Intensity of Surveillance for Patients With Colorectal Adenomas
Authors: Reinier G.S. Meester, Iris Lansdorp-Vogelaar, Sidney J. Winawer, Ann G. Zauber, Amy B. Knudsen, Uri Ladabaum
Journal: Annals of Internal Medicine (2020)

Letters17 March 2020Intensity of Surveillance for Patients With Colorectal AdenomasReinier G.S. Meester, PhD, Iris Lansdorp-Vogelaar, PhD, Sidney J. Winawer, MD, DSc, Ann G. Zauber, PhD, Amy B. Knudsen, PhD, and Uri Ladabaum, MD, MSReinier G.S. Meester, PhDErasmus MC University Medical Center, Rotterdam, the Netherlands (R.G.M., I.L.)Search for more papers by this author, Iris Lansdorp-Vogelaar, PhDErasmus MC University Medical Center, Rotterdam, the Netherlands (R.G.M., I.L.)Search for more papers by this author, Sidney J. Winawer, MD, DScMemorial Sloan Kettering Cancer Center, New York, New York (S.J.W., A.G.Z.)Search for more papers by this author, Ann G. Zauber, PhDMemorial Sloan Kettering Cancer Center, New York, New York (S.J.W., A.G.Z.)Search for more papers by this author, Amy B. Knudsen, PhDMassachusetts General Hospital, Boston, Massachusetts (A.B.K.)Search for more papers by this author, and Uri Ladabaum, MD, MSStanford University, Stanford, California (U.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0829 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree that nonadvanced adenomas probably do not pose high risk for CRC. The 2 cohort studies that Drs. Gupta and Lieberman cite suggest a similar risk among patients with nonadvanced adenomas and no adenomas, but questions remain about the natural history and magnitude of relative risk. In 1 study, some patients in the “no adenoma” group had not received a baseline colonoscopy. In the other study, the group consisted of patients with “abnormal” results on sigmoidoscopy but no adenomas found on subsequent colonoscopy and an unclear history of adenomas. In addition, patients in both studies had substantial ...References1. Zauber AG, Winawer SJ, O'Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687-96. [PMID: 22356322] doi:10.1056/NEJMoa1100370 CrossrefMedlineGoogle Scholar2. Zhao S, Wang S, Pan P, et al. Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy: a systematic review and meta-analysis. Gastroenterology. 2019;156:1661-74. [PMID: 30738046] doi:10.1053/j.gastro.2019.01.260 CrossrefMedlineGoogle Scholar3. Brenner H, Hoffmeister M, Stegmaier C, et al. Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840,149 screening colonoscopies. Gut. 2007;56:1585-9. [PMID: 17591622] CrossrefMedlineGoogle Scholar4. Saini SD, Schoenfeld P, Vijan S. Surveillance colonoscopy is cost-effective for patients with adenomas who are at high risk of colorectal cancer. Gastroenterology. 2010;138:2292-9. [PMID: 20226186] doi:10.1053/j.gastro.2010.03.004 CrossrefMedlineGoogle Scholar5. Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143:844-57. [PMID: 22763141] doi:10.1053/j.gastro.2012.06.001 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Erasmus MC University Medical Center, Rotterdam, the Netherlands (R.G.M., I.L.)Memorial Sloan Kettering Cancer Center, New York, New York (S.J.W., A.G.Z.)Massachusetts General Hospital, Boston, Massachusetts (A.B.K.)Stanford University, Stanford, California (U.L.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3633. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHigh-Intensity Versus Low-Intensity Surveillance for Patients With Colorectal Adenomas Reinier G.S. Meester , Iris Lansdorp-Vogelaar , Sidney J. Winawer , Ann G. Zauber , Amy B. Knudsen , and Uri Ladabaum Intensity of Surveillance for Patients With Colorectal Adenomas Samir Gupta and David Lieberman Metrics 17 March 2020Volume 172, Issue 6Page: 442KeywordsAdenomasCancer epidemiologyCohort studiesColonoscopyDisclosureNatural history of diseaseRelative risk ePublished: 17 March 2020 Issue Published: 17 March 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...