouton CP, Abrams J, Chlebowski RT. Racial differences in colorectal cancer incidence and mortality in the Women's Health Initiative. Cancer Epidemiol Biomarkers Prev 2011; 20:1368-78. [PMID: 21602308 PMCID: PMC3784999 DOI: 10.1158/1055-9965.epi-11-0027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) incidence and mortality rates are higher in African-Americans as compared with other racial/ethnic groups. The women's health initiative (WHI) study sample was used to determine whether differences in CRC risk factors explain racial/ethnic differences in incidence and mortality. METHODS The WHI is a longitudinal study of postmenopausal women recruited from 40 centers. Baseline questionnaires were used to collect sociodemographic and health status information. All CRC diagnoses were centrally adjudicated. Cox regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for invasive CRC by race/ethnicity. RESULTS The study sample included 131,481 (83.7%) White, 14,323 (9.1%) African-American, 6,362 (4.1%) Hispanic, 694 (0.4%) Native American and 4,148 (2.6%) Asian/Pacific Islanders. After a mean follow-up of 10.8 years (SD 2.9), CRC incidence was the highest in African-Americans (annualized rate = 0.14%), followed by Whites and Native Americans (0.12% each), Asian/Pacific Islanders (0.10%), and Hispanics (0.08%). After adjustment for age and trial assignment, Hispanics had a lower risk compared with Whites, HR 0.73 (95% CI: 0.54-0.97) (P = 0.03), and African-Americans had a marginally greater risk, HR 1.16 (95% CI: 0.99-1.34), P = 0.06. Multivariable adjustment attenuated the difference in incidence between African-Americans and Whites (HR 0.99, 95% CI: 0.82-1.20), while strengthening the lower HR for Hispanics (HR 0.68, 95% CI: 0.48-0.97). CONCLUSIONS African-American/White differences in CRC risk are likely due to sociodemographic/cultural factors other than race. IMPACT A number of modifiable exposures could be a focus for reducing CRC risk in African-Americans.
Collapse
Affiliation(s)
- Michael S Simon
- Karmanos Cancer Institute, Department of Oncology, Detroit, MI, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Leufkens AM, Van Duijnhoven FJB, Siersema PD, Boshuizen HC, Vrieling A, Agudo A, Gram IT, Weiderpass E, Dahm C, Overvad K, Tjønneland A, Olsen A, Boutron-Ruault MC, Clavel-Chapelon F, Morois S, Palli D, Grioni S, Tumino R, Sacerdote C, Mattiello A, Herman S, Kaaks R, Steffen A, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Peeters PH, van Gils CH, van Kranen H, Lund E, Dumeaux V, Engeset D, Rodríguez L, Sánchez MJ, Chirlaque MD, Barricarte A, Manjer J, Almquist M, van Guelpen B, Hallmans G, Khaw KT, Wareham N, Tsilidis KK, Straif K, Leon-Roux M, Vineis P, Norat T, Riboli E, Bueno-de-Mesquita HB. Cigarette smoking and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition study. Clin Gastroenterol Hepatol 2011; 9:137-44. [PMID: 21029790 DOI: 10.1016/j.cgh.2010.10.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 10/04/2010] [Accepted: 10/05/2010] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS There has been consistent evidence for a relationship between smoking and colorectal cancer (CRC), although it is not clear whether the colon or rectum is more sensitive to the effects of smoking. We investigated the relationships between cigarette smoking and risk of CRC and tumor location. METHODS We analyzed data from 465,879 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study; 2741 developed CRC during the follow-up period (mean, 8.7 years). Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS The risk of colon carcinoma was increased among ever smokers (HR, 1.18; 95% CI, 1.06-1.32) and former cigarette smokers (HR, 1.21; 95% CI, 1.08-1.36), compared with never smokers; the increased risk for current smokers was of borderline significance (HR, 1.13; 95% CI, 0.98-1.31). When stratified for tumor location, the risk of proximal colon cancer was increased for former (HR, 1.25; 95% CI, 1.04-1.50) and current smokers (HR, 1.31; 95% CI, 1.06-1.64), but the risks for cancers in the distal colon or rectum were not. Subsite analyses showed a nonsignificant difference between the proximal and distal colon (P = .45) for former smokers and a significant difference for current smokers (P = .02). For smokers who had stopped smoking for at least 20 years, the risk of developing colon cancer was similar to that of never smokers. CONCLUSIONS Ever smokers have an increased risk of colon cancer, which appeared to be more pronounced in the proximal than the distal colon location.
Collapse
Affiliation(s)
- Anke M Leufkens
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Colorectal cancer: what should patients and families be told to lower the risk of colorectal cancer? Surg Oncol Clin N Am 2011; 19:693-710. [PMID: 20883947 DOI: 10.1016/j.soc.2010.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Colorectal cancer (CRC) is the second most common cause of cancer-related death in the United States. CRC, however, is potentially preventable, and several strategies may be employed to decrease the incidence of and mortality from CRC. Understanding of individual risk and adherence to screening and surveillance recommendations undoubtedly will reduce CRC-associated deaths. Several natural and synthetic chemopreventive agents may prove effective for both primary and secondary CRC chemoprevention. Finally, dietary modifications (ie, increased dietary fiber, fruits and vegetables, and decreased red meat) and other lifestyle changes (i.e., increased physical activity, weight maintenance, avoidance of smoking, and moderation of alcohol intake) also may lower the risk of developing CRC.
Collapse
|
49
|
The comparison of the clinical manifestations and risk factors of colorectal cancer and adenomas: results from a colonoscopy-based study in southern Chinese. Int J Colorectal Dis 2010; 25:1343-51. [PMID: 20680303 DOI: 10.1007/s00384-010-1030-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Colorectal cancer (CRC) is one of the most common gastrointestinal tumors in the world. This study aimed to compare the clinical manifestations and risk factors of CRC and adenomas in native patients of Guangzhou. METHODS Patients who underwent colonoscopy for the first time at Nanfang Hospital between July 2008 and July 2009 were recruited. Data on demographic information, main clinical manifestations, results of endoscopies and pathology, and possible risk factors of colorectal tumor were collected. Chi-square test and logistic regression were used to compare the clinical characteristics and risk factors for CRC and adenomas. RESULTS Hematochezia and body weight loss were more frequent in proximal and distal CRC groups, respectively (P ≤ 0.05). Older age [odds ratio (OR), 1.079; 95% confidence interval (CI), 1.065-1.093], smoking status (OR, 1.712; 95% CI, 1.158-2.531), BMI =18.5-24.9 and ≥ 25.0 (OR, 2.384; 95% CI, 1.250-4.549; OR, 2.162; 95% CI, 1.044-4.478, respectively) were significant risk factors for advanced adenoma, while female (OR, 0.638; 95% CI, 0.429-0.949) and using aspirin (OR, 0.188; 95% CI, 0.042-0.845) were significant protective factors. Hyperlipemia (OR, 0.109; 95% CI, 0.013-0.886) was identified as a protective factor for proximal CRC. Smoking (OR, 1.717; 95% CI, 1.093-2.696), drinking (OR, 1.817; 95% CI, 1.145-2.883), DM history (OR, 2.204; 95% CI, 1.044-4.652) were identified as independent risk factors for distal CRC, and using aspirin (OR, 0.190; 95% CI, 0.043-0.840) was a protective factor. Drinking (OR, 3.288; 95% CI, 1.546-6.994; OR, 1.862; 95% CI, 1.037-3.343, respectively) was an independent risk factor for both poorly to moderately differentiated CRC and well-differentiated CRC. Besides, DM (OR, 3.761; 95% CI, 1.615-8.762) and hypertension (OR, 0.384; 95% CI, 0.178-0.828) were identified as independent risk factor and protective factor for well-differentiated CRC, respectively. CONCLUSIONS Hematochezia and body weight loss were representative manifestations for distal and proximal CRC, respectively. For southern Chinese the most important influential factors for colorectal tumor are age, smoking, drinking, nutritional state, DM, hypertension, and the use of aspirin.
Collapse
|
50
|
Abstract
BACKGROUND AND AIMS Two of the foremost issues in screening colonoscopy involve delivering quality and maximizing adenoma detection rates (ADR). Little is known about the impact of deep sedation on ADR. This study aims to compare the detection of advanced lesions during screening colonoscopy performed with moderate conscious sedation (MCS) versus deep sedation (DS). METHODS A retrospective cohort study was performed using the Clinical Outcomes Research Initiative database. Average risk screening colonoscopies performed January 2000 to December 2005 were examined for practice setting, patient demographics, and findings, including detection of a polyp >9 mm and suspected malignant lesions. RESULTS A total of 104,868 colonoscopies were examined, 97% of which were performed with MCS. Univariate analysis demonstrated that more polyps of any size were detected with MCS (38 vs. 34%, p < 0.0001) and more advanced lesions were found with DS compared with MCS (7 vs. 6%, p = 0.01). When exclusively examining sites that performed DS > 10% for all procedures, a more significant increase in advanced lesion detection when using DS was observed (7.5 vs. 5.7%, p = 0.003). When adjusted for age, gender, race/ethnicity, site, prep quality, and ASA group, DS was 25% more likely to detect an advanced lesion. CONCLUSIONS Our data suggest that use of DS may be associated with a higher rate of advanced lesion detection. However, this retrospective design has limitations that necessitate follow-up with prospective studies. These follow-up studies would be essential to support any change in the standard practices of sedation.
Collapse
|