Appendix OColorectal Cancer Surveillance Testing After Polypectomy

Schrag D.

Publication Details

Slide 1. Appendix O Colorectal Cancer Surveillance Testing After Polypectomy.

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Appendix O Colorectal Cancer Surveillance Testing After Polypectomy. SLIDE 1 NOTES: No notes.

Slide 2. Overview.

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Overview. SLIDE 2 NOTES: No notes.

Slide 3. What is the Evidence Base Supporting Strategies for SAA?

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What is the Evidence Base Supporting Strategies for SAA? SLIDE 3 NOTES: No notes.

Slide 4. National Polyp Study DESIGN.

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National Polyp Study DESIGN. SLIDE NOTES 4: Any discussion of surveillance would be remiss if it did not focus extensively on the National Polyp Study, which I will refer to as the NPS (Winawer et al., 1993). The NPS was a randomized trial of the timing (more...)

Slide 5. National Polyp Study Surveillance Arms Following Randomization.

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National Polyp Study Surveillance Arms Following Randomization. SLIDE 5 NOTES: The basic design involved a comparison of two arms. A patient randomized to Arm A was assigned to a surveillance colonoscopy at 1 year, at 3 years, and at 6 years following (more...)

Slide 6. NPS Outcomes at Surveillance.

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NPS Outcomes at Surveillance. SLIDE 6 NOTES: Outcomes of each surveillance procedures were defined as shown above. An advanced adenoma was defined in the study somewhat differently from that used in today's conventional current practice and in the guidelines (more...)

Slide 7. National Polyp Study Findings at Follow-Up.

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National Polyp Study Findings at Follow-Up. SLIDE 7 NOTES: Here are the results for the two arms. Arm B – the three-year surveillance protocol – had a 32 percent incidence of any adenoma and a 3.3 percent incidence of advanced adenoma. (more...)

Slide 8. National Polyp Study Surveillance Arms Following Randomization CANCERS.

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National Polyp Study Surveillance Arms Following Randomization CANCERS. SLIDE 8 NOTES: This chart shows the point of detection of 5 cancers detected in the study population. The detection of cancers appears not to have been affected by the surveillance (more...)

Slide 9. National Polyp Study Cumulative Incidence of Adenomas with Advanced Pathology in 938 Patients by Randomization Arm.

Slide 9

National Polyp Study Cumulative Incidence of Adenomas with Advanced Pathology in 938 Patients by Randomization Arm. SLIDE 9 NOTES: The present and next 2 charts show findings of advanced adenomas (as defined by the NPS) as a function of surveillance strategy (more...)

Slide 10. National Polyp Study Cumulative Incidence of Adenomas with Advanced Pathology by Age at Diagnosis and Parental History of Colorectal Cancer.

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National Polyp Study Cumulative Incidence of Adenomas with Advanced Pathology by Age at Diagnosis and Parental History of Colorectal Cancer. SLIDE 10 NOTES: Stratifying patients by age and status of a parent with colorectal cancer shows the increased (more...)

Slide 11. National Polyp Study Cumulative Incidence of Adenomas with Advanced Pathology by High and Low Risk Groups.

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National Polyp Study Cumulative Incidence of Adenomas with Advanced Pathology by High and Low Risk Groups. SLIDE 11 NOTES: If a person had 3 or more high-risk adenomas at the index event, the risk of an advanced adenoma by the sixth years of surveillance (more...)

Slide 12. National Polyp Study Recommendations.

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National Polyp Study Recommendations. SLIDE 12 NOTES: On the basis of these findings, the NPS researchers concluded that surveillance intervals lengthened to six or more years are reasonable for low-risk adenoma patients. (Winawer et al., 1993; Zauber (more...)

Slide 13. Cancer Incidence Observed in Post Polypectomy Prevention Trials.

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Cancer Incidence Observed in Post Polypectomy Prevention Trials. SLIDE 13 NOTES: Is it possible that cancers were missed in the NPS? Some relatively small studies have examined back-to-back colonoscopies. They have shown that the miss rate is inversely (more...)

Slide 14. Adenoma Miss Rates in Tandem Colonoscopies.

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Adenoma Miss Rates in Tandem Colonoscopies. SLIDE 14 NOTE: Is it possible that cancers were missed in the NPS? Some relatively small studies have examined back-to-back colonoscopies. They have shown that the miss rate is inversely related to the size (more...)

Slide 15. What Do Professional Organizations and Societies Recommend Regarding Surveillance Following Removal of an Adenoma?

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What Do Professional Organizations and Societies Recommend Regarding Surveillance Following Removal of an Adenoma? SLIDE 15 NOTES: No notes.

Slide 16. Recommendations for SAA.

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Recommendations for SAA. SLIDE 16 NOTES: There are currently three sets of recommendations for surveillance after adenomas. The multi-society task force, which issued guidelines in 2003, represents the consensus of a number of different provider groups. (more...)

Slide 17. SAA: Guideline Comparison.

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SAA: Guideline Comparison. SLIDE 17 NOTES: The three groups are not very different from one another in their recommendations. After two small adenomas, or no adenoma with advanced pathology, most societies recommend surveillance after 5 years. The American (more...)

Slide 18. What are Population-Based Estimates of Current Surveillance Practice?

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What are Population-Based Estimates of Current Surveillance Practice? SLIDE 18 NOTES: No notes.

Slide 19. Population-Based Estimates of SAA.

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Population-Based Estimates of SAA. SLIDE 19 NOTES: I am not going to address this issue because Todd Anderson's presentation directly addresses it.

Slide 20. Adherence to Surveillance Guidelines.

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Adherence to Surveillance Guidelines. SLIDE 20 NOTES: No notes.

Slide 21. Risk is Heterogeneous.

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Risk is Heterogeneous. SLIDE 21 NOTES: It is important to remember, when considering adherence data, that risk is heterogeneous. We know from the National Polyp Study, for example, that 20 percent of individuals who are over age 60 and have a first-degree (more...)

Slide 22. Model SAA Parameters.

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Model SAA Parameters. SLIDE 22 NOTES: A brief look at the five models investigated in depth as part of this workshop shows that the surveillance patterns differ substantially. Some base surveillance strategies contingent on the size of the initial adenoma, (more...)

REFERENCES

  • Winawer SJ, Zauber AG, May Nah Ho, O'Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET, Lightdale CJ, Edelman M, Fleisher M. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993;329(27):1977–1981. [PubMed: 8247072]

  • Zauber AG, Winawer SJ. Initial management and follow-up surveillance of patients with colorectal adenomas. Gastroenterol Clin North Am. 1997;26(1):85–101. [PubMed: 9119442]