Colorectal cancer in patients under close colonoscopic surveillance.

BACKGROUND & AIMS Colonoscopic polypectomy is considered effective for preventing colorectal cancer (CRC), but the incidence of cancer in patients under colonoscopic surveillance has rarely been investigated. We determined the incidence of CRC in patients under colonoscopic surveillance and examined the circumstances and risk factors for CRC and adenoma with high-grade dysplasia. METHODS Patients were drawn from 3 adenoma chemoprevention trials. All underwent baseline colonoscopy with removal of at least one adenoma and were deemed free of remaining lesions. We identified patients subsequently diagnosed with invasive cancer or adenoma with high-grade dysplasia. The timing, location, and outcome of all cases of cancer and high-grade dysplasia identified are described and risks associated with their development explored. RESULTS CRC was diagnosed in 19 of the 2915 patients over a mean follow-up of 3.7 years (incidence, 1.74 cancers/1000 person-years). The cancers were located in all regions of the colon; 10 were at or proximal to the hepatic flexure. Although most of the cancers (84%) were of early stage, 2 participants died of CRC. Seven patients were diagnosed with adenoma with high-grade dysplasia during follow-up. Older patients and those with a history of more adenomas were at higher risk of being diagnosed with invasive cancer or adenoma with high-grade dysplasia. CONCLUSIONS CRC is diagnosed in a clinically important proportion of patients following complete colonoscopy and polypectomy. More precise and representative estimates of CRC incidence and death among patients undergoing surveillance examinations are needed.

[1]  Peter Lance,et al.  Analysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial. , 2004, Gastrointestinal endoscopy.

[2]  P. Pickhardt,et al.  Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. , 2003, The New England journal of medicine.

[3]  Steven Brown,et al.  A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom , 2003, American Journal of Gastroenterology.

[4]  J. Potter,et al.  Long-term efficacy of sigmoidoscopy in the reduction of colorectal cancer incidence. , 2003, Journal of the National Cancer Institute.

[5]  J. Mandel.  Sigmoidoscopy screening probably works, but how well is still unknown. , 2003, Journal of the National Cancer Institute.

[6]  G. Beck,et al.  A randomized trial of aspirin to prevent colorectal adenomas. , 2003, The New England journal of medicine.

[7]  S. Woolf,et al.  Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. , 2003, Gastroenterology.

[8]  Hermann Brenner,et al.  Cost-effectiveness of colonoscopy in screening for colorectal cancer. , 2002, Archives of internal medicine.

[9]  Michael Pignone,et al.  Cost-Effectiveness Analyses of Colorectal Cancer Screening , 2002, Annals of Internal Medicine.

[10]  J. Church,et al.  Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer , 2002, American Journal of Gastroenterology.

[11]  A. Kalloo,et al.  Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. , 2002, Gastroenterology.

[12]  Amnon Sonnenberg,et al.  Cost-effectiveness of a single colonoscopy in screening for colorectal cancer. , 2002, Archives of internal medicine.

[13]  Michael Pignone,et al.  Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. , 2002, Annals of internal medicine.

[14]  A. Localio,et al.  Initial Evaluation of Rectal Bleeding in Young Persons: A Cost-Effectiveness Analysis , 2002, Annals of Internal Medicine.

[15]  C. Compton,et al.  AJCC Cancer Staging Manual , 2002, Springer New York.

[16]  R. Capocaccia,et al.  Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence , 2001, Gut.

[17]  P. Simpson,et al.  Statistical methods in cancer research , 2001, Journal of surgical oncology.

[18]  J. Bond.  Polyp Guideline: Diagnosis, Treatment, and Surveillance for Patients With Colorectal Polyps* , 2000 .

[19]  J. Bond.  Polyp guideline: diagnosis, treatment, and surveillance for patients with colorectal polyps , 2000, American Journal of Gastroenterology.

[20]  Graham A. Colditz,et al.  Cost-effectiveness of screening for colorectal cancer in the general population. , 2000, JAMA.

[21]  D. Alberts,et al.  Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians' Network. , 2000, The New England journal of medicine.

[22]  T. Fujii,et al.  Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK , 2000, The Lancet.

[23]  G. Beck,et al.  Adenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy. , 2000, Gastrointestinal endoscopy.

[24]  G. Beck,et al.  Calcium supplements for the prevention of colorectal adenomas. Calcium Polyp Prevention Study Group. , 1999, The New England journal of medicine.

[25]  G. Beck,et al.  Adenoma characteristics at first colonoscopy as predictors of adenoma recurrence and characteristics at follow-up. The Polyp Prevention Study Group. , 1998, Gastroenterology.

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

[27]  A. Sonnenberg,et al.  Prevention of Colorectal Cancer by Flexible Endoscopy and Polypectomy: A Case-Control Study of 32 702 Veterans , 1995, Annals of Internal Medicine.

[28]  T A Colacchio,et al.  A clinical trial of antioxidant vitamins to prevent colorectal adenoma. Polyp Prevention Study Group. , 1994, The New England journal of medicine.

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

[30]  O. Kronborg,et al.  The Funen Adenoma Follow-up Study. Incidence and death from colorectal carcinoma in an adenoma surveillance program. , 1993, Scandinavian journal of gastroenterology.

[31]  E T Stewart,et al.  Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. , 1993, The New England journal of medicine.

[32]  J Cuzick,et al.  Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. , 1992, The New England journal of medicine.

[33]  L. Melton,et al.  Colorectal polyps and the risk of subsequent carcinoma. , 1986, Mayo Clinic proceedings.

[34]  O. Kronborg,et al.  Follow-up after colorectal polypectomy. I. A comparison of the effectiveness of repeated examinations of the colon every 6 and 24 months after removal of stalked polyps. , 1983, Scandinavian journal of gastroenterology.

[35]  A. Berger.  FUNDAMENTALS OF BIOSTATISTICS , 1969 .

[36]  J. Higginson,et al.  International Agency for Research on Cancer. , 1968, WHO chronicle.