Post-polypectomy surveillance colonoscopy associated with 77% reduction in CRC risk
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Key takeaways:
- Post-polypectomy surveillance colonoscopy was associated with a 77% relative reduction in incident colorectal cancer risk.
- Surveillance colonoscopy was not associated with reduced risk for fatal CRC.
WASHINGTON — Surveillance colonoscopy after polyp removal was associated with a 77% relative reduction in risk for colorectal cancer, although more research is needed to determine its effect on mortality risk, according to study results.
“Repeat colonoscopy, also known as surveillance, after prior polyp removal is one of the most common reasons for colonoscopy,” Samir Gupta, MD, MSCS, AGAF, staff physician at the Veterans Affairs San Diego Healthcare System and professor of gastroenterology at UC San Diego School of Medicine, told Healio. “However, there is limited evidence on whether this usual practice reduces the risk for developing or dying from colorectal cancer, above and beyond the benefits of the initial polyp removal.”
In a retrospective, case-cohort study, Gupta and colleagues evaluated whether post-polypectomy surveillance colonoscopy — concordant with 2012 U.S. Multisociety Task Force on CRC recommendations — reduces CRC incidence and mortality risk.
Among 516,061 veterans who had a baseline colonoscopy with removal of a conventional adenoma or sessile serrated lesion between 1999 and 2016, researchers included 1,072 incident cases of CRC and 309 fatal cases, which occurred at least 6 months from baseline polypectomy, as well as a subcohort of 1,589 veterans.
At baseline, the median age of the cohort was 64 years, 97% were men and 37.8% had a high-risk polyp.
According to results presented at Digestive Disease Week, guideline-concordant surveillance colonoscopy was associated with a 77% relative reduction in incident CRC risk over 10,421 person-years of follow-up (adjusted HR = 0.23; 95% CI, 0.17-0.31). However, it was not associated with reduction in CRC mortality risk over 8,777 person-years of follow-up (aHR = 0.83; 95% CI, 0.45-1.51).
Gupta noted that 55% of cases and 40% of deaths occurred within 4 years of baseline polyp removal, suggesting that most cancer identified on follow-up is likely due to quality of the baseline exam — “an issue that surveillance colonoscopy cannot fix.”
“Our study strengthens the evidence base behind guidelines that recommend repeat colonoscopy after polyp removal and also underscores how important baseline quality is in avoiding bad colorectal cancer outcomes,” Gupta told Healio.
“We need larger studies with more follow-up to examine whether surveillance colonoscopy reduces the risk for colon cancer death, and we need more research on how to optimize baseline quality of colonoscopy with polyp removal,” he added, as well as “novel strategies” to identify individuals who might be at risk for developing cancer before their first follow-up surveillance colonoscopy.
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Gupta S, et al. Impact of post-polypectomy colonoscopy surveillance on colorectal cancer incidence and mortality: The post polypectomy surveillance (POPPSS) study. Presented at: Digestive Disease Week; May 18-21, 2024; Washington (hybrid).
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