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Colorectal cancer death after adenoma removal in Scandinavia
Institute of Health and Society, University of Oslo, Oslo, Norway; Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Värmland, Sweden; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA.
Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine and K. G. Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway.
Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA, Department of Transplantation Medicine and K. G. Jebsen Center for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway.
Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
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2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 12, p. 1377-1384Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Improved understanding of the subsequent risk death from colorectal cancer (CRC) among individuals who had adenomas removed is needed. We aimed to quantify this risk using prospectively collected data from population-based cohorts.

MATERIALS AND METHODS: Using Norwegian and Swedish registries, a cohort of 90,864 individuals with colorectal adenomas removed between 1980 and 2013 was identified. Surveillance was only recommended for high-risk adenomas. The validity of the registry data did not allow classification into low- and high-risk adenomas. Virtually complete follow-up was achieved through linkage to nationwide registers. We calculated incidence-based standardised mortality ratios (SMRs) with 95% confidence intervals (CI).

RESULTS: The median follow-up was 7.2 years; 48,058 individuals were followed for more than 10 years. We observed 819 deaths (0.9%) from CRC and expected 731 CRC deaths (0.8%), corresponding to an absolute excess risk of 88 cases (0.1%) and a relative risk of 12% (SMR 1.12; 95%CI 1.05-1.20). The relative risk of CRC death following adenoma removal was slightly higher in Sweden (SMR 1.22; 95%CI 1.11-1.34) than in Norway (SMR 1.03; 95%CI 0.93-1.14), and higher in women (SMR 1.24; 95%CI 1.12-1.36) than in men (SMR 1.02; 95%CI 0.93-1.13). Among individuals with more than 10 years of follow-up, the estimates were similar to the overall cohort, absolute excess risk 0.1% (SMR 1.15; 95%CI 1.06-1.24).

CONCLUSION: The excess risk of CRC death following adenoma removal is small. Optimal surveillance recommendations should be tested in randomised trials.

Place, publisher, year, edition, pages
Oxfordshire, United Kingdom: Taylor & Francis, 2017. Vol. 52, no 12, p. 1377-1384
Keywords [en]
Mortality, adenoma, colorectal cancer, risk classification, standardised mortality ratio, surveillance
National Category
Cancer and Oncology Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-62197DOI: 10.1080/00365521.2017.1377763ISI: 000418596600012PubMedID: 28906163Scopus ID: 2-s2.0-85029531921OAI: oai:DiVA.org:oru-62197DiVA, id: diva2:1155693
Funder
Swedish Cancer Society
Note

Funding Agencies:

Norwegian Research Council  

Norwegian Cancer Society  

Foundation Blanceflor 

Karolinska Institutet Distinguished Professor Award 

Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-08-10Bibliographically approved

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Fall, Katja

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