Format

Send to

Choose Destination
Gastroenterology. 2019 Oct 4. pii: S0016-5085(19)41411-X. doi: 10.1053/j.gastro.2019.09.039. [Epub ahead of print]

Long-term Risk of Colorectal Cancer and Related Death After Adenoma Removal in a Large, Community-based Population.

Author information

1
Department of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA. Electronic address: jeffrey.k.lee@kp.org.
2
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
3
Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Gastroenterology, Kaiser Permanente Walnut Creek, Walnut Creek, CA.
4
Department of Family Medicine, and the Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN.
5
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
6
Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
7
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
8
Department of Quality and Clinical Analysis, Kaiser Permanente Southern California, Pasadena, CA.
9
Department of Regional Clinical Effectiveness, Kaiser Permanente Southern California, Pasadena, CA.
10
Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Boston, MA.
11
Department of Population and Data Sciences and the Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
12
Department of Population and Data Sciences and the Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
13
Department of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA.

Abstract

BACKGROUND & AIMS:

The long-term risks of colorectal cancer (CRC) and CRC-related death following adenoma removal are uncertain. Data are needed to inform evidence-based surveillance guidelines, which vary in follow-up recommendations for some polyp types. Using data from a large, community-based integrated health care setting, we examined the risks of CRC and related death by baseline colonoscopy adenoma findings.

METHODS:

Participants at 21 medical centers underwent baseline colonoscopies from 2004 through 2010; findings were categorized as no adenoma, low-risk adenoma, or high-risk adenoma. Participants were followed until the earliest of CRC diagnosis, death, health plan disenrollment, or December 31, 2017. Risks of CRC and related deaths among the high- and low-risk adenoma groups were compared with the no adenoma group using Cox regression adjusting for confounders.

RESULTS:

Among 186,046 patients, 64,422 met eligibility criteria (54.3% female; mean age, 61.6±7.1 y; median follow-up time, 8.1 y from the baseline colonoscopy). Compared with the no-adenoma group (45,881 patients), the high-risk adenoma group (7563 patients) had a higher risk of CRC (hazard ratio [HR], 2.61; 95% CI, 1.87-3.63) and related death (HR, 3.94; 95% CI, 1.90-6.56), whereas the low-risk adenoma group (10,978 patients) did not have a significant increase in risk of CRC (HR, 1.29; 95% confidence interval, 0.89-1.88) or related death (HR, 0.65; 95% CI, 0.19-2.18).

CONCLUSIONS:

With up to 14-years of follow-up, high-risk adenomas were associated with an increased risk of CRC and related death, supporting early colonoscopy surveillance. Low-risk adenomas were not associated with a significantly increased risk of CRC or related deaths. These results can inform current surveillance guidelines for high- and low-risk adenomas.

KEYWORDS:

Colorectal cancer; adenoma; colonoscopy; polyp

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center