J Korean Med Sci.  2017 Aug;32(8):1281-1287. 10.3346/jkms.2017.32.8.1281.

Is Colonoscopic Screening Necessary for Patients Younger than 50 Years with Gastric Adenoma or Cancer?

• Kim NH
• Park JH
• Park DI
• Sohn CI
• Jung YS

• KMID: 2439462
• DOI: http://doi.org/10.3346/jkms.2017.32.8.1281

Abstract

Patients, aged ≥ 50 years, with gastric neoplasm are reported to be at increased risk for colorectal neoplasia (CRN), while data regarding the risk of CRN in young patients, aged < 50 years with gastric neoplasm are limited. We aimed to investigate the risk of CRN according to the presence of gastric neoplasm in patients, aged < 50 years, and conducted a cross-sectional study on 131,888 asymptomatic examinees who underwent both esophagogastroduodenoscopy (EGD) and colonoscopy as part of a health screening program between 2010 and 2014. The prevalence of overall CRN (8.6% vs. 13.2%, P = 0.251) and advanced colorectal neoplasia (ACRN) (0.0% vs. 1.3%, P = 0.345) did not significantly differ according to the presence of gastric neoplasm in subjects, aged < 50 years. However, among subjects aged ≥ 50 years, patients with gastric neoplasm had a significantly higher proportion of overall CRN (48.2% vs. 31.7%, P < 0.001) and ACRN (12.5% vs. 4.5%, P < 0.001) compared with those without gastric neoplasm. Particularly, gastric neoplasm was an independent risk factor for ACRN after controlling for confounding factors among subjects, aged ≥ 50 years. In conclusion, gastric neoplasm was a risk factor for CRN in patients, aged ≥ 50 years, but not in patients, aged < 50 years. Young patients, aged < 50 years with gastric neoplasm do not need to undergo colonoscopy, whereas patients, aged ≥ 50 years with gastric neoplasm, should be considered a higher priority for colonoscopy.

Keyword

Colorectal Neoplasm; Gastric Neoplasm; Colonoscopy; Young

MeSH Terms

Adenoma*
Colonoscopy
Colorectal Neoplasms
Cross-Sectional Studies
Endoscopy, Digestive System
Humans
Mass Screening*
Prevalence
Risk Factors
Stomach Neoplasms

Figure

• 

  Fig. 1 Flow diagram illustrating the selection of study subjects. EGD = esophagogastroduodenoscopy.

Reference

1. Wu CW, Lo SS, Chen JH, Hsieh MC, Li AF, Lui WY. Multiple primary cancers in patients with gastric cancer. Hepatogastroenterology. 2006; 53:463–467.

2. Ławniczak M, Gawin A, Jaroszewicz-Heigelmann H, Rogoza-Mateja W, Raszeja-Wyszomirska J, Białek A, Karpińska-Kaczmarczyk K, Starzyńska T. Synchronous and metachronous neoplasms in gastric cancer patients: a 23-year study. World J Gastroenterol. 2014; 20:7480–7487.

3. Eom BW, Lee HJ, Yoo MW, Cho JJ, Kim WH, Yang HK, Lee KU. Synchronous and metachronous cancers in patients with gastric cancer. J Surg Oncol. 2008; 98:106–110.

4. Ikeda Y, Saku M, Kawanaka H, Nonaka M, Yoshida K. Features of second primary cancer in patients with gastric cancer. Oncology. 2003; 65:113–117.

5. Bozzetti F, Bonfanti G, Mariani L, Miceli R, Andreola S. Risk of second malignancies after surgical treatment for early gastric cancer. Gastric Cancer. 1999; 2:74–75.

6. Ha TK, An JY, Youn HG, Noh JH, Sohn TS, Kim S. Surgical outcome of synchronous second primary cancer in patients with gastric cancer. Yonsei Med J. 2007; 48:981–987.

7. Lee JH, Bae JS, Ryu KW, Lee JS, Park SR, Kim CG, Kook MC, Choi IJ, Kim YW, Park JG, et al. Gastric cancer patients at high-risk of having synchronous cancer. World J Gastroenterol. 2006; 12:2588–2592.

8. Lim SB, Jeong SY, Choi HS, Sohn DK, Hong CW, Jung KH, Chang HJ, Park JG, Choi IJ, Kim CG. Synchronous gastric cancer in primary sporadic colorectal cancer patients in Korea. Int J Colorectal Dis. 2008; 23:61–65.

9. Kim HO, Hwang SI, Yoo CH, Kim H. Preoperative colonoscopy for patients with gastric adenocarcinoma. J Gastroenterol Hepatol. 2009; 24:1740–1744.

10. Yoo HM, Gweon TG, Seo HS, Shim JH, Oh SI, Choi MG, Song KY, Jeon HM, Park CH. Role of preoperative colonoscopy in patients with gastric cancer: a case control study of the prevalence of coexisting colorectal neoplasms. Ann Surg Oncol. 2013; 20:1614–1622.

11. Bae RC, Jeon SW, Cho HJ, Jung MK, Kweon YO, Kim SK. Gastric dysplasia may be an independent risk factor of an advanced colorectal neoplasm. World J Gastroenterol. 2009; 15:5722–5726.

12. Park SY, Kim HS, Yoon KW, Cho SB, Lee WS, Park CH, Joo YE, Choi SK, Rew JS. Prevalence of colorectal adenoma is increased in patients with gastric adenoma. Korean J Gastroenterol. 2009; 54:220–226.

13. Yang MH, Son HJ, Lee JH, Kim MH, Kim JY, Kim YH, Chang DK, Rhee PL, Kim JJ, Rhee JC. Do we need colonoscopy in patients with gastric adenomas? The risk of colorectal adenoma in patients with gastric adenomas. Gastrointest Endosc. 2010; 71:774–781.

14. Wu ZJ, Lin Y, Xiao J, Wu LC, Liu JG. Clinical significance of colonoscopy in patients with upper gastrointestinal polyps and neoplasms: a meta-analysis. PLoS One. 2014; 9:e91810.

15. Uchino S, Noguchi M, Ochiai A, Saito T, Kobayashi M, Hirohashi S. p53 mutation in gastric cancer: a genetic model for carcinogenesis is common to gastric and colorectal cancer. Int J Cancer. 1993; 54:759–764.

16. Meucci G, Tatarella M, Vecchi M, Ranzi ML, Biguzzi E, Beccari G, Clerici E, de Franchis R. High prevalence of Helicobacter pylori infection in patients with colonic adenomas and carcinomas. J Clin Gastroenterol. 1997; 25:605–607.

17. Soweid AM, Kobeissy AA, Jamali FR, El-Tarchichi M, Skoury A, Abdul-Baki H, El-Zahabi L, El-Sayyed A, Barada KA, Sharara AI, et al. A randomized single-blind trial of standard diet versus fiber-free diet with polyethylene glycol electrolyte solution for colonoscopy preparation. Endoscopy. 2010; 42:633–638.

18. Wen CP, David Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC, Eriksen MP. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 2009; 12:497–506.

19. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR; United States Multi-Society Task Force on Colorectal Cancer. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012; 143:844–857.

20. Kwah J, Schroy PC 3rd, Jacobson BC, Calderwood AH. Whites and blacks have similar risk of metachronous advanced colorectal neoplasia. Dig Dis Sci. 2014; 59:2264–2271.

21. Powell SM, Zilz N, Beazer-Barclay Y, Bryan TM, Hamilton SR, Thibodeau SN, Vogelstein B, Kinzler KW. APC mutations occur early during colorectal tumorigenesis. Nature. 1992; 359:235–237.

22. Nakatsuru S, Yanagisawa A, Ichii S, Tahara E, Kato Y, Nakamura Y, Horii A. Somatic mutation of the APC gene in gastric cancer: frequent mutations in very well differentiated adenocarcinoma and signet-ring cell carcinoma. Hum Mol Genet. 1992; 1:559–563.

23. Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, Nakamura Y, White R, Smits AM, Bos JL. Genetic alterations during colorectal-tumor development. N Engl J Med. 1988; 319:525–532.

24. Shibata D, Reale MA, Lavin P, Silverman M, Fearon ER, Steele G Jr, Jessup JM, Loda M, Summerhayes IC. The DCC protein and prognosis in colorectal cancer. N Engl J Med. 1996; 335:1727–1732.

25. Uchino S, Tsuda H, Noguchi M, Yokota J, Terada M, Saito T, Kobayashi M, Sugimura T, Hirohashi S. Frequent loss of heterozygosity at the DCC locus in gastric cancer. Cancer Res. 1992; 52:3099–3102.

26. Laurent-Puig P, Olschwang S, Delattre O, Remvikos Y, Asselain B, Melot T, Validire P, Muleris M, Girodet J, Salmon RJ, et al. Survival and acquired genetic alterations in colorectal cancer. Gastroenterology. 1992; 102:1136–1141.

27. Chung DC, Rustgi AK. DNA mismatch repair and cancer. Gastroenterology. 1995; 109:1685–1699.

28. Ohtani H, Yashiro M, Onoda N, Nishioka N, Kato Y, Yamamoto S, Fukushima S, Hirakawa-Ys Chung K. Synchronous multiple primary gastrointestinal cancer exhibits frequent microsatellite instability. Int J Cancer. 2000; 86:678–683.

29. Isogaki J, Shinmura K, Yin W, Arai T, Koda K, Kimura T, Kino I, Sugimura H. Microsatellite instability and K-ras mutations in gastric adenomas, with reference to associated gastric cancers. Cancer Detect Prev. 1999; 23:204–214.

30. Choi SW, Park WS, Yang JM, Kang CS, Sun HS, Kim BS, Seo EJ, Lee MJ, Park CS. p53 protein overexpression and allele loss of p53 gene in gastric adenocarcinoma. J Korean Med Sci. 1994; 9:299–303.

31. Kim JW, Hwang I, Kim MJ, Jang SJ. Clinicopathological characteristics and predictive markers of early gastric cancer with recurrence. J Korean Med Sci. 2009; 24:1158–1164.

32. Cannon-Albright LA, Skolnick MH, Bishop DT, Lee RG, Burt RW. Common inheritance of susceptibility to colonic adenomatous polyps and associated colorectal cancers. N Engl J Med. 1988; 319:533–537.

33. Grady WM. Genetic testing for high-risk colon cancer patients. Gastroenterology. 2003; 124:1574–1594.

34. Schoen RE, Tangen CM, Kuller LH, Burke GL, Cushman M, Tracy RP, Dobs A, Savage PJ. Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst. 1999; 91:1147–1154.

35. Kim SY, Jung SW, Hyun JJ, Koo JS, Choung RS, Yim HJ, Lee SW, Choi JH. Is colonoscopic screening necessary for patients with gastric adenoma or cancer? Dig Dis Sci. 2013; 58:3263–3269.

36. Lee SS, Jung WT, Kim CY, Ha CY, Min HJ, Kim HJ, Kim TH. The synchronous prevalence of colorectal neoplasms in patients with stomach cancer. J Korean Soc Coloproctol. 2011; 27:246–251.

37. Park DI, Park SH, Yoo TW, Kim HS, Yang SK, Byeon JS, Koh BM, Kim JO, Shim KN, Jeen YT, et al. The prevalence of colorectal neoplasia in patients with gastric cancer: a Korean Association for the Study of Intestinal Disease (KASID) Study. J Clin Gastroenterol. 2010; 44:102–105.

38. Guo Y, Li HY. Association between Helicobacter pylori infection and colorectal neoplasm risk: a meta-analysis based on East Asian population. J Cancer Res Ther. 2014; 10:Suppl. 263–266.