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Volume 329:1977-1981 December 30, 1993 Number 27 Next

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ABSTRACT

Background The current practice of removing adenomatous polyps of the colon and rectum is based on the belief that this will prevent colorectal cancer. To address the hypothesis that colonoscopic polypectomy reduces the incidence of colorectal cancer, we analyzed the results of the National Polyp Study with reference to other published results.

Methods The study cohort consisted of 1418 patients who had a complete colonoscopy during which one or more adenomas of the colon or rectum were removed. The patients subsequently underwent periodic colonoscopy during an average follow-up of 5.9 years, and the incidence of colorectal cancer was ascertained. The incidence rate of colorectal cancer was compared with that in three reference groups, including two cohorts in which colonic polyps were not removed and one general-population registry, after adjustment for sex, age, and polyp size.

Results Ninety-seven percent of the patients were followed clinically for a total of 8401 person-years, and 80 percent returned for one or more of their scheduled colonoscopies. Five asymptomatic early-stage colorectal cancers (malignant polyps) were detected by colonoscopy (three at three years, one at six years, and one at seven years). No symptomatic cancers were detected. The numbers of colorectal cancers expected on the basis of the rates in the three reference groups were 48.3, 43.4, and 20.7, for reductions in the incidence of colorectal cancer of 90, 88, and 76 percent, respectively (P<0.001).

Conclusions Colonoscopic polypectomy resulted in a lower-than-expected incidence of colorectal cancer. These results support the view that colorectal adenomas progress to adenocarcinomas, as well as the current practice of searching for and removing adenomatous polyps to prevent colorectal cancer.

Source Information

From the National Polyp Study Headquarters, Memorial Sloan-Kettering Cancer Center, New York (S.J.W., A.G.Z., M.N.H., S.S.S., M. Shike, R.C.K., L.H.-L., H.G.); Mallory Institute of Pathology, Boston City Hospital, Boston (M.J.O., L.S.G.); Mount Sinai Hospital, New York (J.D.W.); Valley Presbyterian Hospital, Van Nuys, Calif. (M. Schapiro); Veterans Affairs Medical Center, Minneapolis (J.H.B.); Cedars-Sinai Medical Center, Los Angeles (J.F.P.); Massachusetts General Hospital, Boston (F.A.); and Milwaukee County Medical Complex, Milwaukee (E.T.S.).

Other members of the National Polyp Study Workgroup are listed in the Appendix.

Address reprint requests to Dr. Winawer at the Gastroenterology and Nutrition Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.

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