Ongoing colorectal cancer risk despite surveillance colonoscopy: the Polyp Prevention Trial Continued Follow-up Study

Gastrointest Endosc. 2010 Jan;71(1):111-7. doi: 10.1016/j.gie.2009.05.010. Epub 2009 Jul 31.


Background: Despite regular colonoscopy, interval colorectal cancer (CRC) may occur. Long-term studies examining CRC rates in patients with previous colonoscopy are lacking.

Objective: We examined the rate of interval CRC in the Polyp Prevention Trial Continued Follow-up Study (PPT-CFS), an observational study of PPT participants that began after the PPT ended.

Design: Prospective.

Setting: A national U.S. community-based polyp prevention trial.

Main outcome measurements: Medical records of patients with CRC were collected, reviewed, and abstracted in a standardized fashion.

Results: Among 2079 PPT participants, 1297 (62.4%) agreed to participate in the PPT-CFS. They were followed for a median of 6.2 years after 4.3 years of median follow-up in the main PPT. Nine cases of CRC were diagnosed over 7626 person-years of observation (PYO), for an incidence rate of 1.2/1000 PYO. The ratio of CRCs observed compared with that expected by Surveillance, Epidemiology, and End Results was 0.64 (95% CI, 0.28-1.06). Including all CRCs (N = 22) since the beginning of the PPT, the observed compared with expected rate by Surveillance, Epidemiology, and End Results was 0.74 (95% CI, 0.47-1.05). Of patients in whom CRC developed in the PPT-CFS, 78% had a history of an advanced adenoma compared with only 43% of patients who remained cancer free (P = .04).

Limitation: A relatively small number of interval cancers were detected.

Conclusions: Despite frequent colonoscopy during the PPT, in the years after the trial, there was a persistent ongoing risk of cancer. Subjects with a history of advanced adenoma are at increased risk of subsequent cancer and should be followed closely with continued surveillance.

Publication types

  • Clinical Trial

MeSH terms

  • Adenoma / diagnosis
  • Adenoma / epidemiology*
  • Adenoma / prevention & control
  • Aged
  • Colonic Polyps / diagnosis
  • Colonic Polyps / epidemiology*
  • Colonic Polyps / prevention & control
  • Colonoscopy*
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / prevention & control
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Prospective Studies
  • Risk Factors