Studying 647 patients ages 50 and older undergoing colorectal cancer (CRC) screening at a large private gastroenterology practice in Puerto Rico (PR Gastroenterology Institute), researchers found that males were two times more likely to have colorectal neoplasia than women, and were more likely to have multiple polyps compared to women. They also found that patients older than 60 had a 56 percent greater chance of having polyps than those under age 60.

Marcia Cruz-Correa, MD, PhD, associate professor of medicine and biochemistry at the University of Puerto Rico Cancer Center, and study co-author Fernando Ramos, MD, also found that the location of the polyps in Hispanics differed from where they are typically found in non-Hispanic Caucasians: of the patients who had polyps, 70 percent were on the proximal or right side of the colon. Dr. Cruz-Correa attributed the difference in location to underlying molecular differences in the two populations.

"Colorectal cancer screening rates among Hispanics are dangerously low," said Dr. Cruz-Correa. "Currently, only 40 percent get screened despite the fact that colorectal cancer is the second leading cause of death among Hispanic women. As Hispanics become more acculturated to the U.S. lifestyle, they are losing the protective factor of their diet, which may account for the higher rates of colorectal cancer seen in U.S. Hispanics compared to the expected rates of cancer in their country of origin."

Dr. Cruz-Correa added that their findings send a message about the importance of using colonoscopy for CRC screening in Hispanics because it is the most effective method of detecting polyps located on the proximal side of the colon.

Dr. Ramos will present these data on Sunday, May 2 at 8 a.m. CT in Hall F, Ernest N. Morial Convention Center.

Colorectal Cancer Screening in African Americans 45-49 Years Old (Abstract #M1528)

Researchers at Temple University Hospital have found that the presence of high-grade dysplasia detected during colonoscopy is more common in a younger cohort of African American (ages 45 to 49) than their older counterparts, ages 50 to 59, therefore supporting the recommendation that African Americans in the 45 to 49 age group should be screened for colorectal cancer (CRC).

Past research has shown that the incidence of CRC in patients younger than 50 is higher in African Americans. Studies have also shown that African Americans who are going to develop CRC have a one in 10 chance of developing it before the age of 50 compared to a one in twenty chance for Caucasians. Recommendations for screenings of African Americans at an earlier age began in 2005 and were followed by publication of a practice guideline in 2009. However, the recommendation was a "grade 2C" indicating that it was not a strong recommendation.

Frank Friedenberg, MD, professor of medicine at Temple University Hospital, and colleagues sought to further our understanding of the risk of developing CRC at an earlier age for African Americans by examining the results of screening by colonoscopy of African Americans at their institution and comparing the results of those ages 45 to 49 with those ages 50 to 59. Their study of 335 African Americans found adenomatous polyps in 22.3 percent of the younger cohort compared to 19.7 percent of the older cohort. Of the polyps found, 4.5 percent showed high grade dysplasia, indicating they were advanced, in the younger group compared to 0.4 percent in the older group.

Researchers also found that patients in the older group were more likely to consume asprin daily compared to their younger counterparts (26.1 percent versus 13.5 percent), which may have contributed to their lower incidence of polyps since asprin is known to be a protective measure against CRC.

"Our findings certainly support the recommendation that African Americans should consider beginning screening for colorectal cancer at an earlier age," said Dr. Friedenberg. He added that further prospective trials should be done, and that their study indicates a need for efforts to educate the African American community about their increased risk for CRC at a younger age.

Dr. Friedenberg will present these data on Monday, May 3 at 8 a.m. CT in Hall F, Ernest N. Morial Convention Center.

Disappearing Colorectal Metastases after Chemotherapy: Should We Be Concerned? (Abstract # 315)

Patients with colorectal cancer (CRC) that has metastasized to the liver typically receive both aggressive chemotherapy and surgical therapy to remove lesions in the liver, often with outstanding long-term outcomes. When the cancer is initially resectable in the liver, recommendations are inconsistent regarding which therapy should be given first. Despite the possible challenges in identifying lesions for surgical removal that have been reduced in size by chemotherapy, researchers at Johns Hopkins University Hospital have determined that there are multiple potential benefits to providing chemotherapy prior to surgery.

In a study of 177 patients with metastatic CRC, Michael A. Choti, MD, professor of surgery at the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University Hospital, examined 613 lesions that were treated by preoperative chemotherapy. Of those, 117 lesions disappeared in a pre-operative scan. Choti found that about half of the disappearing lesions (47 percent) were still identifiable during surgery.

According to Dr. Choti, shrinking lesions with chemotherapy prior to surgery, while sometimes making them more difficult to identify, can also make them easier to surgically remove. When a tumor has disappeared and cannot be found at surgery, surgeons attempt to remove an area where a lesion was previously present. However, they found that this was only possible in 30 percent of cases. Even if the areas were left behind, recurrences occurred in 60 percent of cases and many of these can be operated upon a second time. Dr. Choti found no difference in the patients' survival rates among those with unidentified sites left behind compared to those with complete resection.

"This study demonstrates the potential benefit of shrinking metastases in the liver using pre-operative chemotherapy, but there is still disagreement within the field. Further research is needed to determine the optimal sequence of treating metastatic colorectal cancer," said Dr. Choti.

He will act as lead researcher in a multi-institutional, National Cancer Institute-sponsored clinical trial that will study the differences in treating patients with different sequences of chemotherapy and surgical therapy.

Dr. Choti will present these data on Monday, May 3 at 10:30 a.m., 244-245, Ernest N. Morial Convention Center.

Source: Digestive Disease Week