Colorectal Cancer Risk Following Adenoma Removal: A Large Prospective Population-Based Cohort Study

Background: Randomized controlled trials have demonstrated significant reductions in colorectal cancer incidence and mortality associated with polypectomy. However, little is known about whether polypectomy is effective at reducing colorectal cancer risk in routine clinical practice. The aim of this investigation was to quantify colorectal cancer risk following polypectomy in a large prospective population-based cohort study. Methods: Patients with incident colorectal polyps between 2000 and 2005 in Northern Ireland were identified via electronic pathology reports received to the Northern Ireland Cancer Registry. Patients were matched to the Northern Ireland Cancer Registry to detect colorectal cancer and deaths up to December 31, 2010. Colorectal cancer standardized incidence ratios (SIR) were calculated and Cox proportional hazards modeling applied to determine colorectal cancer risk. Results: During 44,724 person-years of follow-up, 193 colorectal cancer cases were diagnosed among 6,972 adenoma patients, representing an annual progression rate of 0.43%. Colorectal cancer risk was significantly elevated in patients who had an adenoma removed (SIR, 2.85; 95% CI, 2.61–3.25) compared with the general population. Male sex, older age, rectal site, and villous architecture were associated with an increased colorectal cancer risk in adenoma patients. Further analysis suggested that not having a full colonoscopy performed at, or following, incident polypectomy contributed to the excess colorectal cancer risk. Conclusions: Colorectal cancer risk was elevated in individuals following polypectomy for adenoma, outside of screening programs. Impact: This finding emphasizes the need for full colonoscopy and adenoma clearance, and appropriate surveillance, after endoscopic diagnosis of adenoma. Cancer Epidemiol Biomarkers Prev; 24(9); 1373–80. ©2015 AACR.

[1]  B. Leggett,et al.  Critical Appraisal of the Diagnosis of the Sessile Serrated Adenoma , 2014, The American journal of surgical pathology.

[2]  D. McMillan,et al.  Flexible sigmoidoscopy following a positive faecal occult blood test within a bowel screening programme may reduce the detection of neoplasia , 2013, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[3]  R. McNally,et al.  Outcome of 12‐month surveillance colonoscopy in high‐risk patients in the National Health Service Bowel Cancer Screening Programme , 2013, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[4]  Á. Lanas,et al.  Risk of advanced proximal neoplasms according to distal colorectal findings: comparison of sigmoidoscopy-based strategies. , 2013, Journal of the National Cancer Institute.

[5]  S. Leedham,et al.  Reporting trends of right-sided hyperplastic and sessile serrated polyps in a large teaching hospital over a 4-year period (2009–2012) , 2013, Journal of Clinical Pathology.

[6]  B. Leggett,et al.  The serrated pathway to colorectal carcinoma: current concepts and challenges , 2013, Histopathology.

[7]  J. Viel,et al.  Predictors of Colorectal Polyp Recurrence after the First Polypectomy in Private Practice Settings: A Cohort Study , 2012, PloS one.

[8]  Charles J. Kahi,et al.  Serrated Lesions of the Colorectum: Review and Recommendations From an Expert Panel , 2012, The American Journal of Gastroenterology.

[9]  H. Brenner,et al.  Role of Colonoscopy and Polyp Characteristics in Colorectal Cancer After Colonoscopic Polyp Detection , 2012, Annals of Internal Medicine.

[10]  H. Brenner,et al.  Risk of colorectal cancer after detection and removal of adenomas at colonoscopy: population-based case-control study. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  Mark P Purdue,et al.  Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. , 2012, The New England journal of medicine.

[12]  P. Prorok,et al.  Colorectal cancers not detected by screening flexible sigmoidoscopy in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. , 2012, Gastrointestinal endoscopy.

[13]  D. Han,et al.  The Miss Rate for Colorectal Adenoma Determined by Quality-Adjusted, Back-to-Back Colonoscopies , 2012, Gut and liver.

[14]  V. Jooste,et al.  Long-term risk of colorectal cancer after adenoma removal: a population-based cohort study , 2011, Gut.

[15]  L. Bisanti,et al.  Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial--SCORE. , 2011, Journal of the National Cancer Institute.

[16]  L. Holmberg,et al.  A population-based comparison of the survival of patients with colorectal cancer in England, Norway and Sweden between 1996 and 2004 , 2011, Gut.

[17]  J. Adolfsson,et al.  Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data , 2011, The Lancet.

[18]  Cancer,et al.  Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial , 2010, The Lancet.

[19]  R. Steele,et al.  Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002) , 2010, Gut.

[20]  S. Yoon.  A Pooled Analysis of Advanced Colorectal Neoplasia Diagnoses after Colonoscopic Polypectomy (Gastroenterology 2009;136:832-841) , 2009 .

[21]  R. Pearson.  Comparison of CT colonography, colonoscopy, sigmoidoscopy and fecal occult blood tests for the detection of advanced adenoma in an average risk population , 2009 .

[22]  M. Bretthauer,et al.  Risk of colorectal cancer seven years after flexible sigmoidoscopy screening: randomised controlled trial , 2009, BMJ : British Medical Journal.

[23]  D. Alberts,et al.  A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. , 2009, Gastroenterology.

[24]  R. Ward,et al.  Serrated and non-serrated polyps of the colorectum: their prevalence in an unselected case series and correlation of BRAF mutation analysis with the diagnosis of sessile serrated adenoma , 2009, Journal of Clinical Pathology.

[25]  C. Becker,et al.  Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population , 2008, Gut.

[26]  N. Wright,et al.  Mechanisms of Disease: from stem cells to colorectal cancer , 2006, Nature Clinical Practice Gastroenterology &Hepatology.

[27]  J. Habbema,et al.  Colorectal cancer risk after colonoscopic polypectomy: a population-based study and literature search. , 2005, European journal of cancer.

[28]  J. Habbema,et al.  Colorectal cancer risk in adenoma patients: A nation‐wide study , 2004, International journal of cancer.

[29]  Jingsong He,et al.  Colonoscopic miss rates for right-sided colon cancer: a population-based analysis. , 2004, Gastroenterology.

[30]  Jahn M. Nesland,et al.  Morphologic Reappraisal of Serrated Colorectal Polyps , 2003, The American journal of surgical pathology.

[31]  W. Atkin,et al.  Surveillance guidelines after removal of colorectal adenomatous polyps , 2002, Gut.

[32]  J. Mayberry,et al.  Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel disease , 2002, Gut.

[33]  C. Vecchia,et al.  Trends in the subsite distribution of colorectal carcinomas and polyps , 1998, Cancer.

[34]  M. Costantini,et al.  Distal hyperplastic polyps do not predict proximal adenomas: results from a multicentric study of colorectal adenomas. , 1997, Gastrointestinal endoscopy.

[35]  A. Zauber,et al.  Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. , 1993 .

[36]  R. Sampliner,et al.  Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps. , 1991, Gastrointestinal endoscopy.

[37]  J. Burke,et al.  Carcinoma of the colon and rectum. , 1962, The New England journal of medicine.

[38]  G. Miller.  Carcinoma of the Colon and Rectum. , 1942, Canadian Medical Association journal.

[39]  John Baron,et al.  The colonoscopic miss rate and true one-year recurrence of colorectal neoplastic polyps , 1999, American Journal of Gastroenterology.

[40]  D. Rex,et al.  Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. , 1997, Gastroenterology.

[41]  R. Fitzgibbons,et al.  Hereditary Colorectal Cancer , 1990, Springer Japan.