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Showing content from https://pubmed.ncbi.nlm.nih.gov/28457708/ below:

Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study

Multicenter Study

Affiliations

• ¹ Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK. Electronic address: w.atkin@imperial.ac.uk.
• ² Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
• ³ New Cross Hospital, Wolverhampton, UK.
• ⁴ Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, UK.

• PMID: 28457708
• PMCID: PMC5461371
• DOI: 10.1016/S1470-2045(17)30187-0

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Multicenter Study

Wendy Atkin et al. Lancet Oncol. 2017 Jun.

• ¹ Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK. Electronic address: w.atkin@imperial.ac.uk.
• ² Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
• ³ New Cross Hospital, Wolverhampton, UK.
• ⁴ Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, UK.

• PMID: 28457708
• PMCID: PMC5461371
• DOI: 10.1016/S1470-2045(17)30187-0

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Background: Removal of adenomas reduces colorectal cancer incidence and mortality; however, the benefit of surveillance colonoscopy on colorectal cancer risk remains unclear. We examined heterogeneity in colorectal cancer incidence in intermediate-risk patients and the effect of surveillance on colorectal cancer incidence.

Methods: We did this retrospective, multicentre, cohort study using routine lower gastrointestinal endoscopy and pathology data from patients who, after baseline colonoscopy and polypectomy, were diagnosed with intermediate-risk adenomas mostly (>99%) between Jan 1, 1990, and Dec 31, 2010, at 17 hospitals in the UK. These patients are currently offered surveillance colonoscopy at intervals of 3 years. Patients were followed up through to Dec 31, 2014.We assessed the effect of surveillance on colorectal cancer incidence using Cox regression with adjustment for patient, procedural, and polyp characteristics. We defined lower-risk and higher-risk subgroups on the basis of polyp and procedural characteristics identified as colorectal cancer risk factors. We estimated colorectal cancer incidence and standardised incidence ratios (SIRs) using as standard the general population of England in 2007. This trial is registered, number ISRCTN15213649.

Findings: 253 798 patients who underwent colonic endoscopy were identified, of whom 11 944 with intermediate-risk adenomas were included in this analysis. After a median follow-up of 7·9 years (IQR 5·6-11·1), 210 colorectal cancers were diagnosed. 5019 (42%) patients did not attend surveillance and 6925 (58%) attended one or more surveillance visits. Compared to no surveillance, one or two surveillance visits were associated with a significant reduction in colorectal cancer incidence rate (adjusted hazard ratio 0·57, 95% CI 0·40-0·80 for one visit; 0·51, 0·31-0·84 for two visits). Without surveillance, colorectal cancer incidence in patients with a suboptimal quality colonoscopy, proximal polyps, or a high-grade or large adenoma (≥20 mm) at baseline (8865 [74%] patients) was significantly higher than in the general population (SIR 1·30, 95% CI 1·06-1·57). By contrast, in patients without these features, colorectal cancer incidence was lower than that of the general population (SIR 0·51, 95% CI 0·29-0·84).

Interpretation: Colonoscopy surveillance benefits most patients with intermediate-risk adenomas. However, some patients are already at low risk after baseline colonoscopy and the value of surveillance for them is unclear.

Funding: National Institute for Health Research Health Technology Assessment, Cancer Research UK.

Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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Study profile *Not mutually exclusive.

Study profile *Not mutually exclusive.

Study profile *Not mutually exclusive.

Cumulative colorectal cancer incidence after…

Cumulative colorectal cancer incidence after baseline Cumulative colorectal cancer incidence with no surveillance…

Cumulative colorectal cancer incidence after baseline Cumulative colorectal cancer incidence with no surveillance (ie, censoring at first follow-up) for the whole cohort (A) and for the risk subgroups (B). Cumulative colorectal cancer incidence after one surveillance visit (ie, censoring at the second follow-up) for the whole cohort (C) and for the risk subgroups (D). 95% CIs are shown for each curve.

• Can post-polypectomy surveillance be less intensive?

  Winawer SJ, Zauber AG. Winawer SJ, et al. Lancet Oncol. 2017 Jun;18(6):707-709. doi: 10.1016/S1470-2045(17)30305-4. Epub 2017 Apr 28. Lancet Oncol. 2017. PMID: 28457710 No abstract available.

• Colorectal adenomas, surveillance, and cancer.

  Løberg M, Holme Ø, Bretthauer M, Kalager M. Løberg M, et al. Lancet Oncol. 2017 Aug;18(8):e427. doi: 10.1016/S1470-2045(17)30473-4. Epub 2017 Jul 26. Lancet Oncol. 2017. PMID: 28759374 No abstract available.

• Colorectal adenomas, surveillance, and cancer - Authors' reply.

  Atkin W, Wooldrage K, Sasieni P, Duffy SW, Cross AJ. Atkin W, et al. Lancet Oncol. 2017 Aug;18(8):e428. doi: 10.1016/S1470-2045(17)30532-6. Epub 2017 Jul 26. Lancet Oncol. 2017. PMID: 28759375 No abstract available.

• Colonoscopy surveillance following adenoma removal to reduce the risk of colorectal cancer: a retrospective cohort study.

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• The clinical effectiveness of different surveillance strategies to prevent colorectal cancer in people with intermediate-grade colorectal adenomas: a retrospective cohort analysis, and psychological and economic evaluations.

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• Colorectal cancer risk following polypectomy in a multicentre, retrospective, cohort study: an evaluation of the 2020 UK post-polypectomy surveillance guidelines.

  Cross AJ, Robbins EC, Pack K, Stenson I, Patel B, Rutter MD, Veitch AM, Saunders BP, Duffy SW, Wooldrage K. Cross AJ, et al. Gut. 2021 Dec;70(12):2307-2320. doi: 10.1136/gutjnl-2020-323411. Epub 2021 Mar 5. Gut. 2021. PMID: 33674342 Free PMC article.

• Chemoprevention of colorectal cancer: systematic review and economic evaluation.

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• The impact of coronavirus disease 2019 on surveillance colonoscopies in South Australia.

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• Prevalence of missed lesions in patients with inadequate bowel preparation through a very early repeat colonoscopy.

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• British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines.

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• Faecal haemoglobin can define risk of colorectal neoplasia at surveillance colonoscopy in patients at increased risk of colorectal cancer.

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