Colonoscopic Removal of Adenomas Cuts CRC Mortality

And, more adenomatous polyps identified with colonoscopy than fecal immunochemical testing

WEDNESDAY, Feb. 22 (HealthDay News) -- Colonoscopic removal of adenomatous polyps reduces colorectal cancer mortality, and interim analysis shows that fecal immunochemical testing (FIT) yields similar results to colonoscopy; however, more polyps are identified with colonoscopy screening compared to FIT, according to two studies published in the Feb. 23 issue of the New England Journal of Medicine.

Ann G. Zauber, Ph.D., from the Memorial Sloan-Kettering Cancer Center in New York City, and colleagues investigated the long-term effect of colonoscopic polypectomy in 2,602 patients who had adenomas removed between 1980 and 1990. Patients were followed for a median of 15.8 years, during which time, 1,246 patients died from any causes and 12 died from colorectal cancer. The standardized incidence-based mortality ratio was 0.47 with colonoscopic polypectomy, based on an estimated 25.4 expected deaths from colorectal cancer in the general population.

Enrique Quintero, M.D., Ph.D., from the Hospital Universitario de Canarias in Tenerife, Spain, and colleagues conducted a randomized trial in asymptomatic adults aged 50 to 69 years, comparing one-time colonoscopy in 26,703 adults with FIT every two years in 26,599 adults. The researchers found that, compared with the colonoscopy group, the rate of participation in the FIT group was significantly higher (34.2 versus 24.6 percent; P < 0.001). Colorectal cancer was found in 0.1 percent of both groups. Advanced adenomas were detected in 1.9 and 0.9 percent of the colonoscopy and FIT groups, respectively (odds ratio, 2.30; 95 percent confidence interval [CI], 1.97 to 2.69; P < 0.001), and nonadvanced adenomas were detected in 4.2 and 0.4 percent, respectively (odds ratio, 9.80; 95 percent CI, 8.10 to 11.85; P < 0.001).

"The numbers of subjects in whom colorectal cancer was detected were similar in the two study groups, but more adenomas were identified in the colonoscopy group," Quintero and colleagues write.

Eiken Chemical of Japan, Palex Medical, and Biogen Diagnóstica donated supplies and automated analyzers used for FIT in the Quintero study.

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