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a Regina
Elena Cancer Institute, Rome, Italy, b National Health
Institute, Rome, Italy
Correspondence to: Professor M Crespi, Regina Elena Cancer Institute, Viale Regina Elena, 291, 00161 Rome, Italy. mcrespi{at}uni.net
Accepted for publication 5 December 2000
BACKGROUND
Colorectal
cancer is one of the leading causes of death from cancer in Western
countries. Removal of adenomas is based on the assumption that it could
lead to a reduction in the incidence of
colorectal cancer, as demonstrated by the National
Polyp Study in the USA. A critical issue is whether the benefit
observed in clinical trials can also be observed in standard clinical
practice. To address the issue, a multicentre Italian collaborative
study was organised.
METHODSThe study
cohort comprised 1693 subjects of both sexes, aged 40-69 years,
enrolled between 1980 and 1987 following a total colon examination
(TCE) (that is, total colonoscopy or colonoscopy and double contrast
barium enema), with removal of at least one adenoma larger than 5 mm in
diameter. Exclusion criteria were genetic syndromes, previous adenomas
or colorectal cancer, previous colonic
resection, inflammatory bowel disease, or sessile adenomas more than 3 cm in diameter. Follow up ended in December 1996 by TCE or telephone
interview, and review of the medical records, clinical files, or death
certificates. Incidence ratios for colorectal cancer were compared with
expected age and sex specific incidences in the Italian general population.
RESULTSFollow up data
were obtained for 97.3% of cases for a total of 14 211 person/years.
Mean follow up was 10.5 years. Six colorectal cancer cases (four in
males, two in females) at various stages were ascertained (one at 29 months, two at five years, one at seven years, one at eight years, and
one at 10 years from the index examination). The number of cancers
expected in the reference population was 17.7 for an incidence ratio of
0.34 (confidence interval 0.23-0.63; p<0.01).
CONCLUSIONSColonoscopic
polypectomy substantially reduced the incidence of
colorectal cancer in the cohort compared with that
expected in the general population. These results are of particular
relevance considering that those with adenomas are at increased risk
of colorectal cancer and that this
retrospective study was performed on data obtained in standard clinical
practice. This observation strengthens the concept of effective
population screening in view of the fact that adenomatous polyps are
the most frequent neoplastic outcome of screening and their removal is
associated with a decrease in the incidence of
colorectal cancer.
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