title: Colorectal Cancer Risk Following Adenoma Removal: A Large Prospective Population-Based Cohort Study.
abstract: BACKGROUND
  Randomized controlled trials have demonstrated significant reductions in colorectal cancer incidence and mortality associated with polypectomy. However, little is known about whether polypectomy is effective at reducing colorectal cancer risk in routine clinical practice. The aim of this investigation was to quantify colorectal cancer risk following polypectomy in a large prospective population-based cohort study.
  
  
  METHODS
  Patients with incident colorectal polyps between 2000 and 2005 in Northern Ireland were identified via electronic pathology reports received to the Northern Ireland Cancer Registry. Patients were matched to the Northern Ireland Cancer Registry to detect colorectal cancer and deaths up to December 31, 2010. Colorectal cancer standardized incidence ratios (SIR) were calculated and Cox proportional hazards modeling applied to determine colorectal cancer risk.
  
  
  RESULTS
  During 44,724 person-years of follow-up, 193 colorectal cancer cases were diagnosed among 6,972 adenoma patients, representing an annual progression rate of 0.43%. Colorectal cancer risk was significantly elevated in patients who had an adenoma removed (SIR, 2.85; 95% CI, 2.61-3.25) compared with the general population. Male sex, older age, rectal site, and villous architecture were associated with an increased colorectal cancer risk in adenoma patients. Further analysis suggested that not having a full colonoscopy performed at, or following, incident polypectomy contributed to the excess colorectal cancer risk.
  
  
  CONCLUSIONS
  Colorectal cancer risk was elevated in individuals following polypectomy for adenoma, outside of screening programs.
  
  
  CONCLUSIONS
  This finding emphasizes the need for full colonoscopy and adenoma clearance, and appropriate surveillance, after endoscopic diagnosis of adenoma.
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland h.coleman@qub.ac.uk.
authors.forename: Helen G
authors.initials: HG
authors.lastname: Coleman
authors.affiliation: Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland.
authors.forename: Maurice B
authors.initials: MB
authors.lastname: Loughrey
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Liam J
authors.initials: LJ
authors.lastname: Murray
authors.affiliation: Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, Northern Ireland.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Johnston
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland Northern Ireland Cancer Registry, Centre for Public Health, Queen's University, Belfast, Northern Ireland.
authors.forename: Anna T
authors.initials: AT
authors.lastname: Gavin
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Shrubsole
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Shivaram K
authors.initials: SK
authors.lastname: Bhat
authors.affiliation: Department of Gastroenterology, Ulster Hospital, Dundonald, South Eastern Health and Social Care Trust, Northern Ireland.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Allen
authors.affiliation: Northern Ireland Regional Genetics Service, Belfast Health and Social Care Trust, Belfast, Northern Ireland.
authors.forename: Vivienne
authors.initials: V
authors.lastname: McConnell
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Marie M
authors.initials: MM
authors.lastname: Cantwell
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult