Histopathology and characteristics of colorectal polyps in a Sub-Saharan setting-implications for local colon cancer screening

Abstract

Background: Colorectal cancer (CRC) is a leading cause of global cancer-related mortality and morbidity, with rising incidence in Sub-Saharan African countries over the past decade. This study aims to determine the prevalence, and describe location, as well as histopathology of polyps in patients undergoing colonoscopy in Ghana. The prevalence and polyp characteristics provide additional data and have implications for developing locally relevant screening guidelines.

Research design and methods: Retrospective chart review of patients ≥18 years who completed a colonoscopy at the anonymized from 1 January 2021 to 31 December 2023.

Results: 510 patients were included in the analysis. The mean age was 54.8 (±0.7 SD); 62% were males. Abnormal findings included hemorrhoids (47.1%), polyps (30.0%), diverticular disease (10.2%), and colonic mass (2.4%). Overall adenoma detection rate (ADR) was 26.1%. Histopathology showed 30.8% tubular adenoma, 30.1% hyperplastic polyps, and 16.0% tubulovillous adenoma. The highest burden of polyps was in the 60- to 80-year-old age group. The prevalence of CRC was 2.2% in our study.

Conclusions: CRC prevalence rates remain relatively low in Sub-Saharan Africa. Access to screening is limited, and the numbers may be underestimated. A cost-effective screening strategy to improve early detection and outcomes is needed.

Keywords: Colonoscopy; Sub-Saharan Africa; colorectal cancer; epidemiology; polyp; screening.