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Colorectal cancers soon after colonoscopy: a pooled multicohort analysis

Objective Some individuals are diagnosed with colorectal cancer (CRC) despite recent colonoscopy. We examined individuals under colonoscopic surveillance for colonic adenomas to assess possible reasons for diagnosing cancer after a recent colonoscopy with complete removal of any identified polyps. D... Full description

Journal Title: Gut 2014-06, Vol.63 (6), p.949-956
Main Author: Robertson, Douglas J
Other Authors: Lieberman, David A , Winawer, Sidney J , Ahnen, Dennis J , Baron, John A , Schatzkin, Arthur , Cross, Amanda J , Zauber, Ann G , Church, Timothy R , Lance, Peter , Greenberg, E Robert , Martínez, María Elena
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: England: BMJ Publishing Group Ltd
ID: ISSN: 0017-5749
Link: https://www.ncbi.nlm.nih.gov/pubmed/23793224
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title: Colorectal cancers soon after colonoscopy: a pooled multicohort analysis
format: Article
creator:
  • Robertson, Douglas J
  • Lieberman, David A
  • Winawer, Sidney J
  • Ahnen, Dennis J
  • Baron, John A
  • Schatzkin, Arthur
  • Cross, Amanda J
  • Zauber, Ann G
  • Church, Timothy R
  • Lance, Peter
  • Greenberg, E Robert
  • Martínez, María Elena
subjects:
  • Abridged Index Medicus
  • Adenoma - pathology
  • Adenoma - surgery
  • Age Factors
  • Aged
  • Algorithms
  • Article
  • Colonoscopy
  • Colorectal cancer
  • Colorectal Neoplasms - diagnosis
  • Colorectal Neoplasms - epidemiology
  • Colorectal Neoplasms - surgery
  • Diagnosis
  • Diagnostic Errors
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Mortality
  • Patients
  • Prevention
  • Risk factors
  • Sentinel health events
  • Sex Factors
  • Studies
  • Surveillance
  • Task forces
  • Time Factors
  • Tumors
  • United States - epidemiology
  • Usage
ispartof: Gut, 2014-06, Vol.63 (6), p.949-956
description: Objective Some individuals are diagnosed with colorectal cancer (CRC) despite recent colonoscopy. We examined individuals under colonoscopic surveillance for colonic adenomas to assess possible reasons for diagnosing cancer after a recent colonoscopy with complete removal of any identified polyps. Design Primary data were pooled from eight large (>800 patients) North American studies in which participants with adenoma(s) had a baseline colonoscopy (with intent to remove all visualised lesions) and were followed with subsequent colonoscopy. We used an algorithm based on the time from previous colonoscopy and the presence, size and histology of adenomas detected at prior exam to assign interval cancers as likely being new, missed, incompletely resected (while previously an adenoma) or due to failed biopsy detection. Results 9167 participants (mean age 62) were included in the analyses, with a median follow-up of 47.2 months. Invasive cancer was diagnosed in 58 patients (0.6%) during follow-up (1.71 per 1000 person-years follow-up). Most cancers (78%) were early stage (I or II); however, 9 (16%) resulted in death from CRC. We classified 30 cancers (52%) as probable missed lesions, 11 (19%) as possibly related to incomplete resection of an earlier, non-invasive lesion and 14 (24%) as probable new lesions. The cancer diagnosis may have been delayed in three cases (5%) because of failed biopsy detection. Conclusions Despite recent colonoscopy with intent to remove all neoplasia, CRC will occasionally be diagnosed. These cancers primarily seem to represent lesions that were missed or incompletely removed at the prior colonoscopy and might be avoided by increased emphasis on identifying and completely removing all neoplastic lesions at colonoscopy.
language: eng
source:
identifier: ISSN: 0017-5749
fulltext: no_fulltext
issn:
  • 0017-5749
  • 1468-3288
url: Link


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titleColorectal cancers soon after colonoscopy: a pooled multicohort analysis
creatorRobertson, Douglas J ; Lieberman, David A ; Winawer, Sidney J ; Ahnen, Dennis J ; Baron, John A ; Schatzkin, Arthur ; Cross, Amanda J ; Zauber, Ann G ; Church, Timothy R ; Lance, Peter ; Greenberg, E Robert ; Martínez, María Elena
creatorcontribRobertson, Douglas J ; Lieberman, David A ; Winawer, Sidney J ; Ahnen, Dennis J ; Baron, John A ; Schatzkin, Arthur ; Cross, Amanda J ; Zauber, Ann G ; Church, Timothy R ; Lance, Peter ; Greenberg, E Robert ; Martínez, María Elena
descriptionObjective Some individuals are diagnosed with colorectal cancer (CRC) despite recent colonoscopy. We examined individuals under colonoscopic surveillance for colonic adenomas to assess possible reasons for diagnosing cancer after a recent colonoscopy with complete removal of any identified polyps. Design Primary data were pooled from eight large (>800 patients) North American studies in which participants with adenoma(s) had a baseline colonoscopy (with intent to remove all visualised lesions) and were followed with subsequent colonoscopy. We used an algorithm based on the time from previous colonoscopy and the presence, size and histology of adenomas detected at prior exam to assign interval cancers as likely being new, missed, incompletely resected (while previously an adenoma) or due to failed biopsy detection. Results 9167 participants (mean age 62) were included in the analyses, with a median follow-up of 47.2 months. Invasive cancer was diagnosed in 58 patients (0.6%) during follow-up (1.71 per 1000 person-years follow-up). Most cancers (78%) were early stage (I or II); however, 9 (16%) resulted in death from CRC. We classified 30 cancers (52%) as probable missed lesions, 11 (19%) as possibly related to incomplete resection of an earlier, non-invasive lesion and 14 (24%) as probable new lesions. The cancer diagnosis may have been delayed in three cases (5%) because of failed biopsy detection. Conclusions Despite recent colonoscopy with intent to remove all neoplasia, CRC will occasionally be diagnosed. These cancers primarily seem to represent lesions that were missed or incompletely removed at the prior colonoscopy and might be avoided by increased emphasis on identifying and completely removing all neoplastic lesions at colonoscopy.
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subjectAbridged Index Medicus ; Adenoma - pathology ; Adenoma - surgery ; Age Factors ; Aged ; Algorithms ; Article ; Colonoscopy ; Colorectal cancer ; Colorectal Neoplasms - diagnosis ; Colorectal Neoplasms - epidemiology ; Colorectal Neoplasms - surgery ; Diagnosis ; Diagnostic Errors ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Mortality ; Patients ; Prevention ; Risk factors ; Sentinel health events ; Sex Factors ; Studies ; Surveillance ; Task forces ; Time Factors ; Tumors ; United States - epidemiology ; Usage
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descriptionObjective Some individuals are diagnosed with colorectal cancer (CRC) despite recent colonoscopy. We examined individuals under colonoscopic surveillance for colonic adenomas to assess possible reasons for diagnosing cancer after a recent colonoscopy with complete removal of any identified polyps. Design Primary data were pooled from eight large (>800 patients) North American studies in which participants with adenoma(s) had a baseline colonoscopy (with intent to remove all visualised lesions) and were followed with subsequent colonoscopy. We used an algorithm based on the time from previous colonoscopy and the presence, size and histology of adenomas detected at prior exam to assign interval cancers as likely being new, missed, incompletely resected (while previously an adenoma) or due to failed biopsy detection. Results 9167 participants (mean age 62) were included in the analyses, with a median follow-up of 47.2 months. Invasive cancer was diagnosed in 58 patients (0.6%) during follow-up (1.71 per 1000 person-years follow-up). Most cancers (78%) were early stage (I or II); however, 9 (16%) resulted in death from CRC. We classified 30 cancers (52%) as probable missed lesions, 11 (19%) as possibly related to incomplete resection of an earlier, non-invasive lesion and 14 (24%) as probable new lesions. The cancer diagnosis may have been delayed in three cases (5%) because of failed biopsy detection. Conclusions Despite recent colonoscopy with intent to remove all neoplasia, CRC will occasionally be diagnosed. These cancers primarily seem to represent lesions that were missed or incompletely removed at the prior colonoscopy and might be avoided by increased emphasis on identifying and completely removing all neoplastic lesions at colonoscopy.
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abstractObjective Some individuals are diagnosed with colorectal cancer (CRC) despite recent colonoscopy. We examined individuals under colonoscopic surveillance for colonic adenomas to assess possible reasons for diagnosing cancer after a recent colonoscopy with complete removal of any identified polyps. Design Primary data were pooled from eight large (>800 patients) North American studies in which participants with adenoma(s) had a baseline colonoscopy (with intent to remove all visualised lesions) and were followed with subsequent colonoscopy. We used an algorithm based on the time from previous colonoscopy and the presence, size and histology of adenomas detected at prior exam to assign interval cancers as likely being new, missed, incompletely resected (while previously an adenoma) or due to failed biopsy detection. Results 9167 participants (mean age 62) were included in the analyses, with a median follow-up of 47.2 months. Invasive cancer was diagnosed in 58 patients (0.6%) during follow-up (1.71 per 1000 person-years follow-up). Most cancers (78%) were early stage (I or II); however, 9 (16%) resulted in death from CRC. We classified 30 cancers (52%) as probable missed lesions, 11 (19%) as possibly related to incomplete resection of an earlier, non-invasive lesion and 14 (24%) as probable new lesions. The cancer diagnosis may have been delayed in three cases (5%) because of failed biopsy detection. Conclusions Despite recent colonoscopy with intent to remove all neoplasia, CRC will occasionally be diagnosed. These cancers primarily seem to represent lesions that were missed or incompletely removed at the prior colonoscopy and might be avoided by increased emphasis on identifying and completely removing all neoplastic lesions at colonoscopy.
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