Impacto de la carga familiar y de los hábitos higiénico-dietéticos sobre el desarrollo de pólipos adenomatosos y cáncer colorrectalestudio prospectivo en el área sanitaria de León

Résumé

Introduction: Colorectal cancer (CRC) is a very common tumor in terms of incidence and mortality. Within its multifactorial pathogenesis, hereditary forms of CRC represent 3% of all CRC cases. However, up to 30% of diagnoses imply familial aggregation (familial CRC). While age and male sex are non-modifiable factors that increase risk, other factors associated with lifestyle may have a causative or protective role against this tumor, with contradictory results in the published literature. Backgrounds and Aims: Analyze the pathology found in asymptomatic CRC family background patients regarding to age, sex, degree of relationship and age of the affected relative. Compare these data with the pathology found based on toxic habits, various hygienic-dietary aspects, and drugs. Assess the reasons for requesting colonoscopies in our unit and their correlation with pathological findings. Methods: A descriptive, prospective study with patients who attended an outpatient colonoscopy was developed. Using a self-administered form, sociodemographic, hygienic-dietary, drug, and family background data on CRC or other tumors were collected. After performing the test, the findings we collected and classified as normal colonoscopy, adenomas, high-risk adenomas (HAR) or CRC. A univariate analysis and later on multivariate regression were performed to assess the influence of diet, toxic habits and drugs and the presence of lesions. Results: Data were collected from 2.763 patients with a mean age of 61.21 (14.80) years, 50.1% of them male. After excluding those who had already undergone previous colonoscopies, we have a total of 1,390 patients with a mean age of 57.88 (15.17) years, 47.8% of them male. CRC was diagnosed in 5% of the patients and adenomas in 20.4% (9.4% HAR). The finding of polyps and HAR was more frequent in males (26.9% vs 14.5% and 12.6 vs 6.3% respectively; p<0.001). The mean age was significantly higher in patients with adenomas (56.51 vs 63.22 years; p<0.001). The presence of first-degree family backgrounds (23.9% vs 18.8%; p = 0.03), daily consumption of processed meats (6.7% vs 2.9%; p = 0.02) and daily alcohol consumption versus occasional consumption and teetotaler (32% vs 20% vs 18.6%; p = 0.002) increased the risk of adenomas. The consumption of acetylsalicylic acid (ASA) and statins showed an increased risk of adenomas (27.4% vs 19.6%; p = 0.03 and 28.2% vs 17.6%; p<0.001) respectively, as well as HAR (15.8% vs 8.6%; p = 0.01) for ASA and (14.2% vs 7.6%; p<0.001) for statins. Other antiaggregants were associated with a higher risk of adenomas (35.5% vs 20.1%; p = 0.04) and CRC (16.1% vs 4.8%; p = 0.01). Only rectal bleeding (OR=2.09 IC95%=1.26-3.46; p = 0.005) and anemia (OR=4.14 IC95%=2.37-7.24; p<0.001) had a predictive value for the diagnosis of CRC. Conclusions: Advanced age is a risk factor for adenomas, HRA and CRC. The male sex has been associated with adenomas and HRA. Other dietary factors associated with the presence of adenomas are the consumption of red and processed meat and alcohol intake. Family background for first-degree CRC and drugs such as ASA, other antiplatelet agents, and statins have shown to be associated with an increased risk of colonoscopy lesions.