Background
Colon cancer screening is being introduced in many countries, but standard Western
screening approaches may not be appropriate for Asian societies if differences in
colon cancer epidemiology exist. Comparative analysis of colorectal neoplasia patterns
in South Korean and Western subjects has implications for appropriate screening approaches
in non-Western societies.
Methods
The results of concurrent screening colonoscopies performed in average-risk patients
50 to 69 years old in 2 teaching hospitals, Kyung Hee University Hospital (Seoul,
South Korea) and Virginia Mason Medical Center (Seattle, Wash), were compared with
respect to prevalence, histologic features, anatomic distribution, and shape characteristics
of colorectal neoplasia.
Results
The U.S. (n = 3460) and South Korean (n = 2193) cohorts were similar with regard to
the prevalence of adenomas (28.5% vs 29.8%, respectively, P = .312) and advanced neoplasia (6.4% vs 5.4%, respectively, P = .102), but the proportion of proximal adenomas was greater in the U.S. cohort (62.8%
vs 45.9%, P < .001). The prevalence of adenomas and advanced neoplasia was similar in male patients,
but there was a greater prevalence of neoplasia (23.5% vs 18.8%, P = .006) and advanced neoplasia (5.1% vs 2.7%, P < .001) in U.S. women than South Korean women. When large (≥10 mm) adenomas were
considered, proximal location and nonpolypoid (flat) shape were more common in the
U.S. cohort (79.4% vs 37.1%, P = .003 and 43.5% vs 12.3%, P < .001, respectively). The overall prevalence of large flat adenomas in the U.S. cohort
was 5 times that of the South Korean cohort (2.6% vs 0.5%, P < .001). Adjustment for sex ratio discrepancies (48.3% men in the U.S. cohort vs 60.8%
in the South Korean cohort, P < .001) did not result in any significant changes in the conclusions.
Conclusion
Compared with Westerners, South Koreans have a more distal distribution of adenomas
and advanced neoplasia and lower prevalence of large flat adenomas. South Korean women
have a lower prevalence of colorectal neoplasia than Western women. Such disparities
suggest that Western screening strategies cannot be directly adopted by other countries,
but need to be customized by society.
Abbreviations:
CRC (colorectal cancer), GDKHUH (Gang Dong Kyung Hee University Hospital), VMMC (Virginia Mason Medical Center)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 27, 2015
Accepted:
April 8,
2015
Received:
January 15,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this article.
If you would like to chat with an author of this article, you may contact Dr Lin at [email protected]
Identification
Copyright
© 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
