Browsing by Author "Boland, C. Richard"

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    Early-Age Onset Colorectal Neoplasia in Average-Risk Individuals Undergoing Screening Colonoscopy: A Systematic Review and Meta-Analysis
    (Elsevier, 2021-10) Kolb, Jennifer M.; Hu, Junxiao; DeSanto, Kristen; Gao, Dexiang; Singh, Siddharth; Imperiale, Thomas; Lieberman, David A.; Boland, C. Richard; Patel, Swati G.; Medicine, School of Medicine
    Background/Aims Incidence and mortality associated with early age onset colorectal cancer (EAO-CRC) is increasing, prompting professional society recommendations to lower the screening age in average risk individuals. The yield of screening individuals <50 years old is not known. Methods A systematic review of 3 databases from inception through July 2020 was performed in all languages that reported colonoscopy findings in average risk individuals<50 years old. The primary outcomes were EAO colorectal neoplasia (EAO-CRN) and advanced colorectal neoplasia (EAO-aCRN) prevalence. Subgroup analyses were performed based on sex, geographic location, time period, and age including comparison to age 50-59. Generalized linear mixed model with random intercept logistic regression and fixed subgroup effects were performed Results Of 10,123 unique articles, 17 studies published between 2002-2020, including 51,811 average-risk individuals from four continents, were included. The pooled rate of EAO-CRN was 13.7% (95%CI: 0.112-0.168) and EAO-aCRN was 2.2% (95%CI: 0.016-0.031). Prevalence of CRC was .05% (0.00029-0.0008). Rates of EAO-CRN were higher in men compared to women (RR 1.71, 1.49–1.98), and highest in the United States (15.6%:12.2-19.7) compared to Europe (14.9%:6.9-29.3), East Asia (13.4%:10.3-17.2), and the Middle East (9.8%:7.8-12.2)(p=0.04) The rate of EAO-CRN in age 45-49 and 50-59 was 17.8% (14.5-21.6) and 24.8% (19.5-30.8), respectively (p=0.04). The rate of EAO-aCRN in age 45-49 was 3.6% (1.9-6.7) and 4.2% (3.2-5.7), respectively (p=0.69) Conclusions The rate of advanced colorecta neoplasia in individuals age 45-49 was similar to the rate observed in age 50-59, suggesting that expanding screening to this population could yield similar impact on colorectal cancer risk reduction.
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    Recommendations on Surveillance and Management of Biallelic Mismatch Repair Deficiency (BMMRD) Syndrome: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer
    (Elsevier, 2017-05) Durno, Carol; Boland, C. Richard; Cohen, Shlomi; Dominitz, Jason A.; Giardiello, Frank M.; Johnson, David A.; Kaltenbach, Tonya; Levin, T. R.; Lieberman, David; Robertson, Douglas J.; Rex, Douglas K.; Department of Medicine, School of Medicine
    The US Multi-Society Task Force on Colorectal Cancer, with invited experts, developed a consensus statement and recommendations to assist health care providers with appropriate management of patients with biallelic mismatch repair deficiency (BMMRD) syndrome, also called constitutional mismatch repair deficiency syndrome. This position paper outlines what is known about BMMRD, the unique genetic and clinical aspects of the disease, and reviews the current management approaches to this disorder. This article represents a starting point from which diagnostic and management decisions can undergo rigorous testing for efficacy. There is a lack of strong evidence and a requirement for further research. Nevertheless, providers need direction on how to recognize and care for BMMRD patients today. In addition to identifying areas of research, this article provides guidance for surveillance and management. The major challenge is that BMMRD is rare, limiting the ability to accumulate unbiased data and develop controlled prospective trials. The formation of effective international consortia that collaborate and share data is proposed to accelerate our understanding of this disease.