Low-Risk Adenoma Removal Associated with Reduced Colorectal Cancer Mortality

Editor’s note: This article is about the results of a research study for colorectal cancer. The researchers looked at the medical records of people who had high- and low-risk adenomas removed to see which patients later died of colorectal cancer. They found that people who had high-risk adenomas removed were more likely to die of colorectal cancer within 8 years. People who had low-risk adenomas removed were no more likely to die of colorectal cancer than the general population. Based on the results, people who have low-risk adenomas removed might not need to undergo surveillance after surgery. Surveillance can involve invasive colonoscopies, so many of these patients might actually be better off without surveillance.

“Patients who had low-risk adenomas removed demonstrated lower rates of long-term colorectal cancer mortality than those who had high-risk adenomas removed, according to results of a population-based study.

“The low mortality rate associated with low-risk adenomas may obviate the need for post-colonoscopy surveillance in this population, researchers wrote.

“Magnus Løberg, MD, of the department of health management and health economics at University of Oslo, and colleagues used Norway’s cancer registry and cause of death registry to assess colorectal cancer mortality among 40,826 adults who had colorectal adenomas removed between 1993 and 2007.

“Patients with high-risk adenomas — or those with high-grade dysplasia, a villous component or a size ≥10 mm — underwent colonoscopy after 10 years, whereas those with three or more adenomas underwent colonoscopy after 5 years in compliance with Norwegian guidelines.”

Facts, Myths, and the Stool DNA Test

“Publicity surrounding the FDA’s approval of a stool DNA test for colorectal cancer screening made fact and fiction difficult to distinguish, according to Deborah Fisher, MD, MHS, a gastroenterologist and associate professor at Duke University in Durham, N.C. She wants to set the record straight in this guest blog.

“I am a gastroenterologist and much of my research and clinical focus is colorectal cancer screening. Some of my previous comments on the new stool DNA test, Cologuard, have already been published in the New York Times as well as on MedPage Today. However, I have recently noticed a number of misleading articles in various newspapers across the country and wanted to address these, likely common, misconceptions about the new test.

“First, I want to openly acknowledge the positives about Cologuard. The study in the New England Journal of Medicine examining its ability to find a colon or rectal cancer as a one-time test (compared to colonoscopy as the gold standard) was large, well-designed and well-executed. It showed that as a one-time test Cologuard was 92% sensitive for cancer. It also showed that the false positive rate was about 13%.

“The problem has arisen in how the study results are being spun. Here are a few emerging myths to debunk:”

Fewer Die from Colorectal Cancer

“Patients with intestinal polyps have a lower risk of dying from cancer than previously thought, according to Norwegian researchers.

“This group of patients may therefore need less frequent colonoscopic surveillance than what is common today. As a potential concequence, the researchers argue, health service resources may be diverted to other, patient groups.

“The findings were released today in The New England Journal of Medicine (NEJM).”

Colon Cancer Decreases but Misconceptions Remain

“Recent reports have shown that colon cancer rates have fallen by 30 percent over the past decade, particularly in people over age 50, because of the effectiveness of colonoscopies and awareness efforts surrounding the condition.

“Martha Ferguson, MD, UC Cancer Institute physician, associate professor at the UC College of Medicine and UC Health Colon and Rectal surgeon, says that these numbers are promising but that there are still misconceptions that are causing people to forgo their colonoscopy.

” ‘Colonoscopies are recommended every 10 years for average-risk people beginning at age 50—earlier if there is a family history of colon cancer,’ Ferguson says. ‘However, some people think that a colonoscopy is going to be a miserable, painful test, and that isn’t the case.’ “