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Nonpolypoid colorectal lesions may signal cancer in women.

NEW ORLEANS -- Nonpolypoid colorectal neoplasms in women are significantly more likely to contain advanced histology compared with those in men, based on data from a review of more than 2,300 adults who underwent routine colonoscopies.

The lifetime risk of colorectal cancer is approximately 6% in both men and women, Dr. Eveline Rondagh of Maastricht (the Netherlands) Universitysaid at the meeting.

Previous large-scale studies have shown a higher overall prevalence of adenomas in men. But Dr. Rondagh and colleagues hypothesized that this difference might be balanced by a greater prevalence of nonpolypoid colorectal neoplasms (NP-CRNs) in women.

The researchers analyzed data from 2,310 consecutive patients aged 18 years and older undergoing routine colonoscopies at a single center between February 2008 and February 2009.

The average age of the patients was 58 years; 46% were men and 54% were women.

Approximately 27% of the patients had at least one colorectal neoplasm, and 4% had at least one NP-CRN.

Nonpolypoid lesions were defined as lesions with a height less than half of their diameters.

Both the overall prevalence of colorectal neoplasms and the overall prevalence of NP-CRNs were higher in men than in women (34% vs. 21% and 6% vs. 4%, respectively).

"Although women had fewer colorectal neoplasms, colorectal neoplasms in women were more likely to contain advanced histology," Dr. Rondagh said.

This difference was significant for NP-CRNs.

In women, the odds ratio for NP-CRNs to contain high-grade dysplasia or early colorectal cancer was 2.9, compared with an odds ratio of 0.9 for men.

In addition, a polyp size of 10 mm or greater, and a left-sided location, were significant independent predictors of high-grade dysplasia or early colorectal cancer overall.

But NP-CRNs contained high-grade dysplasia or early colorectal cancer significantly more often than polypoid adenomas (16% vs. 9%), and NP-CRNs were more common in the right colon vs. the left colon (31% vs. 12%), Dr. Rondagh said.

The results support findings from previous studies and emphasize the need to pay special attention to NP-CRNs in women, she noted.

After age, size, and location were adjusted for, female sex was an independent predictor of advanced histology in NP-CRNs.

In women, NP-CRNs were almost three times as likely as polypoid lesions to contain advanced histology, Dr. Rondagh said.

"The message for endoscopists should be, 'Beware of nonpolypoid lesions, especially in women and in the right colon,' " Dr. Rondagh said.

There was an abrupt increase in the prevalence of advanced histology in women after age 50 years, while men showed a more gradual increase with age. The researchers hypothesized that differences in the prevalence of advanced histology differences between women and men might be partly explained by hormonal changes related to menopause, but more research is needed to confirm this association.


Major Finding: In women, nonpolypoid colorectal neoplasms are approximately three times as likely as polypoid lesions to contain advanced histology.

Data Source: A retrospective study of 2,310 adults aged 18 years and older who underwent routine colonoscopies over a 1-year period.

Disclosures: None was reported.


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Title Annotation:CLINICAL ROUNDS
Author:Splete, Heidi
Publication:OB GYN News
Date:Jul 1, 2010
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