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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.
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.
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.
Colonoscopy screening works, but the effect a health system gets is the effect of the invitation, not of the procedure; uptake, not test performance, is the binding constraint, and this is the trial that made that argument unavoidable.
The paper that made the adenoma detection rate the central quality measure of every screening endoscopy service, and the reason endoscopist-level auditing is a condition of accreditation.
Shares Quality indicators for colonoscopy and the risk of interval cancer, Effect of colonoscopy screening on risks of colorectal cancer and related death (NordICC), Colonoscopy, Endoscopy (EGD, EUS, ERCP) and the tag colorectal-evidence.
Shares Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, The hardest cancers are found late and the tag colorectal-evidence.
Shares Quality indicators for colonoscopy and the risk of interval cancer, Effect of colonoscopy screening on risks of colorectal cancer and related death (NordICC), Colonoscopy, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood) and the tag colorectal-evidence.
Shares Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, The hardest cancers are found late and the tag colorectal-evidence.
Shares Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, 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 and the tag colorectal-evidence.
Shares Effect of colonoscopy screening on risks of colorectal cancer and related death (NordICC), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, New England Journal of Medicine and the tag colorectal-evidence.
Shares Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Prevention we already have is not deployed, The hardest cancers are found late, 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 and the tag colorectal-evidence.
Shares Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, 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, Colorectal cancer and the tag colorectal-evidence.