S408 Prevalence of High-Risk Polyps by Race and Sex in a Multi-Ethnic Population

Introduction: Removal of high-risk colorectal polyps with colonoscopy has decreased incidence and mortality of colorectal cancer (CRC). Despite decrease in CRC incidence and mortality, disparities and inequities persist in outcomes. Polyp histology is related to risk of developing adenocarcinoma and may be one of the mechanisms underlying this difference. A 2018 systematic review and meta-analysis showed no difference in prevalence of advanced adenomas and advanced pre-cancerous colorectal polyps in Black and White individuals. We aimed to analyze differences in polyp histology by race/ethnicity and sex in a multi-ethnic population. Methods: A retrospective chart review was performed at New York University Langone Medical Center and Bellevue Hospital Center on patients undergoing first screening colonoscopies from 2000 to 2014. Charts of 8,519 patients were reviewed of which 6449 charts were eligible. Hyperplastic polyps were excluded from analysis. Adenomas and adenocarcinomas were included, high risk lesions were grouped and included sessile serrated adenomas, serrated adenomas, tubulovillous adenomas, villous adenomas high grade dysplasia, and intramucosal adenocarcinomas. Data collected included age, sex, race/ethnicity, indication, polyp location and histology. Descriptive statistics and chi-squared analyses were used to compare polyp histology based on race and sex. Results: Overall, 2,056 total lesions were detected, with most occurring in men (56.3%). Tubular adenomas accounted for 86% (1769) of all lesions, with 57% (1009) occurring in men. Tubulovillous adenomas accounted for 5.74% (118), sessile serrated adenomas accounted for 4.72% (97), serrated adenoma for 0.83% (17), high grade dysplasia in 0.78% (16), villous adenoma 0.10% (2). Adenocarcinoma accounted for 1.02% (21) of total lesions. Analysis of high-risk lesions by Chi-square analysis found no significant association with sex (χ2 3.20, p = 0.07) or race (χ2 7.17, p = 0.13) and likelihood of high-risk lesions when sessile serrated and serrated adenomas were excluded. When included there was a significant association between race and high-risk lesions (χ2 15.44, p = 0.004) (Table 1). Conclusion: Our findings indicate there is a significant association between race, sex and the likelihood of high-risk lesions in this multi-ethnic population when sessile serrated and serrated adenomas are included. It is possible there is a relationship between race and the genetic and histologic characteristics of these lesions. More research is needed to clarify this relationship. Table 1. - Polyp Histology by Race and Sex General (All Races) White Hispanic General Male Female General Male Female General Male Female Colonoscopies 5058 2365 2686 1394 752 641 1522 586 935 Total Lesions Detected 2056 1157 894 915 558 356 448 213 235 Sessile Serrated Adenoma 97 (4.72%) 47 (4.06%) 49 (5.48%) 71 (7.76%) 40 (7.17%) 31 (8.71%) 12 (2.68%) 1 (0.47%) 11 (4.68%) Serrated Adenoma 17 (0.83%) 9 (0.78%) 8 (0.89%) 6 (0.66%) 5 (0.90%) 1 (0.28%) 3 (0.67%) 0 (0%) 3 (1.28%) Tubular Adenoma 1769 (86.04%) 1009 (87.21%) 756 (84.56%) 761 (83.17%) 473 (84.77%) 287 (80.62%) 394 (87.95%) 194 (91.08%) 200 (85.12%) Tubulovillous Adenoma 118 (5.74%) 58 (5.01%) 60 (6.71%) 48 (5.25%) 21 (3.76%) 27 (7.58%) 30 (6.70%) 13 (6.10%) 17 (7.23%) Villous Adenoma 2 (0.10%) 1 (0.09%) 1 (0.11%) 1 (0.11%) 1 (0.18%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Low Grade Dysplasia 2 (0.10% 1 (0.09%) 1 (0.11%) 2 (0.22%) 1 (0.18%) 1 (0.28%) 0 (0%) 0 (0%) 0 (0%) High Grade Dysplasia 16 (0.78%) 11 (0.95%) 5 (0.56%) 7 (0.77%) 4 (0.72%) 3 (0.84%) 2 (0.45%) 2 (0.94%) 0 (0%) Intramucosal Adenocarcinoma 14 (0.68%) 9 (0.78%) 5 (0.56%) 6 (0.66%) 4 (0.72%) 2 (0.56%) 4 (0.89%) 2 (0.94%) 2 (0.85%) Adenocarcinoma 21 (1.02%) 12 (1.04%) 9 (1.01%) 13 (1.42%) 9 (1.61%) 4 (1.12%) 3 (0.67%) 1 (0.47%) 2 (0.85%) Asian Black Other General Male Female General Male Female General Male Female Colonoscopies 874 421 451 807 394 412 217 114 101 Total Lesions Detected 283 158 125 264 150 113 77 45 29 Sessile Serrated Adenoma 5 (1.77%) 2 (1.27%) 3 (2.40%) 5 (1.89%) 2 (1.33%) 3 (2.65%) 3 (3.90%) 2 (4.44%) 0 (0%) Serrated Adenoma 2 (0.71%) 1 (0.63%) 1 (0.8%) 4 (1.52%) 2 (1.33%) 2 (1.77%) 0 (0%) 0 (0%) 0 (0%) Tubular Adenoma 261 (92.23%) 146 (92.41%) 115 (92.0%) 229 (86.74%) 130 (86.67%) 98 (86.73%) 64 (83.12%) 36 (80.0%) 26 (89.66%) Tubulovillous Adenoma 11 (3.89%) 7 (4.43%) 4 (3.20%) 20 (7.58%) 12 (8.00%) 8 (7.08%) 5 (6.49%) 3 (6.67%) 2 (6.90%) Villous Adenoma 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) Low Grade Dysplasia 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) High Grade Dysplasia 1 (0.35%) 0 (0%) 1 (0.8%) 3 (1.14%) 3 (2.00%) 0 (0%) 3 (3.90%) 2 (4.44%) 1 (3.45%) Intramucosal Adenocarcinoma 1 (0.35%) 1 (0.63%) 0 (0%) 2 (0.76%) 1 (0.67%) 1 (0.88%) 1 (1.30%) 1 (2.22%) 0 (0%) Adenocarcinoma 2 (0.71%) 1 (0.63%) 1 (0.8%) 1 (0.38%) 0 (0%) 1 (0.88%) 1 (1.30%) 1 (2.22%) 0 (0%)