Diabetics may need early colon cancer screening

Type 2 diabetes patients may need to be screened earlier for colorectal cancer, researchers said here. In a single-center study, diabetics, ages 40 to 49, had a comparable number of adenomas detected as healthy patients, ages 50 to 59, Hongha Vu, MD, of Washington University in St. Louis, Mo., and colleagues reported at a press briefing during Digestive Disease Week (DDW). "These patients appear to be at the same risk level as those ages 50 to 59," Vu said, cautioning, however, that larger, prospective trials are needed before guidelines can be changed. Currently, colorectal cancer screening in the U.S. is recommended to start in healthy patients at age 50, though at-risk groups, such as blacks and patients with a family history of disease, should start earlier. Type 2 diabetes has been associated with an increased risk of colorectal neoplasia, but these patients are not currently recognized as an official at-risk population for earlier screening. In order to determine if type 2 diabetes is associated with an increased risk of developing colorectal adenomas in younger diabetic patients, Vu and colleagues conducted a retrospective study of patients who'd had a colonoscopy at their center between June 2005 and June 2011. They assessed three cohorts: Patients, ages 40 to 49, with diabetes Those ages 40 to 49 without diabetes Healthy patients, ages 50 to 59 A total of 3,749 patients, ages 40 to 49, had a colonoscopy during that time, 125 of whom had diabetes. Vu noted that these younger patients had their colonoscopies for diagnostic purposes, to investigate symptoms such as pain or diarrhea. The researchers matched patients from the other two cohorts to the diabetes cohort for date of exam and gender. They found that the adenoma detection rate in the diabetes group was similar to that of healthy patients who started screening at age 50 (30.4% versus 32%). Those rates were far higher than adenomas detected in patients ages 40 to 49 without diabetes (14.4%), they reported. That translated to a significantly higher adenoma detection rate for diabetics compared with younger patients without diabetes (OR 2.6, 95% CI 1.5 to 5.3) and compared with healthy controls, ages 50 to 59 (OR 2.8, 95% CI 1.5 to 5.3). Those odds ratios were increased after adjustment for several factors including gender, indication, race, hypertension, hyperlipidemia, tobacco, alcohol, and body mass index (OR 15.3, 95% CI 1.8 to 132.3, P=0.01, and OR 14.1, 95% CI 1.6 to 126.6, P=0.02, respectively). Vu said the study was limited by its retrospective nature, and again emphasized that larger, prospective studies will be needed before any official guideline recommendations can be made for colon screening in diabetic patients. John Petrini, MD, of the Sansum Clinic in Santa Barbara, Calif., who moderated the DDW press briefing said researchers will "probably want to see at least one confirmatory study and one prospective study." That way, he said, "you'll have more info to go with to the third party payers...to get them to agree to the screening [this patient population]." Primary source: Digestive Disease Week