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Nonpolypoid colorectal neoplasms: gender differences in prevalence and malignant potential
Eveline J A Rondagh1, Ad A M Masclee, Mirthe E van der Valk
1Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Netherlands.
Scandinavian Journal of Gastroenterology
|December 14, 2011
Summary
Nonpolypoid colorectal neoplasms are more common in men but pose a higher cancer risk in women. These flat lesions, particularly in the proximal colon, are often missed and can harbor advanced histology.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Colonoscopy is key for colorectal cancer (CRC) prevention, but cancer can still occur, especially in the proximal colon and in women.
- Nonpolypoid colorectal neoplasms (NPNCs) are flat lesions that may contribute to interval CRC cases.
- Understanding NPNC prevalence and malignant potential is crucial for improving CRC screening and prevention strategies.
Purpose of the Study:
- To investigate the prevalence and malignant potential of NPNCs in a large patient population.
- To analyze gender and location-specific differences in NPNCs and their association with advanced histology.
- To elucidate the role of NPNCs in colorectal carcinogenesis.
Main Methods:
- A cross-sectional study was conducted on consecutive patients undergoing elective colonoscopy at an academic medical center.
- Endoscopists received specific training in the detection and management of NPNCs.
- Advanced histology was defined as high-grade dysplasia or early-stage cancer.
Main Results:
- A total of 2310 patients were included, with 53.9% being women.
- Prevalence of colorectal neoplasms and NPNCs was lower in women than in men.
- In women, NPNCs were significantly more likely to harbor advanced histology compared to polypoid lesions (OR 2.89), a trend not observed in men.
- Proximal neoplasms with advanced histology were more likely to be nonpolypoid than distal ones (OR 4.68).
Conclusions:
- Nonpolypoid lesions are implicated in colorectal carcinogenesis in both genders.
- While women present with fewer overall neoplasms, their NPNCs show a higher propensity for advanced histology.
- These findings highlight the importance of recognizing and managing NPNCs, particularly in women and for proximal lesions, to reduce CRC incidence.
