Premium
Intermediate sized adenomas may represent an increased cancer risk
Author(s) -
Pearson T. E.,
Lewis G.,
Bugg W.,
Bright P.,
Lillie J.,
Marks C.
Publication year - 2006
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2006.01140_3.x
Subject(s) - medicine , colonoscopy , colorectal cancer , polypectomy , cancer , incidence (geometry) , adenoma , population , family history , endoscopy , tubular adenoma , gastroenterology , physics , environmental health , optics
Objective: The purpose of colonoscopic polypectomy is cancer prevention. Multiple or large adenomas require intensive follow up but solitary or smaller lesions are considered safer and less frequent examinations are necessary. The aim of this study was to test if these principles are supported in practice. Method: Individuals with polyps but no family history of colorectal cancer (CRC), where pathology and endoscopy reports could be cross‐referenced to confirm size, number and histological classification were included. Cases of colorectal cancer were identified from records of repeat examinations. Follow‐up interval and number of subsequent examinations was determined. A control population of individuals with a normal initial colonoscopy were also studied. Results: In total 0.05% of individuals with a normal initial colonoscopy developed CRC. The cancer incidence following numerous or large polyps was not significantly higher than the controls although on average more examinations were performed (see table). Individuals with a single small adenoma did not appear to have increased risk of cancer with fewer colonoscopies, but there were significantly higher numbers of cancers where intermediate sized polyps had been identified. Conclusion: Risk of cancer is reduced in large or numerous polyps by frequent examinations. Intermediate sized polyps appear to need more intensive follow‐up protocols than small single adenomas for effective cancer prevention.First exam result Number Follow up (months) Number of exams Metachronous cancersNormal 4935 88.7 (1–201) 1.2 24 (0.05%)Single (< 5 mm) 74 64.3 (7–148) 1.3 1 (1.4%) χ 2 = 1.1 P = 0.29 Between 5 and 10 mm 73 73.4 (6–165) 1.5 3 (4.1%) χ 2 = 17.61 P < 0.0001 > 3 mm 27 68.1 (6–152) 2.5 0 (0%) χ 2 = 0.13 P = 0.72 Larger than 10 mm 114 73.7 (3–170) 2.9 1 (0.9%) χ 2 = 0.35 P = 0.56