title: Sessile serrated adenomas in the proximal colon are likely to be flat, large and occur in smokers.
abstract: OBJECTIVE
  To examine the epidemiology and the morphology of the proximal sessile serrated adenomas (SSAs).
  
  
  METHODS
  We conducted a retrospective study to identify patients with SSAs using a university-based hospital pathology database query from January 2007 to April 2011. Data collected included: age, gender, ethnicity, body mass index, diabetes, smoking, family history of colorectal cancer, aspirin, and statin use. We collected data on morphology of SSAs including site (proximal or distal), size, and endoscopic appearance (flat or protuberant). We also compared proximal SSAs to proximal tubular adenomas detected during same time period.
  
  
  RESULTS
  One hundred and twenty patients with SSAs were identified: 61% were distal and 39% were proximal SSAs. Proximal SSAs were more likely to be flat than distal (100% vs 78% respectively; P = 0.0001). Proximal SSAs were more likely to occur in smokers (OR = 2.63; 95%CI: 1.17-5.90; P = 0.02) and in patients with family history of colorectal cancer (OR = 4.72; 95%CI: 1.43-15.55; P = 0.01) compared to distal. Proximal SSAs were statistically more likely to be ≥ 6 mm in size (OR = 2.94; P = 0.008), and also more likely to be large (≥ 1 cm) (OR = 4.55; P = 0.0005) compared to the distal lesions. Smokers were more likely to have proximal (P = 0.02), flat (P = 0.01) and large (P = 0.007) SSAs compared to non-smokers. Compared to proximal tubular adenomas, proximal SSAs were more likely to be large and occur in smokers.
  
  
  CONCLUSIONS
  Proximal SSAs which accounted for two-fifths of all SSAs were more likely to present as flat lesions, larger SSAs, and were more likely to occur in smokers and in patients with family history of colorectal cancer. Our data has implications for colorectal cancer screening.
authors: Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, United States.
authors: Tarun
authors: T
authors: Rustagi
authors: Priya
authors: P
authors: Rangasamy
authors: Matthew
authors: M
authors: Myers
authors: Melinda
authors: M
authors: Sanders
authors: Haleh
authors: H
authors: Vaziri
authors: George Y
authors: GY
authors: Wu
authors: John W
authors: JW
authors: Birk
authors: Petr
authors: P
authors: Protiva
authors: Joseph C
authors: JC
authors: Anderson
mesh_terms: D000236:Adenoma / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology*; D000368:Aged; D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000235:genetics / Q000473:pathology*; D003113:Colonoscopy; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D020022:Genetic Predisposition to Disease; D006785:Hospitals, University; D006801:Humans; D066298:In Vitro Techniques; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010375:Pedigree; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D047368:Tumor Burden
keywords: Adenoma; Colonoscopy; Colorectal cancer; Proximal; Serrated; Sessile; Smoking
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