Department of Medicine and Cancer Center, Howard University College of Medicine, 2041 Georgia Avenue, NW, Washington, DC 20060, USA.
Dig Dis Sci. 2010 May;55(5):1442-9. doi: 10.1007/s10620-010-1133-5. Epub 2010 Mar 12.
Among the ethnic groups, the age-standardized incidence rate of colorectal cancer (CRC) is highest among African-Americans. The majority of CRC arise from preexisting adenoma. It is shown that 30% of the US adult population has adenomas. The potential risk of malignant transformation in adenomas differs by specific pathologic and clinical characteristics that we aimed to study in AAs.
All pathologic reports (150,000) in Howard University Hospital from 1959 to 2006 were reviewed manually. Those pathology reports compatible with the colorectal polyps were carefully reviewed and selected by a GI pathologist. All cases with cancer were then excluded from the list. Data were then entered into Microsoft Excel and checked for missing data and duplications. Differences in right-side and left-side polyps for sex, histology, and clinical symptoms were assessed by Chi-2 test.
A total number of 5,013 colorectal polyps were diagnosed in this period that include 47% male, with mean age (SD) of 63 (12). Half of the cases were diagnosed in 2001-2006. Tubular adenoma was the most frequent pathology (73%). The highest frequency of right-sided polyps was observed in the 1990s (56%). Left-sided polyps were younger (p < 0.0001), more hyperplasic (23 vs. 5%; p < 0.0001), and more frequent in female (56 vs. 52%; p = 0.02) compared to right-sided polyps. The frequency of right-sided adenoma significantly increases from 18% in the 1960s to 51% in the period of 2001-2006 (p < 0.0001). The most frequent symptom in both sides was GI bleeding (21%).
There was a ratio of 8:1 for neoplastic to hyperplastic polyps in our study, which is more than what has been reported in Caucasians (7:1). Our data shows a shift in polyps from the left side to the right side of the colon in recent years. This data is consistent with the lack of a reduction in the incidence of colon cancer in African-Americans. Screening is thus very important in AA to reduce the incidence of colon cancer.
在各民族中，非裔美国人的结直肠癌（CRC）标准化发病率最高。大多数 CRC 源于先前存在的腺瘤。据显示，美国成年人中有 30%患有腺瘤。腺瘤的恶性转化的潜在风险因具体的病理和临床特征而异，这是我们旨在研究非裔美国人的特征。
手动回顾霍华德大学医院 1959 年至 2006 年的所有病理报告（15 万份）。由一位胃肠病理学家仔细审查和选择与结直肠息肉相符的病理报告。然后从列表中排除所有患有癌症的病例。数据随后输入 Microsoft Excel 并检查缺失数据和重复数据。通过卡方检验评估性别、组织学和临床症状的右侧和左侧息肉之间的差异。
在此期间共诊断出 5013 例结直肠息肉，其中 47%为男性，平均年龄（标准差）为 63（12）岁。半数病例诊断于 2001-2006 年。管状腺瘤是最常见的病理类型（73%）。观察到 20 世纪 90 年代右侧息肉的频率最高（56%）。左侧息肉更年轻（p < 0.0001），增生性更多（23%对 5%；p < 0.0001），且女性更为常见（56%对 52%；p = 0.02）与右侧息肉相比。右侧腺瘤的频率从 20 世纪 60 年代的 18%显著增加到 2001-2006 年期间的 51%（p < 0.0001）。两侧最常见的症状均为胃肠道出血（21%）。
在我们的研究中，肿瘤性息肉与增生性息肉的比例为 8:1，高于高加索人的报告（7:1）。我们的数据显示，近年来息肉从结肠左侧向右侧转移。这一数据与非裔美国人结直肠癌发病率没有下降的情况相符。因此，在非裔美国人中进行筛查非常重要，以降低结直肠癌的发病率。
