An initial colonoscopy that removes all precancerous polyps may significantly reduce expected later mortality from colorectal cancer, according to a presentation at the annual meeting of the American College of Gastroenterology.

Epidemiologists and clinical researchers from Memorial Sloan-Kettering used a model to examine the relative effect of an initial screening colonoscopy which clears pre-cancerous polyps from the colon versus surveillance follow-up colonoscopy.

“The model demonstrated a dramatic reduction in expected colorectal cancer mortality with initial polypectomy with or without surveillance, and suggests that the initial polypectomy accounts for the major component of the mortality reduction,” said Ann G. Zauber, PhD.

Using a “MISCAN” model, researchers used National Polyp Study data to predict colorectal cancer mortality among three groups of patients: those with no initial removal of polyps or follow-up colonoscopic surveillance compared with patients with only initial polypectomy and patients who had both polypectomy and follow-up surveillance. The model predicted mortality at up to thirty years after the initial colorectal exam and removal of pre-cancerous polyps.

According to Zauber, the major effect on colorectal cancer mortality reduction produced by the initial polypectomy rather than the surveillance colonoscopies is consistent with the low incidence of advanced adenomas observed during National Polyp Study follow-up (that is, precancerous growths larger than 1 cm, polyps with a villous component, high grade dysplasia or invasive colorectal cancer.)

Zauber and her colleagues suggest that these findings may support the recommendation to lengthen the interval to six or more years for follow-up surveillance for patients who have polyps removed. Current recommendations by the American College of Gastroenterology call for surveillance colonoscopy in three to five years for follow-up of patients with prior colorectal cancer, prior adenomas or disease with causes increased risk of colorectal cancer.

An editorial by colorectal cancer expert T.R. Levin, M.D, FACG in the August issue of the American Journal of Gastroenterology offers an overview of post-polypectomy surveillance.

According to Dr. Levin,“Postpolypectomy and postcancer resection surveillance are among the most common indications for colonoscopy in clinical practice. Together, they account for more than one in five colonoscopies in the Clinical Outcomes Research Initiative database. Survey results have also demonstrated that postpolypectomy surveillance for small adenomas and hyperplastic polyps is often recommended by specialists and primary care physicians more frequently than guideline recommendations.”

According to College President Dr. David A. Johnson, “there is growing evidence to support the extension of surveillance to longer intervals, all subject to optimal clearing of the colon of precancerous polyps ? which is contingent on adequate resection at the time of polypectomy and adequate visualization of the colon, which depends on adequate bowel preparation, as well as efforts by the endoscopist during the exam. Although given the constraints of a modeling study such as this one from Sloan-Kettering, there need to be prospective trials to support and validate longer colorectal cancer surveillance intervals before changing the current recommendations.”