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Study Examines Interval Colorectal Cancer Despite Surveillance Colonoscopy OAK BROOK, Ill -- January 7, 2010 -- A study published in the January issue of GIE: Gastrointestinal Endoscopy, examines the occurrence of interval colorectal cancer despite regular colonoscopy, and highlights the importance of close follow-up for patients who have a history of advanced adenomas. Researchers studied the rate of interval colorectal cancer in patients participating in the Polyp Prevention Trial Continued Follow-up Study and found that 9 cases of colorectal cancer were diagnosed over 7,626 person-years of observation for an incidence rate of 1.2 per 1,000 person-years of observation. Of patients in whom colorectal cancer developed, 78% had a history of advanced adenoma. The majority of the cancers detected were early stage (78% stage I or II) and therefore highly curable. Of the 9 cancers detected, 8 were located in the proximal colon, where studies have suggested that colonoscopy is less successful in detection. Four of the cancers were detected in colon segments where a polyp was previously found, 2 were determined to be attributed to incomplete removal of a previous adenoma, and biopsy detection of a neoplastic lesion failed in the other 2 cases. Of the 5 cases that were detected at previously polyp-free segments, 1 case was missed, 2 were newly developed cancers, and 2 cases were owing to indeterminate reasons. “Despite regular colonoscopy, interval colorectal cancer may occur,” said lead author Robert E. Schoen, MD, University of Pittsburgh, Pittsburgh, Pennsylvania. “We set out to examine the rate at which these interval cancers appear.” “Our results showed that 9 patients developed colorectal cancer for a rate of 1.2 cases per 1,000 person-years of observation despite undergoing a mean of more >3 colonoscopies,” he said. “The majority of patients in our study in whom colorectal cancer developed had a previous advanced adenoma.” “Our results confirm the need for continued colonoscopy surveillance in at-risk patients because of the ongoing risk of colorectal cancer, especially among those with a history of advanced adenoma,” said Dr. Schoen. “And, we must be sure that a polyp, especially if it is an advanced adenoma, is completely removed, since cancer may develop subsequently at that site if residual tissue remains.” The Polyp Prevention Trial (PPT) was a 4-year multicentre, randomised, controlled trial designed to examine the effect of a low-fat, high-fiber, high-fruit and vegetable diet on the recurrence of colorectal adenomas. During the main phase of the trial, 1,905 patients completed the study and underwent an average of 3.1 colonoscopies. After the completion of the trial, patients were given the opportunity to enroll in the observational PPT Continued Follow-up Study (PPT-CFS) for an additional 4 years or more. Patients agreed to provide information to researchers via annual health and lifestyle questionnaires that included questions about hospitalisation, colonoscopy, and cancer diagnoses. Subsequent colonoscopy was performed at the discretion of the clinicians caring for the patients. The aim of the study was to determine the rate of interval colorectal cancer subsequent to the main phase of the PPT and to characterise and examine the circumstances surrounding the diagnosis of cancer. Researchers emphasised that this study was not a population-based study of colonoscopy effectiveness in that all patients began with adenomatous polyps. Researchers noted some study limitations, including only a small number of cases of colorectal cancer were identified limiting statistical analysis and 68% of those originally enrolled in the PPT participated in the PPT-CFS, which could have led to a biased sample. They concluded that despite frequent colonoscopy during the PPT, there was a persistent ongoing risk of cancer in the years after the trial. Patients with a history of advanced adenoma are at increased risk of subsequent cancer and should be followed closely with continued surveillance. SOURCE: American Society for Gastrointestinal Endoscopy E-mail this page to a friend or colleague! To print, use this version