Nav: Home

Serrated polyps plus conventional adenomas may mean higher risk for colorectal cancer

October 11, 2017

LEBANON, NH - Most colorectal cancer develops from precursors known as polyps, the most common and well researched of which are conventional adenomas. Conventional adenomas often progress to colorectal cancer through an intermediate step called high-risk adenomas. Another type of polyp known as serrated polyps, may precede up to 15% of colorectal cancer. Serrated polyps may occur in up to 20% of all adults over 50 years of age, however, when it comes to progression to colorectal cancer, less is known about serrated polyps than conventional adenomas. A Dartmouth research team led by Joseph Anderson, MD, MHCDS, used data from the New Hampshire Colonoscopy Registry (NHCR), led by Lynn Butterly, MD, to examine the risk of developing future high-risk adenomas in people with serrated polyps. They found that when the combination of serrated polyps and high-risk adenomas was present, so was a higher risk of future high-risk adenomas.

The team identified a subgroup of individuals from the NHCR with serrated polyps, hypothesizing that they may be at a higher risk for high-risk adenomas, and thus colorectal cancer, than people with high-risk adenomas alone. "We found that while people with serrated polyps were at increased risk for future serrated polyps, they were not at risk for future high-risk adenomas. Not surprisingly, people with high-risk adenomas were at increased risk for high-risk adenomas," said Anderson. "However, we made a novel observation that people with both serrated polyps and high-risk adenomas had a risk for future high-risk adenomas that was substantially higher than even people with high-risk adenomas alone." The team's findings, "Risk of Metachronous High-risk Adenomas and Large Serrated Polyps in Individuals With Serrated Polyps on Index Colonoscopy: Data from the New Hampshire Colonoscopy Registry," was recently published in Gastroenterology and will be the first paper presented at the American College of Gastroenterology's World Congress of Gastroenterology conference in October, 2017. The data will be presented in the President's Plenary Session, which features the top abstracts at the national meeting.

Several important aspects of the NHCR allowed the team to carry out their study. The first is the size of the registry. The NHCR is a population-based colonoscopy registry that has been collecting and analyzing data on colonoscopies across New Hampshire since 2004 and contains data on over 150,000 colonoscopies.

Next is the thoroughness of NHCR data collection. Consenting participants complete a questionnaire prior to colonoscopy, including demographic characteristics, health history, and known risk factors for colorectal cancer. A procedure form is completed during or immediately following colonoscopy and records the indication for the colonoscopy, findings (location, size and specific treatment of polyps, cancer, or other findings), type and quality of bowel preparation, sedation medication, anatomical landmark reached during the procedure, withdrawal time, follow-up recommendations, and immediate complications. The NHCR requests pathology reports for all colonoscopies with tissue biopsies or excisions directly from each pathology laboratory. Trained NHCR staff then link polyp level pathology data to information from the colonoscopy procedure form in the NHCR database.

The NHCR also provides a longitudinal nature of the data collection. "We follow patients at each successive colonoscopy and can examine the risk that patients can have for future polyps based on an index exam," said Anderson. "The NHCR provided data for a large group of individuals who had both an index and follow up colonoscopy allowing us to address the important clinical question of risk for people with serrated polyps."

The team's data have some important implications. "We have identified a subgroup of individuals with both high-risk adenomas and serrated polyps who may need more intense surveillance such as increased frequency of colonoscopies," said Anderson. "We also observed that having serrated polyps on index exam is associated with an increased risk for future serrated polyps but not high-risk adenomas. Examining rates of serrated polyps rather than high-risk adenomas on follow-up colonoscopy may be the best way to monitor the success of surveillance in people with serrated polyps."

Looking ahead, Anderson's team will dig further into understanding how the risk factors (such as age, sex, smoking, alcohol intake, exercise, education level and family history of colorectal cancer) and molecular mutations found in individuals with both serrated polyps and high-risk adenomas can help identify others who may also be at risk for having both serrated polyps and high-risk adenomas, as these individuals may have a different, higher risk profile for colorectal cancer.
-end-
Joseph Anderson, MD, MHCDS, is an Associate Professor of Medicine at Dartmouth's Geisel School of Medicine, Gastroenterologist at the Department of Veterans Affairs Medical Center in White River Junction, VT, and co-Investigator at the New Hampshire Colonoscopy Registry, a Dartmouth-Hitchcock Norris Cotton Cancer Center-sponsored initiative.

About Norris Cotton Cancer Center at Dartmouth-Hitchcock

Norris Cotton Cancer Center combines advanced cancer research at Dartmouth's Geisel School of Medicine with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center in Lebanon, NH, at Dartmouth-Hitchcock regional locations in Manchester, Nashua and Keene, NH, and St. Johnsbury, VT, and at partner hospitals throughout New Hampshire and Vermont. It is one of 49 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at cancer.dartmouth.edu.

Dartmouth-Hitchcock Medical Center

Related Cancer Articles:

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.
Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.
More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.
New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.
American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.
Oncotarget: Cancer pioneer employs physics to approach cancer in last research article
In the cover article of Tuesday's issue of Oncotarget, James Frost, MD, PhD, Kenneth Pienta, MD, and the late Donald Coffey, Ph.D., use a theory of physical and biophysical symmetry to derive a new conceptualization of cancer.
Health indicators for newborns of breast cancer survivors may vary by cancer type
In a study published in the International Journal of Cancer, researchers from the UNC Lineberger Comprehensive Cancer Center analyzed health indicators for children born to young breast cancer survivors in North Carolina.
Few women with history of breast cancer and ovarian cancer take a recommended genetic test
More than 80 percent of women living with a history of breast or ovarian cancer at high-risk of having a gene mutation have never taken the test that can detect it.
More Cancer News and Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Teaching For Better Humans 2.0
More than test scores or good grades–what do kids need for the future? This hour, TED speakers explore how to help children grow into better humans, both during and after this time of crisis. Guests include educators Richard Culatta and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#556 The Power of Friendship
It's 2020 and times are tough. Maybe some of us are learning about social distancing the hard way. Maybe we just are all a little anxious. No matter what, we could probably use a friend. But what is a friend, exactly? And why do we need them so much? This week host Bethany Brookshire speaks with Lydia Denworth, author of the new book "Friendship: The Evolution, Biology, and Extraordinary Power of Life's Fundamental Bond". This episode is hosted by Bethany Brookshire, science writer from Science News.
Now Playing: Radiolab

Dispatch 3: Shared Immunity
More than a million people have caught Covid-19, and tens of thousands have died. But thousands more have survived and recovered. A week or so ago (aka, what feels like ten years in corona time) producer Molly Webster learned that many of those survivors possess a kind of superpower: antibodies trained to fight the virus. Not only that, they might be able to pass this power on to the people who are sick with corona, and still in the fight. Today we have the story of an experimental treatment that's popping up all over the country: convalescent plasma transfusion, a century-old procedure that some say may become one of our best weapons against this devastating, new disease.   If you have recovered from Covid-19 and want to donate plasma, national and local donation registries are gearing up to collect blood.  To sign up with the American Red Cross, a national organization that works in local communities, head here.  To find out more about the The National COVID-19 Convalescent Plasma Project, which we spoke about in our episode, including information on clinical trials or plasma donation projects in your community, go here.  And if you are in the greater New York City area, and want to donate convalescent plasma, head over to the New York Blood Center to sign up. Or, register with specific NYC hospitals here.   If you are sick with Covid-19, and are interested in participating in a clinical trial, or are looking for a plasma donor match, check in with your local hospital, university, or blood center for more; you can also find more information on trials at The National COVID-19 Convalescent Plasma Project. And lastly, Tatiana Prowell's tweet that tipped us off is here. This episode was reported by Molly Webster and produced by Pat Walters. Special thanks to Drs. Evan Bloch and Tim Byun, as well as the Albert Einstein College of Medicine.  Support Radiolab today at Radiolab.org/donate.