# Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths (National Polyp Study)

Source: https://onco.cc/key-papers/paper-zauber-national-polyp-study-colonoscopic-polypectomy-nejm-2012/  
OnCo record `paper-zauber-national-polyp-study-colonoscopic-polypectomy-nejm-2012` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Twenty-three years after having their adenomas removed at colonoscopy, 2,602 people in the National Polyp Study had half the bowel cancer deaths expected for the general population. This is the evidence that removing a polyp prevents a death.

## Summary

Zauber, Winawer, O'Brien and colleagues followed everyone prospectively referred for initial colonoscopy at National Polyp Study centres between 1980 and 1990 who had polyps, using the National Death Index to identify deaths and their causes for as long as 23 years. Mortality from colorectal cancer among patients whose adenomas had been removed was compared with the expected incidence-based mortality in the general population, estimated from the SEER programme, and with the observed mortality among patients who had non-adenomatous polyps.

Mortality from colorectal cancer was similar in the two polyp groups during the first ten years after polypectomy, which is the interval in which the removal of adenomas would not yet be expected to show.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: colorectal-evidence
- Journal: New England Journal of Medicine
- Year: 2012
- DOI: 10.1056/NEJMoa1100370
- Authors: Zauber AG, Winawer SJ, O'Brien MJ, et al.
- Findings: After a median of 15.8 years, 1,246 of 2,602 patients with adenomas removed had died of any cause and 12 had died of colorectal cancer.; Against 25.4 expected deaths in the general population, the standardised incidence-based mortality ratio was 0.47 (95 percent CI 0.26 to 0.80): a 53 percent reduction.; Colorectal cancer mortality was similar in patients with adenomas and with non-adenomatous polyps during the first ten years (relative risk 1.2, 95 percent CI 0.1 to 10.6).
- What it means: The clinical proof of Vogelstein's sequence: interrupting the adenoma-carcinoma pathway with a snare prevents the cancer, which is why colonoscopy is the only screening test that both detects and prevents.
- Caveats: Not randomised; the comparator is SEER expected mortality, so differences in the screened population's baseline risk cannot be ruled out.; Colonoscopy technique, bowel preparation and adenoma detection rates in 1980 to 1990 differ from today's.

## Sources

- N Engl J Med 2012: https://doi.org/10.1056/NEJMoa1100370
- PubMed: https://pubmed.ncbi.nlm.nih.gov/22356322/
- Europe PMC full text (PMC3322371): https://europepmc.org/article/MED/22356322

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- terms: [Colonoscopy](https://onco.cc/terms/colonoscopy/), [Endoscopy (EGD, EUS, ERCP)](https://onco.cc/terms/endoscopy/)
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- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/)

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