Ongoing colorectal cancer risk despite surveillance colonoscopy: the Polyp Prevention Trial Continued Follow-up Study.
BACKGROUND
Despite regular colonoscopy, interval colorectal cancer (CRC) may occur. Long-term studies examining CRC rates in patients with previous colonoscopy are lacking.


OBJECTIVE
We examined the rate of interval CRC in the Polyp Prevention Trial Continued Follow-up Study (PPT-CFS), an observational study of PPT participants that began after the PPT ended.


METHODS
Prospective.


METHODS
A national U.S. community-based polyp prevention trial.


METHODS
Medical records of patients with CRC were collected, reviewed, and abstracted in a standardized fashion.


RESULTS
Among 2079 PPT participants, 1297 (62.4%) agreed to participate in the PPT-CFS. They were followed for a median of 6.2 years after 4.3 years of median follow-up in the main PPT. Nine cases of CRC were diagnosed over 7626 person-years of observation (PYO), for an incidence rate of 1.2/1000 PYO. The ratio of CRCs observed compared with that expected by Surveillance, Epidemiology, and End Results was 0.64 (95% CI, 0.28-1.06). Including all CRCs (N = 22) since the beginning of the PPT, the observed compared with expected rate by Surveillance, Epidemiology, and End Results was 0.74 (95% CI, 0.47-1.05). Of patients in whom CRC developed in the PPT-CFS, 78% had a history of an advanced adenoma compared with only 43% of patients who remained cancer free (P = .04).


CONCLUSIONS
A relatively small number of interval cancers were detected.


CONCLUSIONS
Despite frequent colonoscopy during the PPT, in the years after the trial, there was a persistent ongoing risk of cancer. Subjects with a history of advanced adenoma are at increased risk of subsequent cancer and should be followed closely with continued surveillance.
Leung
Keith
K
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Pinsky
Paul
P
Laiyemo
Adeyinka O
AO
Lanza
Elaine
E
Schatzkin
Arthur
A
Schoen
Robert E
RE
D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors