Original ArticleAnalysis of colorectal cancer occurrence during surveillance colonoscopy in the dietary Polyp Prevention Trial
Section snippets
Patients and methods
Patients recruited for the PPT were at least 35 years of age and had one or more histopathologically confirmed colorectal adenomas removed during a qualifying colonoscopy within 6 months before randomization. Exclusion criteria were the following: history of CRC, surgical resection of an adenoma, bowel resection, polyposis syndromes, inflammatory bowel disease (IBD), body weight greater than 150% of recommended weight, use of lipid-lowering drugs, and a medical condition or a dietary
Results
Of 2079 patients followed in the dietary PPT, 13 had cancers detected over 5810 PYO. This represents a CRC occurrence in 0.63% or 2.2 cases/1000 PYO.
Demographic information; polyp findings at the T0 colonoscopy; time interval to cancer diagnosis; location, size, and stage of the detected CRC; and circumstances of cancer discovery are presented in Table 1, Table 2.
The average age at diagnosis was 70.0 years (range 53-79 years), and 76.9% of the patients (10/13) were men. Only one patient had a
Discussion
Colonoscopy is considered the criterion standard procedure for detection of colorectal neoplasia, but it is not perfect. Cancers occur despite colonoscopy. There is a paucity of studies of the circumstances of CRC occurrence in the setting of prior colonoscopy, and there is no consensus as to the optimal method for evaluating such cancers.
Haseman et al.4 identified 47 cancers that occurred within 3 years of a colonoscopy. Given the limited number of poorly differentiated tumors and the low
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See CME section; p. 444.
Presented at the American Society for Gastrointestinal Endoscopy Meeting, May 15-20, 2004, New Orleans, Louisiana (Gastrointest Endosc 2004;59:AB110).