Randomized Comparison of Surveillance Intervals after Colonoscopic Removal of Newly Diagnosed Adenomatous Polyps

Sj, Winawer; Ag, Zauber; O’Brien, Michael; Mn, Ho; Gottlieb, Leonard S.; Ss, Sternberg; Jd, Waye; Bond, John H.; Schapiro, Melvin; Et, Stewart

doi:10.1056/nejm199304013281301

Cited by 919 publications

(588 citation statements)

References 19 publications

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“…oder hochgradiger intraepithelialer Neoplasie sollte die Kontrollkoloskopie aufgrund des erhöhten Risikos einer fortgeschrittenen Neoplasie nach 3 Jahren erfolgen. Grundlage für diese Empfehlung sind die Daten der National Polyp Study, in der eine Untersuchung nach 3 Jahren eine ähnliche Rate an fortgeschrittenen Neoplasien ergab wie nach 1 Jahr [611]. Patienten mit 5 oder mehr Adenomen haben ein deutlich erhöhtes Risiko für eine fortgeschrittene Neoplasie von 24,9 % in einer gepoolten Analyse [619], vor allem, wenn 1 der Adenome ≥ 10 mm ist [622].…”

Section: Level Of Evidence 3bunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

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Section: Level Of Evidence 3bunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

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“…6 All patients referred for colonoscopy or polypectomy between November 1980 and February 1990 in 7 participating centers who did not have a family or personal history of familial polyposis, inflammatory bowel disease, or a personal history of polypectomy or colorectal cancer were eligible for enrollment in the study. A total of 9,112 subjects referred for colonoscopy were candidates for the study.…”

Section: National Polyp Study Datamentioning

confidence: 99%

“…The eligible but nonrandomized and the eligible randomized adenoma patients had similar characteristics. 6 All detected polyps were removed and a surveillance colonoscopy was offered to the randomized patients in arm A at 1, 3 and 6 years after initial colonoscopy and in arm B at 3 and 6 years after initial colonoscopy. If the colon was not cleared with high confidence at surveillance colonoscopy, the patient was scheduled for repeat colonoscopy.…”

Section: National Polyp Study Datamentioning

confidence: 99%

“…Adenoma Յ 5 mm; 15% Adenoma size at initial polypectomy of all patients included in the National Polyp Study; see Table II Adenoma 6-9 mm; 28% Adenoma 10ϩ mm; 99% Cancer: 100% Sensitivity of initial and surveillance colonoscopic examination Adenoma Յ 5 mm; 80% Back-to-back colonoscopy studies 23-25 Adenoma 6-9 mm; 85% Adenoma 10ϩ mm; 95% Cancer; 95% Reach of initial and surveillance colonoscopic examination 100% National Polyp Study design 6 tion is considered to be of high confidence. Then in the model, it is assumed that all initial and surveillance colonoscopic examinations consist of one colonoscopy and that the reach of the colonoscopy is 100%, i.e., the complete bowel is visualized so that subsequently none of the patients need to undergo a second colonoscopy.…”

Section: Sensitivity Of Fictitious Screening Testmentioning

confidence: 99%

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National Polyp Study data: Evidence for regression of adenomas

Loeve

Boer

Zauber

et al. 2004

Intl Journal of Cancer

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136

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The data of the National Polyp Study, a large longitudinal study on surveillance of adenoma patients, is used for testing assumptions on the adenoma-carcinoma sequence. The observed adenoma and colorectal cancer incidence in the National Polyp Study were compared with the simulated outcomes of the MISCAN-COLON model of epidemiology and control of colorectal cancer for the U.S. population based on expert opinion. Variants of this model were explored in order to identify assumptions on the adenoma-carcinoma sequence that are consistent with the study observations. The high observed adenoma detection rates at surveillance and low observed colorectal cancer incidence in the National Polyp Study could only be explained by assuming a high incidence rate of adenomas accompanied by regression of adenomas. The National Polyp Study data suggest that adenoma prevalence results from a dynamic process of both formation as well as regression of adenomas. This lowers the expectations for the effects of colorectal cancer screening strategies that focus on adenoma detection.

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“…2 CRC arises from neoplastic adenomatous polyps, 5 the prevalence of which increases from 20% to 25% at age 50 years and to 50% percent by ages 75-80 years. 6 Research demonstrates that, although most CRC can be prevented by early endoscopic resection of colon adenomas, 5 patients who have polyps removed have a 30% likelihood of developing recurrent polyps, 7,8 and many do not undergo additional screening. 9 Because polyp risk increases with age, interventions among older adults to prevent recurrent polyps likely would reduce the absolute number of CRC diagnoses among those at highest risk for the disease.…”

mentioning

confidence: 99%

Age‐related vulnerabilities of older adults with colon adenomas

Clipp

Carver

Pollak

et al. 2004

Cancer

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BACKGROUNDThis report addresses the interface between cancer and aging in the context of colorectal carcinoma (CRC), the second leading cause of cancer death in the U.S. overall and the first leading cause among individuals age ≥ 75 years. Because polyp risk increases with age, interventions to prevent recurrent polyps among older adults likely would reduce CRC morbidity and mortality.METHODSData for this study derive from Project Prevent, a multisite, randomized controlled trial designed to reduce behavioral risk factors for CRC among 1247 adults who underwent the removal of ≥ 1 adenomatous colon polyps. Middle‐aged and older patients were compared on key cognitive‐behavioral mechanisms associated with CRC risk and established age‐related factors associated with adverse health outcomes. Relations between cognitive‐behavioral mechanisms and age‐related vulnerability factors identified subgroups of older polyp patients that may have an enhanced risk for CRC.RESULTSCompared with middle‐aged patients, older patients were less concerned about developing CRC, less motivated to reduce their risk, and less confident that their behavior change efforts would succeed. As expected, they also reported more age‐related physical, social, and economic vulnerabilities, as expected. Evidence for enhanced CRC risk was found for older patients with multiple comorbid conditions, low social support for change, and perceptions of income inadequacy.CONCLUSIONSThe presence of age‐related vulnerability factors may enhance the risk of CRC among older cancer patients by creating barriers to behavioral change. Efforts to reduce the cancer burden in older populations will require attention beyond early detection and surveillance to interventions that account for the unique physical and psychosocial characteristics of older adults. Cancer 2004;100:1085–94. © 2004 American Cancer Society.

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Randomized Comparison of Surveillance Intervals after Colonoscopic Removal of Newly Diagnosed Adenomatous Polyps

Cited by 919 publications

References 19 publications

S3-Leitlinie – Kolorektales Karzinom

S3-Leitlinie – Kolorektales Karzinom

National Polyp Study data: Evidence for regression of adenomas

Age‐related vulnerabilities of older adults with colon adenomas

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