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Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths


In the National Polyp Study (NPS), it was shown that colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. As a result, a study published in the New England Journal of Medicine (2012;366:687-696), was performed to evaluate the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer.


The analysis included all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death, with follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with nonadenomatous polyps (internal control group).


Results showed that among 2,602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1,246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2).


According to the authors, the findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer.


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