University of Kansas
School of Medicine
Kansas City
This month, Sharma’s Endoscopy Insights focuses on gastrointestinal cancers, a critical topic for gastroenterologists given their role in upper and lower endoscopic screening.
A family history of colorectal cancer is associated with a significantly high risk for adenoma and advanced adenoma, as well as advanced neoplasia. In the first study I highlight, the authors conducted a meta-analysis and further solidified the importance of a more aggressive screening strategy in people with a positive history of CRC.
The second study I discuss shows a projected increase in the incidence in mortality related to five common GI cancers by 2040. The data were sourced from the Surveillance, Epidemiology, and End Results (SEER) Program database from the National Center for Health Statistics and the Global Burden of Diseases (GBD) database. Although the incidence and mortality rates for the five cancers varied between 2000 and 2020, an overall increase in these cancers, especially in men, is anticipated in the next 20 years.
Family History
Am J Gastroenterol 2024 Oct 9. doi:10.14309/ajg.0000000000003120
In this study, researchers in China examined the risk for colorectal neoplasia in patients with a family history of CRC. To conduct this systematic review and meta-analysis, the authors searched PubMed, Web of Science and Embase from each database’s inception through May 9, 2024. They identified 75 observational studies, including 931,515 patients that investigated the connection between CRC history in first-degree relatives and the risk for adenoma, non-advanced adenoma, advanced adenoma and advanced neoplasia.
The 75 studies included 48 cross-sectional studies, 23 case–control studies and four cohort studies. The meta-analysis authors also made efforts to exclude studies with overlapping samples to avoid inflating the results.
The researchers found that a family history of CRC in first-degree relatives was associated with increased risks across the board compared with the risks for people without a family history. This included increased risk for adenoma (pooled odds ratio [OR], 1.67; 95% CI, 1.46-1.88), non-advanced adenoma (pooled OR, 1.35; 95% CI, 1.21-1.51), advanced adenoma (pooled OR, 1.66; 95% CI, 1.46-1.88) and advanced neoplasia (pooled OR, 1.58; 95% CI, 1.44-1.73).
Patients with two or more first-degree relatives who had had CRC were at even more distinct risk: adenoma (pooled OR, 4.18; 95% CI, 1.76-9.91), advanced adenoma (pooled OR, 2.42; 95% CI, 1.72-3.40), and advanced neoplasia (pooled OR, 2.00; 95% CI, 1.68-2.38). These trends persisted across subgroups.
These findings emphasize the importance of screening individuals with a positive family history of CRC.
Cancer Trends
Am J Gastroenterol 2024 Nov 12. doi:10.14309/ajg.0000000000003198
In this study, researchers in China examined incidence and mortality trends and predictions for five GI cancers in the United States..
The researchers analyzed data from the SEER database and the 2019 GBD study for five major GI cancers: CRC, pancreatic, liver, stomach and esophageal.
Men consistently had higher incidence and mortality rates across all GI cancers and all U.S. states, according to the study.
From 2000 to 2020, the incidence of CRC remained stable for American Indian and Alaska Native men, Hispanic men, and Hispanic women. Incidence rates in all other groups and mortality rates in all groups declined. Over the same period, pancreatic cancer incidence increased for all groups except for American Indian and Alaska Native men, and mortality rates rose for white men and Hispanic women. The incidence of liver cancer rose among American Indian and Alaska Native men and white, Hispanic, American Indian and Alaska Native women, but mortality rates declined for most groups. Stomach cancer incidence and mortality either declined or stabilized for all groups, and esophageal cancer rates generally declined.
Despite these stable or downward trends in most groups over the last 20 years, the researchers project that by 2040, both the incidence and mortality rates will increase for most GI cancers, particularly in men.
The study authors suggest this anticipated trend could be related to a variety of factors, including the growth and aging of the U.S. population, lifestyle factors such as rising obesity rates, and disparities in access to screenings and healthcare services.
Further studies are needed to fully understand the reasons behind these trends, the researchers noted. They also suggested that improving access to care across different groups and U.S. geographic regions will be essential to improving outcomes and reducing healthcare disparities.
This article is from the January 2025 print issue.