Prevalence of Colorectal Polyps in a Group of Subjects at Average-risk of Colorectal Cancer Undergoing Colonoscopic Screening in Tehran, Iran between 2008 and 2013

  • Sohrabi, Masoudreza ;
  • Zamani, Farhad ;
  • Ajdarkosh, Hossien ;
  • Rakhshani, Naser ;
  • Ameli, Mitra ;
  • Mohamadnejad, Mehdi ;
  • Kabir, Ali ;
  • Hemmasi, Gholamreza ;
  • Khonsari, Mahmoudreza ;
  • Motamed, Nima
  • Published : 2014.12.18


Background: Colorectal cancer (CRC) is one of the prime causes of mortality around the globe, with a significantly rising incidence in the Middle East region in recent decades. Since detection of CRC in the early stages is an important issue, and also since to date there are no comprehensive epidemiologic studies depicting the Middle East region with special attention to the average risk group, further investigation is of significant necessity in this regard. Aim: Our aim was to investigate the prevalence of preneoplastic and neoplastic lesions of the colon in an average risk population. Materials and Methods: A total of 1,208 eligible asymptomatic, average- risk adults older than 40 years of age, referred to Firuzgar Hospotal in the years 2008-2012, were enrolled. They underwent colonoscopy screening and all polypoid lesions were removed and examined by an expert gastrointestinal pathologist. The lesions were classified by size, location, numbers and pathologic findings. Size of lesions was measured objectively by endoscopists. Results: The mean age of participants was $56.5{\pm}9.59$ and 51.6% were male. The overall polyp detection rate was 199/1208 (16.5 %), 26 subjects having non-neoplastic polyps, including hyperplastic lesions, and 173/1208 (14.3%) having neoplastic polyps, of which 26 (2.15%) were advanced neoplasms. The prevalence of colorectal neoplasia was more common among the 50-59 age group. Advanced adenoma was more frequent among the 60-69 age group. The majority of adenomas were detected in the distal colon, but a quarter of advanced adenomas were found in the proximal colon; advance age and male gender was associated with the presence of adenoma. Conclusions: It seems that CRC screening among average-risk population might be recommended in countries such as Iran. However, sigmioidoscopy alone would miss many colorectal adenomas. Furthermore, the 50-59 age group could be considered as an appropriate target population for this purpose in Iran.




  1. Abdifard E, Ghaderi S, Hosseini S, Heidari M (2013). Incidence trends of colorectal cancer in the West of Iran during 2000- 2005. Asian Pac J Cancer Prev, 14, 1807-11.
  2. Ahnen DJ, Wade SW, Jones WF, et al (2014). The increasing incidence of young-onset colorectal cancer: A call to action. Mayo Clin Proc, 89, 216-24
  3. Ansari R, Mahdavinia M, Sadjadi A, et al (2006). Incidence and age distribution of colorectal cancer in Iran: results of a population-based cancer registry. Cancer Lett, 240, 143-7.
  4. Aswakul P, Prachayakul V, Lohsiriwat V, Bunyaarunnate T, Kachintorn U (2012). Screening colonoscopy from a large single center of Thailand - something needs to be changed? Asian Pac J Cancer Prev, 13, 1361-4.
  5. Azadeh S, Moghimi-Dehkordi B, Fatem SR, et al (2008). Colorectal cancer in Iran: an epidemiological study. Asian Pac J Cancer Prev, 9, 123-6.
  6. Bafandeh Y, Daghestani D, Esmaili H (2005). Demographic and anatomical survey of colorectal polyps in an Iranian population. Asian Pac J Cancer Prev, 6, 537-40.
  7. Bafandeh Y, Khoshbaten M, Eftekhar Sadat AT, Farhang S (2008). Clinical predictors of colorectal polyps and carcinoma in a low prevalence region: results of a colonoscopy based study. World J Gastroenterol, 14, 1534-8.
  8. Baghestani AR, Daneshvar T, Pourhoseingholi MA, Asadzade H (2014). Survival of colorectal cancer patients in the presence of competing-risk. Asian Pac J Cancer Prev, 15, 6253-5.
  9. Benson AB, Venook AP, Bekaii-Saab T, et al (2014). Colon cancer, version 3.2014. J Natl Compr Canc Netw, 12, 1028-59.
  10. Benson VS, Patnick J, Davies AK, et al (2008). Colorectal cancer screening: a comparison of 35 initiatives in 17 countries. Int J Cancer, 122, 1357-67.
  11. Boursi B, Halak A, Umansky M, et al (2009). Colonoscopic screening of an average-risk population for colorectal neoplasia. Endoscopy, 41, 516-21.
  12. Choe JW1, Chang HS, Yang SK, et al (2007). Screening colonoscopy in asymptomatic average-risk Koreans: analysis in relation to age and sex. J Gastroenterol Hepatol, 22, 1003-8.
  13. Chung SJ, Kim YS, Yang SY, et al (2010). Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40-49 years undergoing screening colonoscopy. J Gastroenterol Hepatol, 25, 519-25.
  14. Corley DA, Jensen CD, Marks AR, et al (2013). Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs. Clin Gastroenterol Hepatol, 11, 172-180.
  15. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  16. Ferlitsch M, Reinhart K, Pramhas S, et al (2011). Sex-specific prevalence of adenomas, advanced adenomas, and colorectal cancer in individuals undergoing screening colonoscopy. JAMA, 306, 1352-8.
  17. Gupta AK, Samadder J, Elliott E, Sethi S, Schoenfeld P (2011). Prevalence of any size adenomas and advanced adenomas in 40- to 49-year-old individuals undergoing screening colonoscopy because of a family history of colorectal carcinoma in a first-degree relative. Gastrointest Endosc, 74, 110-8.
  18. Heitman SJ, Ronksley PE, Hilsden RJ, et al (2009). Prevalence of adenomas and colorectal cancer in average risk individuals: a systematic review and meta-analysis. Clin Gastroenterol Hepatol, 7, 1272-8.
  19. Hewitson P, Glasziou P, Watson E, Towler B, Irwig L (2008). Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol, 103, 1541-9.
  20. Imperiale TF, Wagner DR, Lin CY, et al (2000). Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med, 343, 169-174.
  21. Jemal A, Siegel R, Xu J, Ward E (2010). Cancer statistics, 2010. CA Cancer J Clin, 60, 277-300.
  22. Kolahdoozan S, Sadjadi A, Radmard AR, Khademi H (2010). Five common cancers in Iran. Arch Iran Med, 13,143-6.
  23. Levin B, Lieberman DA, McFarland B, et al (2008). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American cancer society, the US multi-society task force on colorectal cancer, and the American college of radiology. Gastroenterology, 134, 1570-95.
  24. Lieberman DA, Weiss DG, Bond JH, et al (2000). Use of colonoscopy to screen asymptomatic adults for colorectal cancer. veterans affairs cooperative study group, 380. N Engl J Med, 343, 162-8.
  25. Mehran A, Jaffe P, Efron J, Vernava A, Liberman A (2003). Screening colonoscopy in the asymptomatic 50- to 59-yearold population. Surg Endosc, 17, 1974-7.
  26. Moghimi-Dehkordi B, Safaee A, Zali MR (2008). Prognostic factors in 1,138 Iranian colorectal cancer patients. Int J Colorectal Dis, 23, 683-8.
  27. Moghimi-Dehkordi B, Safaee A, Zali MR (2009). Comparison of colorectal and gastric cancer: survival and prognostic factors. Saudi J Gastroenterol, 15, 18-23.
  28. Morois S, Cottet V, Racine A, et al (2014). Colonoscopy reduced distal colorectal cancer risk and excess cancer risk associated with family history. Cancer Causes Control. [Epub ahead of print]
  29. Ness RM, Holmes AM, Klein R, Dittus R (2000). Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages. Am J Gastroenterol, 95, 1800-11.
  30. Ng SC,Wong SH (2013). Colorectal cancer screening in Asia. Br Med Bull, 105, 29-42.
  31. Pahlavan PS, Kanthan R (2006). The epidemiology and clinical findings of colorectal cancer in Iran. J Gastrointestin Liver Dis, 15, 15-19.
  32. Regula J, Rupinski M, Kraszewska E, et al (2006). Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med, 355, 1863-72.
  33. Rex DK, Johnson DA, Anderson JC, et al (2009). American College of Gastroenterology guidelines for colorectal cancer screening 2009. Am J Gastroenterol, 104, 739-50.
  34. Rondagh EJ, Bouwens MW, Riedl RG, et al (2012). Endoscopic appearance of proximal colorectal neoplasms and potential implications for colonoscopy in cancer prevention. Gastrointest Endosc, 75, 1218-25.
  35. Roya N, Abbas B (2013). Colorectal cancer trends in Kerman province, the largest province in Iran, with forecasting until 2016. Asian Pac J Cancer Prev, 14, 791-3.
  36. Rundle AG1, Lebwohl B, Vogel R, Levine S, Neugut AI (2008). Colonoscopic screening in average-risk individuals ages 40 to 49 vs 50 to 59 years. Gastroenterology, 134, 1311-5.
  37. Sadjadi A, Nouraie M, Mohagheghi MA, et al (2005). Cancer occurrence in Iran in 2002, an international perspective. Asian Pac J Cancer Prev, 6, 359-63.
  38. Safaee A, Fatemi SR, Ashtari S, et al (2012). Four years incidence rate of colorectal cancer in Iran: a survey of national cancer registry data - implications for screening. Asian Pac J Cancer Prev, 13, 2695-8.
  39. Siegel R, Naishadham D, Jemal A (2012). Cancer statistics, 2012. CA Cancer J Clin, 62,10-29.
  40. Somi MH, Golzari M, Farhang S, Naghashi S, Abdollahi L (2014). Gastrointestinal cancer incidence in East Azerbaijan, Iran: update on 5 year incidence and trends. Asian Pac J Cancer Prev, 15, 3945-9.
  41. Strul H1, Kariv R, Leshno M, et al (2006). The prevalence rate and anatomic location of colorectal adenoma and cancer detected by colonoscopy in average-risk individuals aged 40-80 years. Am J Gastroenterol, 101, 255-62.
  42. Talaiezadeh A1, Tabesh H, Sattari A, Ebrahimi S (2013). Cancer incidence in southwest of iran: first report from Khuzestan population-based cancer registry, 2002-2009. Asian Pac J Cancer Prev, 14, 7517-22.
  43. Thoma MN1, Castro F, Golawala M, Chen R (2011). Detection of colorectal neoplasia by colonoscopy in average-risk patients age 40-49 versus 50-59 years. Dig Dis Sci, 56, 1503-8.
  44. Winawer S J (2012). Colonoscopy: Colorectal cancer screening is a 'package'. Nat Rev Gastroenterol Hepatol, 9, 130-1.
  45. Winawer SJ1, Zauber AG, Ho MN,et al (1993). Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med, 329, 1977-81.
  46. Yang MH, Rampal S, Sung J, et al (2014). The prevalence of colorectal adenomas in asymptomatic Korean men and women. Cancer Epidemiol Biomarkers Prev, 499-507

Cited by

  1. Trace Element and Heavy Metal Levels in Colorectal Cancer: Comparison Between Cancerous and Non-cancerous Tissues pp.1559-0720, 2017,
  2. Advanced colonic neoplasia in the first degree relatives of colon cancer patients: A colonoscopy-based study vol.139, pp.10, 2016,