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

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Title: Adenoma surveillance on colorectal cancer incidence: a retrospective, multicentre, cohort study
Author(s): Atkin, WS
Wooldrage, K
Brenner, A
Martin, J
Shah, U
Perera, S
Lucas, F
Brown, JP
Kralj-Hans, I
Greliak, P
Pack, K
Wood, J
Thomson, A
Veitch, A
Duffy, SW
Cross, AJ
Item Type: Journal Article
Abstract: 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.
Publication Date: 27-Apr-2017
Date of Acceptance: 2-Mar-2017
URI: http://hdl.handle.net/10044/1/45420
DOI: https://dx.doi.org/10.1016/S1470-2045(17)30187-0
ISSN: 1474-5488
Publisher: Elsevier: Lancet
Start Page: 823
End Page: 834
Journal / Book Title: Lancet Oncology
Volume: 18
Issue: 6
Copyright Statement: © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/)
Sponsor/Funder: Department of Health
Cancer Research UK
Funder's Grant Number: 04/33/01
A16894
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
INADEQUATE BOWEL PREPARATION
LONG-TERM RISK
COLONOSCOPIC SURVEILLANCE
INCOMPLETE COLONOSCOPY
QUALITY-ASSURANCE
POLYPECTOMY
GUIDELINES
UK
REMOVAL
STRATIFICATION
Adenocarcinoma
Adenoma
Aged
Colonoscopy
Colorectal Neoplasms
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Patient Compliance
Population Surveillance
Retrospective Studies
Risk Factors
Tumor Burden
United Kingdom
Humans
Adenoma
Adenocarcinoma
Colorectal Neoplasms
Colonoscopy
Tumor Burden
Population Surveillance
Incidence
Risk Factors
Retrospective Studies
Follow-Up Studies
Patient Compliance
Aged
Middle Aged
Female
Male
United Kingdom
1112 Oncology And Carcinogenesis
Oncology & Carcinogenesis
Publication Status: Published
Appears in Collections:Division of Surgery
Division of Cancer
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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