Adenoma Prevalence and Distribution Among US Latino Subgroups Undergoing Screening Colonoscopy.

BACKGROUND: Colorectal cancer (CRC) is the second leading malignancy diagnosed among US Latinos. Latinos in the USA represent a heterogeneous amalgam of subgroups varying in genetic background, culture, and socioeconomic status. Little is known about the frequency of CRC precursor lesions found at screening colonoscopy among Latino subgroups. AIM: The aim was to determine the prevalence and distribution of histologically confirmed adenomas found at screening colonoscopy among average-risk, asymptomatic US Latinos according to their subgroup and socio-demographic background. METHODS: Cross-sectional analysis of pathological findings resulting from screening colonoscopy among average-risk, asymptomatic US Latinos aged ≥50 in two prospective randomized controlled trials at an academic medical center. RESULTS: Among the 561 Latinos who completed screening colonoscopy, the two largest subgroups were Puerto Ricans and Dominicans. The findings among both subgroups were: adenomas 30.6%, proximal adenomas 23.5%, advanced adenomas 12.0%, and proximal advanced adenomas 8.9%. These rates are at least as high as those found at screening colonoscopy among US whites. While Puerto Ricans were more likely than Dominicans to be born in the USA, speak English, be acculturated, have a smoking history, and be obese, there were no significant differences in adenoma rates between these subgroups. CONCLUSIONS: The prevalence of adenomas, advanced adenomas, and proximal neoplasia was high among both subgroups. These findings have implications for CRC screening and surveillance among the increasingly growing Latino population in the USA.

Impact of Concomitant Endometriosis on Phenotype and Natural History of Inflammatory Bowel Disease.

BACKGROUND: Inflammatory bowel disease (IBD) and endometriosis are immune-mediated chronic inflammatory disorders affecting young women. The clinical significance of concomitant endometriosis on the course of IBD has not been previously studied. The aim of this study was to determine whether women with concomitant endometriosis and IBD have a unique phenotype and worse prognosis of IBD. METHODS: This was a case-control study performed at a tertiary referral center. Cases were women with diagnoses of both endometriosis and IBD. Two random IBD controls without endometriosis were selected for each case, frequency matched for age and IBD type, Crohn's disease (CD) or ulcerative colitis. Primary outcomes included disease phenotype; the use of immunomodulators, antiTNF agents, or combination therapy and the need for IBD-related surgery. RESULTS: We identified 51 cases with endometriosis and IBD (28 CD, 23 ulcerative colitis). There was no difference in race, age at IBD diagnosis, and mean duration of IBD between endometriosis-IBD cases and controls. Among endometriosis-CD patients whose endometriosis was surgically verified, there was a higher risk for stricturing disease compared with CD controls (odds ratio, 11.8; 95% confidence interval, 2.03-69.0). There was no difference in phenotype in endometriosis-ulcerative colitis patients. There were no significant differences in IBD-related medication use or surgeries overall or when stratified by IBD type. CONCLUSIONS: Patients with CD and endometriosis, which was surgically diagnosed, were more likely to have stricturing CD. Concomitant endometriosis did not impact the natural history of IBD.

Diminutive polyps among black and Latino populations undergoing screening colonoscopy: evidence supporting a resect and discard approach.

BACKGROUND: A resect and discard strategy for diminutive (≤5 mm) colon polyps has been proposed to save costs of screening colonoscopy (SC). Prior studies on neoplasia prevalence based on polyp size have involved mostly white patients. OBJECTIVE: To determine the prevalence of adenomas and advanced histologic features by size among primarily black and Latino patients enrolled in a prospective SC study. DESIGN: Retrospective analysis of data from a prospective clinical trial. SETTING: Urban academic medical center. PATIENTS: Average risk, asymptomatic, minority patients aged ≥50 years undergoing SC. INTERVENTIONS: Screening colonoscopy. MAIN OUTCOME MEASUREMENTS: Rates of neoplasia and advanced histologic features (villous histology, high-grade dysplasia, or cancer) by polyp size and location. RESULTS: A total of 566 polyps from 295 patients were analyzed. Diminutive polyps and small (6-9 mm) polyps had lower prevalence of ≥1 advanced feature compared with large (≥10 mm) polyps (0.9% and 2.7%, respectively, vs 13.6%; P < .001 for both comparisons). Distal polyps were less likely to be neoplastic (31.7% vs 61.4%; P < .001) than proximal polyps in all size categories (P < .001 for all comparisons). After adjusting for sex, ethnicity, age, and location, large polyps were more likely to have ≥1 advanced feature than diminutive polyps (adjusted odds ratio [OR] 19.5; 95% CI, 4.4-85.6) or small polyps (adjusted OR 6.1; 95% CI, 2.2-16.9). LIMITATIONS: Use of pathology reports for polyp size. CONCLUSION: Among a cohort of minority patients, advanced histologic features were very rare in diminutive polyps. Distal polyps were less likely to be neoplastic than proximal polyps in all size categories. This supports a resect and discard strategy for diminutive polyps, especially in the distal colon.

Patient-, provider-, and system-level factors in low adherence to surveillance colonoscopy guidelines: implications for future interventions.

PURPOSE: Patients with a history of advanced adenomas are at increased risk of developing colorectal cancer (CRC), yet rates of adherence to current surveillance colonoscopy guidelines are poor. We determined rates of referral and adherence to 3-year interval surveillance colonoscopy in patients with advanced adenomas and identified modifiable factors as possible intervention targets to improve surveillance referral and adherence in these at-risk patients. METHODS: We reviewed electronic medical records (EMR) of patients (N = 103) who had pathology findings on screening colonoscopy that warranted a 3-year surveillance colonoscopy. We abstracted demographics, surveillance colonoscopy completion rate, documentation of initial pathology in the "Problem List" of the EMR, and timing and nature of visits to a primary care physician (PCP). RESULTS: Only 22 (21.4 %) patients had a record of surveillance colonoscopy completion. Among non-completers, 50.6 % of patients had no PCP visit within a year of their surveillance due date, 19.8 % saw a PCP and were not referred, and 29.6 % saw a PCP and were referred to either a gastroenterology consultation or a surveillance colonoscopy. Pathology found on initial screening was noted in the Problem List of 77.3 % of completers but only 33.3 % of non-completers (p ≤ 0.001). CONCLUSIONS: Possible targets for interventions include using EMRs to improve physician communication and encouraging patients to have timely PCP visits and follow-through after colonoscopy referral. Clinical studies in this area have the potential to improve outcomes for patients by reducing CRC mortality through early detection.

Colorectal neoplasia detection among black and Latino individuals undergoing screening colonoscopy: a prospective cohort study.

BACKGROUND: Most prospective studies of screening colonoscopy (SC) in average-risk, asymptomatic individuals have included few minority individuals. Little is known about the prevalence and distribution of adenomas found at screening colonoscopy among black and Latino individuals. OBJECTIVE: To determine the prevalence and distribution of histologically confirmed adenomas among black and Latino participants enrolled in a prospective SC study. DESIGN: Cross-sectional analysis of consecutive patients undergoing SC between 2008 and 2011. SETTING: Urban academic medical center. PATIENTS: Average risk, asymptomatic black and Latino patients aged ≥50 years undergoing SC. INTERVENTION SC MAIN OUTCOME MEASUREMENTS: Adenoma prevalence and distribution by ethnic group. RESULTS: A total of 584 patients (270 black, 314 Latino) completed SC. Overall, 26.4% had adenomas, and 20% had proximal adenomas. Advanced adenomas occurred in 11.5% (12.2% black vs 10.8% Latino; P = .21) and proximal advanced adenomas in 7.5% (5.9% black vs 8.9% Latino; P = .17). These rates were at least as high as those of other studies that enrolled mainly white participants. LIMITATIONS: Lack of comparison group of white patients. CONCLUSION: The prevalence of adenomas, advanced adenomas, and proximal adenomas was high in both black and Latino participants. The high prevalence of clinically significant proximal lesions has implications for the choice of colon cancer screening test and colonoscopic surveillance intervals.

Effect of dermoscopy education on the ability of medical students to detect skin cancer.

OBJECTIVES: To determine students' ability to discriminate benign vs malignant lesions and to assess attitudes regarding skin cancer examination (SCE). DESIGN: Second-year medical students at 1 institution participated in an SCE intervention for 2 consecutive years. INTERVENTION: Cohort 1 received intervention A, consisting of SCE teaching without a dermoscopy tutorial. Cohort 2 received intervention B, consisting of SCE teaching with a dermoscopy tutorial, access to online dermoscopy resources, and a dermoscope. MAIN OUTCOME MEASURE: Surveys before and after the lecture included an image-based test of 10 lesions to assess ability to differentiate benign from malignant lesions. RESULTS: There were 130 participants from cohort 1 and 131 participants from cohort 2 at the postintervention survey. At baseline, students in both groups reported similar attitudes regarding the value of SCE (P = .05) and intention to perform SCE on patients (P = .55). Overall, cohort 2 exhibited improvement (P < .001) from preintervention (52.0% correct) to postintervention assessments (63.0% correct), whereas cohort 1 did not (47.0% and 46.0% correct, respectively; P = .50). Although both groups improved (P < .001) in the diagnosis of the superficial spreading melanoma, cohort 2 improved in the diagnosis of the basal cell carcinoma (P < .001) and cohort 1 displayed deterioration in identifying the malignant nature of this lesion (P < .001). For the nodular melanoma, correct diagnosis decreased significantly in cohort 1 (P < .001) and negligibly in cohort 2 (P = .90). CONCLUSIONS: Students receiving the dermoscopy tutorial improve in diagnosis of cutaneous lesions compared with those not receiving the dermoscopy intervention. Teaching SCE with inclusion of dermoscopy may be an effective means of enhancing skin cancer knowledge.