Testicular cancer survivors (TCS) treated with platinum-based chemotherapy have an increased risk of colorectal cancer (CRC). We determined the yield of colonoscopy in TCS to assess its potential in reducing CRC incidence and mortality. We conducted a colonoscopy screening study among TCS in four Dutch hospitals to assess the yield of colorectal neoplasia. Neoplasia was defined as adenomas, serrated polyps (SPs), advanced adenomas (AAs: ≥10 mm diameter, high-grade dysplasia or ≥25% villous component), advanced serrated polyps (ASPs: ≥10 mm diameter or dysplasia) or CRC. Advanced neoplasia (AN) was defined as AA, ASP or CRC. Colonoscopy yield was compared to average-risk American males who underwent screening colonoscopy (n = 24,193) using a propensity score matched analysis, adjusted for age, smoking status, alcohol consumption and body mass index. A total of 137 TCS underwent colonoscopy. Median age was 50 years among TCS (IQR 43-57) vs 55 years (IQR 51-62) among American controls. A total of 126 TCS were matched to 602 controls. The prevalence of AN was higher in TCS than in controls (8.7% vs 1.7%; P = .0002). Nonadvanced adenomas and SPs were detected in 45.2% of TCS vs 5.5% of controls (P < .0001). No lesions were detected in 46.0% of TCS vs 92.9% of controls (P < .0001). TCS treated with platinum-based chemotherapy have a higher prevalence of neoplasia and AN than matched controls. These results support our hypothesis that platinum-based chemotherapy increases the risk of colorectal neoplasia in TCS. Cost-effectiveness studies are warranted to ascertain the threshold of AN prevalence that justifies the recommendation of colonoscopy for TCS.
International journal of cancer. 2023 Dec 27 [Epub ahead of print]
Emilie C H Breekveldt, Berbel L M Ykema, Tanya M Bisseling, Leon M G Moons, Manon C W Spaander, Inge L Huibregtse, Dorien T J van der Biessen-van Beek, Sasja F Mulder, Lisette Saveur, J Martijn Kerst, Danielle Zweers, Britt B M Suelmann, Ronald de Wit, Agnes Reijm, Sophia van Baalen, Lynn F Butterly, William M Hisey, Christina M Robinson, Anneke J van Vuuren, Beatriz Carvalho, Iris Lansdorp-Vogelaar, Michael Schaapveld, Flora E van Leeuwen, Petur Snaebjornsson, Monique E van Leerdam
Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands., Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands., Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands., Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands., Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands., Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA., Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands., Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.