RetroSearch Browse

Home - News ( United States | United Kingdom | Italy | Germany ) - Football scores

Showing content from https://pubmed.ncbi.nlm.nih.gov/29800214/ below:

Association of Colonoscopy Adenoma Findings With Long-term Colorectal Cancer Incidence

Randomized Controlled Trial

. 2018 May 15;319(19):2021-2031. doi: 10.1001/jama.2018.5809. Association of Colonoscopy Adenoma Findings With Long-term Colorectal Cancer Incidence

Affiliations

¹ Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
² Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland.
³ Information Management Services, Rockville, Maryland.
⁴ Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.

PMID: 29800214
PMCID: PMC6583246
DOI: 10.1001/jama.2018.5809

Item in Clipboard

Randomized Controlled Trial

Association of Colonoscopy Adenoma Findings With Long-term Colorectal Cancer Incidence

Benjamin Click et al. JAMA. 2018.

. 2018 May 15;319(19):2021-2031. doi: 10.1001/jama.2018.5809. Affiliations

¹ Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
² Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland.
³ Information Management Services, Rockville, Maryland.
⁴ Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.

PMID: 29800214
PMCID: PMC6583246
DOI: 10.1001/jama.2018.5809

Item in Clipboard

Abstract

Importance: Individuals with adenomatous polyps are advised to undergo repeated colonoscopy surveillance to prevent subsequent colorectal cancer (CRC), but the relationship between adenomas at colonoscopy and long-term CRC incidence is unclear.

Objective: To compare long-term CRC incidence by colonoscopy adenoma findings.

Design, setting, and participants: Multicenter, prospective cohort study of participants in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer randomized clinical trial of flexible sigmoidoscopy (FSG) beginning in 1993 with follow-up for CRC incidence to 2013 across the United States. Participants included 154 900 men and women aged 55 to 74 years enrolled in PLCO of whom 15 935 underwent colonoscopy following their first positive FSG screening result. The final day of follow-up was December 31, 2013.

Exposures: Enrolled participants had been randomized to FSG or usual care. Participants who underwent FSG and had abnormal findings were referred for follow-up. Subsequent colonoscopy findings were categorized as advanced adenoma (≥1 cm, high-grade dysplasia, or tubulovillous or villous histology), nonadvanced adenoma (<1 cm without advanced histology), or no adenoma.

Main outcomes and measures: The primary outcome was CRC incidence within 15 years of the baseline colonoscopy. The secondary outcome was CRC mortality.

Results: There were 15 935 participants who underwent colonoscopy (men, 59.7%; white, 90.7%; median age, 64 y [IQR, 61-68]). On initial colonoscopy, 2882 participants (18.1%) had an advanced adenoma, 5068 participants (31.8%) had a nonadvanced adenoma, and 7985 participants (50.1%) had no adenoma; median follow-up for CRC incidence was 12.9 years. CRC incidence rates per 10 000 person-years of observation were 20.0 (95% CI, 15.3-24.7; n = 70) for advanced adenoma, 9.1 (95% CI, 6.7-11.5; n = 55) for nonadvanced adenoma, and 7.5 (95% CI, 5.8-9.7; n = 71) for no adenoma. Participants with advanced adenoma were significantly more likely to develop CRC compared with participants with no adenoma (rate ratio [RR], 2.7 [95% CI, 1.9-3.7]; P < .001). There was no significant difference in CRC risk between participants with nonadvanced adenoma compared with no adenoma (RR, 1.2 [95% CI, 0.8-1.7]; P = .30). Compared with participants with no adenoma, those with advanced adenoma were at significantly increased risk of CRC death (RR, 2.6 [95% CI, 1.2-5.7], P = .01), but mortality risk in participants with nonadvanced adenoma was not significantly different (RR, 1.2 [95% CI, 0.5-2.7], P = .68).

Conclusions and relevance: Over a median of 13 years of follow-up, participants with an advanced adenoma at diagnostic colonoscopy prompted by a positive flexible sigmoidoscopy result were at significantly increased risk of developing colorectal cancer compared with those with no adenoma. Identification of nonadvanced adenoma may not be associated with increased colorectal cancer risk.

Trial registration: clinicaltrials.gov Identifier: NCT00002540.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Schoen reported receiving grant support from Medtronic. No other disclosures were reported.

Figures
Figure 1.. Flow of Included Participants Through…

Figure 1.. Flow of Included Participants Through the Prostate, Lung, Colorectal, and Ovarian Cancer Screening…
Figure 1.. Flow of Included Participants Through the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

FSG indicates flexible sigmoidoscopy. ^aData for number screened for eligibility and reasons for exclusion were not available.

Figure 2.. Cumulative Colorectal Cancer Incidence by…

Figure 2.. Cumulative Colorectal Cancer Incidence by Adenoma Status Among Participants Aged 55 to 74…
Figure 2.. Cumulative Colorectal Cancer Incidence by Adenoma Status Among Participants Aged 55 to 74 Years Enrolled in the Prostate, Lung, Colorectal, and Ovarian Cancer Randomized Clinical Trial

Error bars indicate 95% CIs at the given time point. Median time of follow-up was 13.6 years (interquartile range [IQR], 10.3-15.0) for advanced adenoma, 13.1 years (IQR, 9.9-15.0) for nonadvanced adenoma, and 12.5 years (IQR, 9.7-15.0) for no adenoma. P values for pairwise comparisons (log-rank test) were P < .001 for advanced adenoma vs no adenoma, P < .001 for advanced adenoma vs nonadvanced adenoma, and P = .32 for nonadvanced adenoma vs no adenoma.