COLORECTAL CANCER

Incidence and recurrence rates of colorectal adenomas estimated by annually repeated colonoscopies on asymptomatic Japanese

Y Yamaji¹, T Mitsushima², H Ikuma², H Watabe¹, M Okamoto¹, T Kawabe³, R Wada⁴, H Doi⁵, M Omata³

¹ Division of Gastroenterology, Department of Internal Medicine, University of Tokyo, and Makuhari Clinic, Tokyo, Japan
² Department of Gastroenterology, Kameda General Hospital, and Makuhari Clinic, Tokyo, Japan
³ Division of Gastroenterology, Department of Internal Medicine, University of Tokyo, Tokyo, Japan
⁴ Department of Gastroenterology, Kameda General Hospital, Tokyo, Japan
⁵ Makuhari Clinic, Tokyo, Japan

Correspondence to:
Correspondence to:
Dr Y Yamaji
Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; yamaji-tky{at}umin.ac.jp

Background: Whereas high recurrence rates of colorectal adenomas after polypectomy are widely recognised, little is known of the natural incidence in those with no neoplastic lesions initially. It is also known that single colonoscopy has a significant miss rate.

Aims: To elucidate the incidence and recurrence rates of colorectal neoplasms from a large cohort of asymptomatic Japanese patients on the basis of annually repeated colonoscopies.

Methods: A total of 6225 subjects (4659 men and 1566 women) participating in an annual colonoscopic screening programme and completing three or more colonoscopies were analysed during the 14 year period between 1988 and 2002. Patients were divided into three groups according to the findings of the initial two colonoscopies: 4084 subjects with no neoplasm, 1818 with small adenomas <10 mm, and 323 with advanced lesions, including carcinoma in situ, severe dysplasia, or large adenomas 10 mm. Mean age at the second colonoscopy was 48.8 years.

Results: For all types of colorectal neoplasms, the incidence rate in those with no initial neoplasm was 7.2%/year whereas recurrence rates in those with small adenomas and advanced lesions were 19.3% and 22.9%/year, respectively. For advanced colorectal lesions, the incidence rate was 0.21%/year whereas recurrence rates in those with small adenomas and advanced lesions were 0.64% and 1.88%/year, respectively. Colorectal neoplasms were in general more likely to develop in males and older subjects.

Conclusions: Although recurrence rates after polypectomy were elevated, the incidence rates in subjects with no neoplastic lesions initially were quite high.

Keywords: colorectal adenoma; incidence; recurrence; screening; colonoscopy

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