Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths

By A. Zauber, S. Winawer, M. O'brien, I. Lansdorp-Vogelaar, M. van Ballegooijen, B. Hankey, W. Shi, J. Bond, M. Schapiro, J. Panish and 2 more. 2012

2,816 citations recorded by the source corpus.

BACKGROUND In the National Polyp Study (NPS), colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. We evaluated the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer. METHODS We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with non-adenomatous polyps (internal control group). RESULTS Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6). CONCLUSIONS These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.)

Subfields: Epidemiology, Oncology, Pulmonary and Respiratory Medicine

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In Epidemiology

1. R. Siegel
2. A. Jemal
3. Elizabeth E. Ward

In Oncology

1. R. Siegel
2. A. Jemal
3. Elizabeth E. Ward
4. Lindsey A. Torre
5. Douglas Rex
6. K. Miller
7. F. Bray
8. J. Ferlay

In Pulmonary and Respiratory Medicine

1. A. Jemal
2. Elizabeth E. Ward
3. R. Siegel
4. Douglas Rex

Citations in the corpus

• Application of Artificial Intelligence Technology in Oncology: Towards the Establishment of Precision Medicine (2020, neutral): “In fact, in the United States, the results of the National Polyp Study reported in 1993 and its cohort study reported in 2012 demonstrated that the endoscopic removal of adenomatous polyps, a precursor lesion to CRC, reduced the morbidity of CRC by 76–90% and mortality by 53% [58,59].”
• Colorectal cancer statistics, 2023 (2023, background): “Observational studies suggest that colonoscopy reduces CRC incidence by about 40% and mortality by about 60%.(41,42,128) The prevalence of reported up‐to‐ date screening with any recommended test among individuals aged 50 years and older increased from 38% in 2000 to 66% in 2018 according to data fr”
• Global Cancer in Women: Burden and Trends (2017, background): “…have been attributed to changing patterns in risk factors and the uptake of endoscopy screening, which can detect and remove precancerous lesions (105 – 109), whereas decreases or plateaus in other countries without established screening programs (Australia, New Zealand) are probably due to risk…”
• Quality Indicators for Colonoscopy (2015, background): “In addition, however, adenoma detection and resection directly prevent CRC and CRC mortality.(30,134) Because CRC prevention is an ideal outcome, and because effective polyp detection or resection are clearly established as the mechanism by which colonoscopy produces prevention, ADR is now designate”
• Automatic Detection and Classification of Colorectal Polyps by Transferring Low-Level CNN Features From Nonmedical Domain (2017, background): “Long-term follow-up studies confirmed that removal of adenomatous polyps reduces CRC mortality [2].”
• International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer (2012, background): “Evidence for success is best provided by large randomised controlled trials in which the outcomes of subjects who undergo surveillance are compared with appropriate controls, as has been demonstrated for colonoscopy screening.(58) However, given the relatively low incidence of familial PC, such tria”
• Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline (2017, background): “Atkin, 1992 [1] Cohort Rectal and sigmoid cancer incidence among patients with adenomas removed from rectosigmoid compared with expected age- and sexspecific incidences in the UK general population 1618 patients enrolled between 1957 and 1980, following removal of at least one adenoma.”
• ACG Clinical Guidelines: Colorectal Cancer Screening 2021. (2021, background): “It allows for not only the detection of early-stage cancers but also the detection and removal of polyps and confers a long-term protection from CRC incidence and mortality (5,10,11).”
• Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. (2012, neutral): “The surveillance schema identified 2 major risk groups based on the likelihood of developing advanced neoplasia during surveillance: (1) low-risk adenomas (LRAs), defined as 1–2 tubular adenomas 10 mm, and (2) high-risk adenomas (HRAs), defined as adenoma with villous histology, highgrade dysplasia ”