The Chinese University of Hong Kong (CUHK) conducted the world’s first large prospective cohort study on the risk of advanced adenoma among siblings of individuals affected by this problem. Results showed that siblings of individuals with advanced adenoma were 6 times more likely to have advanced adenoma than unaffected people. Researchers advise if one of the family members has advanced adenomas, the respective siblings should consider to undergo colonoscopy to prevent colorectal cancer. The study has been published in the leading medical journal Gastroenterology.

Continuous increase of colorectal cancer incidence observed and high risk group should consider to undergo colonoscopy

In recent years, colorectal cancer has surpassed lung cancer as the most common cancer in Hong Kong. It also ranks second in the top 10 fatal cancers in the local community. There are about 4,769 new cases per year and nearly 2,000 fatal cases. The Department of Health of the HKSAR Government is about to launch a Colorectal Cancer Pilot Screening Programme this year. The Faculty of Medicine at CUHK welcomes the scheme and believes it could curb the morbidity and mortality due to colorectal cancer.

Over the last decade, the Faculty of Medicine at CUHK has been advocating prevention and risk assessment of colorectal cancer through the CUHK Jockey Club Bowel Cancer Education Centre. The researchers believe that the findings of the captioned study will take the work of prevention of colorectal cancer to a whole new level.

Prof. Simon Siu Man NG, Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine at CUHK, said, ‘Colorectal carcinomas are mainly evolved from intestinal polyps (adenomas) over time. If the polyps could be discovered in time and removed through colonoscopy, the incidence of colorectal cancer could be curbed effectively.’

Dr. Siew Chien NG, Associate Professor, Department of Medicine and Therapeutics, Faculty of Medicine at CUHK, stated, ‘Individual cell types of intestinal polyps are known to have a higher chance of developing malignancy, including adenomas with a volume of 10mm or more, and/ or with 25% villous components, or have high grade dysplasia. These cell types are known as advanced adenomas. The significant finding of the recent research is that siblings of individuals with advanced adenomas have a higher risk of having the condition, as well as all kinds of adenoma, than those of unaffected people. They should consider to undergo colonoscopy for the early detection and removal of advanced adenomas.’

From 2010 to 2014, researchers at CUHK recruited 600 people aged 52 to 64 to participate in the case-control study. The frequency of colorectal advanced adenoma in 200 asymptomatic siblings of subjects with advanced adenomas was compared with 400 age-matched and sex-matched siblings of subjects with normal colonoscopies and no family history of colorectal cancer. Findings in both groups were validated by colonoscopy. Results show that subjects from the affected families had 6 times the chance of advanced adenoma compared with the subjects from the control group. They were also 3 times more likely to have adenoma of all kinds.

Research findings optimise clinical advice and help develop public health policy

Dr. Siew NG continued, ‘Our research has two significant indications. First, it optimises clinical advice. Recent findings confirmed the discovery and removal of adenoma is an important indicator for preventing familial colorectal cancer.If one of the family members has advanced adenomas, the respective siblings should consider to undergo colonoscopy to prevent colorectal cancer. Second, it helps develop public health policy. The research results revealed a new high risk group in the community. The Government and medical profession should make a more efficient allocation of resources for the prevention of colorectal cancer, which could reduce the incidence of it in the long run.’

Prof. Justin Che Yuen WU, Director of S.H. Ho Centre for Digestive Health, Institute of Digestive Disease, Faculty of Medicine at CUHK, concluded, ‘This is the world’s first large prospective cohort study confirming the risk of advanced adenomas among siblings of the affected individuals and has been published in the leading medical journal Gastroenterology. World-renowned leaders in this field include Prof. Charles J. KAHI and Prof. David LIEBERMAN also gave their recognition to our study. Our study will start a new era in colorectal cancer prevention. The gastroenterology research team of the Faculty of Medicine at CUHK will conduct further research and hopefully the results could bring benefits to different countries and help revise the guidelines of colorectal cancer prevention.’

To facilitate the public to learn more about intestinal polyps and prevention of colorectal cancer, S.H. Ho Centre for Digestive Health is now implementing the ‘Colorectal Cancer Risk Assessment and Health Promotion Scheme’. This programme provides information of colorectal cancer prevention such as fecal occult blood tests and colonoscopy. First degree relatives of individuals with colorectal cancer or polyps could also understand relevant research and check-up more and assess their risk through this scheme. Member of the public could register online through www.digestivehealth.org.hk or call 24-hour hotline 3151 5666 (This is a telephone recording system, valid from now until 20 July 2016).

CUHK research team conducts a world’s first study showing siblings of individuals with advanced adenoma were 6 times more likely to have advanced adenoma than unaffected people. (From left) Dr. Siew NG, Associate Professor, Department of Medicine and Therapeutics; Prof. Justin WU, Director of S.H. Ho Centre for Digestive Health, Institute of Digestive Disease; and Prof. Simon NG, Division of Colorectal Surgery, Department of Surgery.
Mr Poon says he joined the study after his younger brother confirmed having advanced adenoma. After colonoscopy he was found having the same issue.
Prof. Simon NG states that if the polyps could be discovered in time and removed through colonoscopy, the incidence of colorectal cancer could be curbed effectively.

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