Prospective Comparative Evaluation of an Office-Based Rapid Immunological Test with a Guaiac-based Fecal Occult Blood Test for Colorectal Cancer Screening in General Population with Average-Risk.

Background & Aims: Hyperplastic polyps may increase the risk for colorectal cancer.The present study sought to determine the association between the presence of large hyperplastic polyps in the colorectum and synchronous advanced colorectal neoplasia.Methods: Among 4,714 asymptomatic persons who underwent screening colonoscopy, cases of advanced colorectal neoplasia (tubular adenoma >/=1cm, adenoma with any villous histology, adenoma with carcinoma in situ or high grade dysplasia, or invasive adenocarcinoma) were compared with controls without advanced neoplasia for the presence of large (>/= 1 cm) hyperplastic polyps.Candidate predictors of advanced neoplasia were age, sex, family history of colorectal cancer, body mass index, the presence and number of small tubular adenomas (<1cm) and small hyperplastic polyps (<1cm), and the presence of large hyperplastic polyps.Independent predictors of advanced neoplasia were determined by multivariate logistic regression analysis.Results: We identified 467 cases and 4, 247 controls.In total, 109 subjects (2.3% of the study population) had large hyperplastic polyps.Independent predictors of advanced colonic neoplasia were increasing age (OR=4.51,95% CI 1.43-14.3,P=0.01 for subjects >/=80 years vs. 50 to 54 years), 3 or more non-advanced tubular adenomas (OR=2.33,95% CI 1.37-3.96,P=0.0017), and large hyperplastic polyps (OR = 3.24, 95% CI 2.05-5.13,P<0.0001).Right-sided (OR=3.38,95% CI 1.81-6.32)and left-sided (OR=2.66,95% CI 1.37-5.19)large hyperplastic polyps had a similar association with advanced colorectal neoplasia (right vs. left P=0.622).BMI, male sex, colorectal cancer in a first degree-relative, and the presence of multiple small hyperplastic polyps did not associate independently with advanced colonic neoplasia.Conclusions: Although found in a small percentage of average risk subjects undergoing screening colonoscopy, large hyperplastic polyps are strongly and independently associated with synchronous advanced colorectal neoplasia.Our results suggest that large hyperplastic polyps are important lesions that may merit complete removal and subsequent colonoscopic surveillance.