DESCRIPTION: (Adapted from the Investigator's Abstract) Most colorectal
cancers arise from adenomatous polyps of the large bowel. Patients who have
had one or more adenomas removed are at an increased risk of developing
multiple sequential (metachronous) or recurrent adenomas. Studies assessing
predictors for recurrent adenomas will provide valuable information for
designing individualized, cost-effective, surveillance strategies for
adenoma patients after initial polypectomy. This proposed study will build
upon a recently completed case-control study in Minnesota, in which 574
incident adenoma patients were recruited and comprehensive information on
environmental and lifestyle factors and pathologic characteristic of the
initial adenomas were collected. Blood samples from these patients were
also obtained and are currently being analyzed for polymorphisms of the
familial polyposis gene (APC) and genes that encode N-acetyltransferases
(NAT) and glutatathione S-transferase (GST).
The investigators propose to follow these adenoma patients for 5 years to
assess potential predictors for recurrent adenomas. In addition to the
above mentioned existing data, paraffin embedded tissue blocks of the
initial adenomas will be collected from all patients and analyzed for
selected tumorigenesis markers, k-ras and p53 gene mutations and cell
proliferation activity. These tumorigenesis markers will be analyzed along
with previously collected data on lifestyle factors, pathologic
characteristics of incident adenomas, and genetic susceptibility markers, in
relation to adenoma recurrence. The feasibility of the study has been
clearly demonstrated in our pilot studies. Further, because the study
population is well characterized and a large proportion of data has already
been collected, the proposed study will be extremely cost-effective. The
results of this study are likely to have great implications for
cost-effective managed care of adenoma patients to reduce morbidity and
mortality of colorectal cancer, one of the most common malignancies in this
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