Hermann Brenner, MD, MPH; Jenny Chang-Claude, PhD; Lina Jansen, PhD; Christoph M. Seiler, MD, MSc; Michael Hoffmeister, PhD
Acknowledgment: The authors are grateful to the study participants and the interviewers who collected the data. They thank the following hospitals and cooperating institutions that recruited patients for this study: Chirurgische Universitätsklinik Heidelberg, Klinik am Gesundbrunnen Heilbronn, Sankt Vincentiuskrankenhaus Speyer, Sankt Josefskrankenhaus Heidelberg, Chirurgische Universitätsklinik Mannheim, Diakonissenkrankenhaus Speyer, Krankenhaus Salem Heidelberg, Kreiskrankenhaus Schwetzingen, Sankt Marien- und Sankt Annastiftkrankenhaus Ludwigshafen, Klinikum Ludwigshafen, Stadtklinik Frankenthal, Diakoniekrankenhaus Mannheim, Kreiskrankenhaus Sinsheim, Klinikum am Plattenwald Bad Friedrichshall, Kreiskrankenhaus Weinheim, Kreiskrankenhaus Eberbach, Kreiskrankenhaus Buchen, Kreiskrankenhaus Mosbach, Enddarmzentrum Mannheim, Kreiskrankenhaus Brackenheim, and Cancer Registry of Rhineland-Palatinate, Mainz. The authors also thank Ute Handte-Daub, Renate Hettler-Jensen, Petra Bächer, and Utz Benscheid for excellent technical assistance.
Grant Support: By grants BR 1704/6-1, BR 1704/6-3, BR 1704/6-4, and CH 117/1-1 from the German Research Council (Deutsche Forschungsgemeinschaft) and grants 01KH0404 and 01ER0814 from the German Federal Ministry of Education and Research.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0247.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available by request from and written agreement with Dr. Brenner (e-mail, email@example.com).
Requests for Single Reprints: Hermann Brenner, MD, MPH, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Brenner, Jansen, and Hoffmeister: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.
Dr. Chang-Claude: Division of Cancer Epidemiology, Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.
Dr. Seiler: Department of General, Visceral and Trauma Surgery, University Clinic Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
Author Contributions: Conception and design: H. Brenner, J. Chang-Claude.
Analysis and interpretation of the data: H. Brenner.
Drafting of the article: H. Brenner.
Critical revision of the article for important intellectual content: H. Brenner, J. Chang-Claude, L. Jansen, C.M. Seiler, M. Hoffmeister.
Final approval of the article: H. Brenner, J. Chang-Claude, L. Jansen, C.M. Seiler, M. Hoffmeister.
Provision of study materials or patients: C.M. Seiler.
Statistical expertise: H. Brenner.
Obtaining of funding: H. Brenner, J. Chang-Claude.
Collection and assembly of data: H. Brenner, L. Jansen, C.M. Seiler, M. Hoffmeister.
Brenner H, Chang-Claude J, Jansen L, Seiler CM, Hoffmeister M. Role of Colonoscopy and Polyp Characteristics in Colorectal Cancer After Colonoscopic Polyp Detection: A Population-Based Case–Control Study. Ann Intern Med. 2012;157:225-232. doi: 10.7326/0003-4819-157-4-201208210-00002
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Published: Ann Intern Med. 2012;157(4):225-232.
Studies have identified characteristics of adenomas detected on colonoscopy to be predictive of adenoma recurrence.
To assess the role of both colonoscopy-related factors and polyp characteristics on the risk for colorectal cancer after colonoscopic polyp detection.
Population-based case–control study (3148 case participants and 3274 control participants).
Rhine-Neckar region of Germany.
Case and control participants with physician-validated detection of polyps (other than hyperplastic polyps) at a previous colonoscopy in the past 10 years.
Detailed history and results of previous colonoscopies were obtained through interviews and medical records. Case and control participants were compared according to colonoscopy-related factors (incompleteness, poor bowel preparation, incomplete removal of all polyps, and no surveillance colonoscopy within 5 years) and polyp characteristics (≥1 cm, villous components or high-grade dysplasia, ≥3 polyps, and ≥1 proximal polyp). Odds ratios (ORs) and attributable fractions were derived by using multiple logistic regression and the Levin formula.
155 case participants and 260 control participants with physician-validated polyp detection in the past 10 years were identified. The following characteristics were significantly more common among case participants than among control participants: not all polyps completely removed (29.0% vs. 9.6%; OR, 3.73 [95% CI, 2.11 to 6.60]), no surveillance colonoscopy within 5 years (26.5% vs. 11.5%; OR, 2.96 [CI, 1.70 to 5.16]), and detection of 3 or more polyps (14.2% vs. 7.3%; OR, 2.21 [CI, 1.07 to 4.54]). Odds ratios ranged from 1.12 to 1.42 and CIs included 1.00 for all other variables. Overall, 41.1% and 21.7% of cancer cases were statistically attributable to colonoscopy-related factors and polyp characteristics, respectively.
This was an observational study with potential for residual confounding and selection bias.
Colonoscopy-related factors are more important than polyp characteristics for stratification of colorectal cancer risk after colonoscopic polyp detection in the community setting.
German Research Council and German Federal Ministry of Education and Research.
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Colonoscopy/Sigmoidoscopy, Colorectal Cancer, Gastroenterology/Hepatology, Gastrointestinal Cancer, Hematology/Oncology.
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