ABSTRACTS: ACCEPTED: COLORECTAL CANCER PREVENTION
Nwankwo, Eugene C. MD, MS1; Lines, Jefferson BS2; Trehan, Sahiba3; Balducci, Michelle2; Trehan, Amit MBBS4; Banwait, kuldip MD5; Pathapati, Srinivas MD4; Misra, Subhasis MD, MS6; Obokhare, Izi MD2
1St. Louis University School of Medicine, St. Louis, MO;
2Texas Tech University Health Sciences Center, Amarillo, TX;
3Texas Tech University Health Sciences Center, College Station, TX;
4BSA Health System, Amarillo, TX;
5Panhandle Gastroenterology, Amarillo, TX;
6Brandon Regional Hospital, Brandon, FL.
Introduction:
There is limited knowledge about the relationship between Adenoma Detection (ADRs), patient ethnicity, and histologic differences of adenomatous polyps in patients who undergo colonoscopy with a positive fecal immunochemical test (FIT). We hypothesized that colonoscopy done on these patients would yield higher ADRs, and better risk stratify patients based on the types of cancerous polyps.
Methods:
We reviewed ADRs for colonoscopies performed after a positive FIT test and compared them to ADR rates for routine colonoscopy performed without an initial FIT test between November 2014 and March 2017 at multiple endoscopy sites. Data were compare to a national outpatient sample.
Results:
979 patients underwent FIT. 12.1% (n = 119) tested positive. 32.8% (n = 39) had one or more tubular adenomatous (TA) polyps on pathological examination. Among these, the majority were female, 64.1% (n = 25). 15.9% (n = 19) had a hyperplastic polyp, 1.7% (n = 2) had findings consistent with ulcerative colitis and 0.8% (n = 1) had adenocarcinoma. The control group (n = 2603) underwent colonoscopy as the initial screening tool, 719 had at least one TA. Control group ADR rate was 27.5% and cancer rate was 1%. Of the total individuals screened with FIT and colonoscopy, there was a mean ADR of 38.7% among Blacks. Within this cohort, the ADR varied slightly between adenoma types. Rates were 46% for Hyperplastic Adenomas (HA), 39% for Tubulous Adenoma (TA), and 31% for Tubulovillous Adenomas (TVA). Among Hispanics, the ADR for HA was 20%, 80% for TA, and 7% for TVA. Asian/Pacific Islanders showed ADR of 10% (HA), 30% (TA), and 10% for TV (P < 0.001).
Conclusion:
Overall, ADR’s were highest for the most aggressive types of polyps were found to be highest in non-white patients compared to their white counterparts. ADR increased when colonoscopy was conducted after a positive FIT test. Colonoscopies after a positive FIT test will improve ADRs significantly, and also lower the overall healthcare cost for screening colon cancer in this era of escalating healthcare costs.
© 2021 by The American College of Gastroenterology
