McNeil RB

Background: CSP 380-Risk Factors for Large Colonic Adenomas, a screening colonoscopy study, enrolled 3,121 patients from 1994-97 at 13 VA sites. We report 10 year outcomes based on risk group after baseline colonoscopy.

Methods: Asymptomatic veterans age 50-75 who had not undergone colorectal cancer (CRC) screening in the prior 10 years underwent colonoscopy and were classified into 6 risk groups: no neoplasia, 1-2 small adenomas, 3-10 adenomas, > 10 adenomas, advanced adenoma (polyp ≥ 1 cm, villous histology, or high grade dysplasia), and CRC. Subjects were followed for 10 years until death or last colonoscopy. We report the proportions who developed advanced neoplasia (AN, defined as advanced adenoma or CRC) and CRC.

Results: Of the patients enrolled, 1,917 had at least one follow-up colonoscopy. Of these 1,917, 933 had no neoplasia at baseline; 4.0% developed AN, including 0.8% with CRC. At baseline, 560 patients had 1-2 small adenomas; 5.9% developed AN, including 0.9% with CRC. For those with 3-10 adenomas (134), 15.7% developed AN, including 0.7% with CRC. Two had > 10 adenomas; neither developed AN or CRC. At baseline, 265 patients had advanced adenoma; 19.2% developed AN, including 1.9% with CRC. Twenty-three patients had baseline CRC; 34.8% developed AN, including 21.7% with CRC. Patients with baseline CRC were at highest risk of developing AN. Those with advanced adenoma or 3-10 adenomas were at moderate risk. Those with no neoplasia or 1-2 small adenomas were at lowest risk. Except for those with baseline CRC, all risk groups showed a dramatic decline in CRC incidence after 3 years, with 10-year CRC risk similar to those with no neoplasia at baseline.

Conclusion: 1) Baseline colonoscopy result is a predictor of future risk for AN. 2) Those with baseline CRC remain at risk for recurrence. Intensive surveillance is warranted. 3) Those with 1-2 small adenomas or no adenomas at baseline have a low risk of AN after 2-3 years, and may not need surveillance. 4) Those with baseline advanced adenoma or > 3 adenomas show a dramatic decline in CRC risk after 3 years, suggesting that frequent surveillance may only be necessary in the first 5 years.

Background: CSP 380-Risk Factors for Large Colonic Adenomas, a screening colonoscopy study, enrolled 3,121 patients from 1994-97 at 13 VA sites. We report 10 year outcomes based on risk group after baseline colonoscopy.

Methods: Asymptomatic veterans age 50-75 who had not undergone colorectal cancer (CRC) screening in the prior 10 years underwent colonoscopy and were classified into 6 risk groups: no neoplasia, 1-2 small adenomas, 3-10 adenomas, > 10 adenomas, advanced adenoma (polyp ≥ 1 cm, villous histology, or high grade dysplasia), and CRC. Subjects were followed for 10 years until death or last colonoscopy. We report the proportions who developed advanced neoplasia (AN, defined as advanced adenoma or CRC) and CRC.

Results: Of the patients enrolled, 1,917 had at least one follow-up colonoscopy. Of these 1,917, 933 had no neoplasia at baseline; 4.0% developed AN, including 0.8% with CRC. At baseline, 560 patients had 1-2 small adenomas; 5.9% developed AN, including 0.9% with CRC. For those with 3-10 adenomas (134), 15.7% developed AN, including 0.7% with CRC. Two had > 10 adenomas; neither developed AN or CRC. At baseline, 265 patients had advanced adenoma; 19.2% developed AN, including 1.9% with CRC. Twenty-three patients had baseline CRC; 34.8% developed AN, including 21.7% with CRC. Patients with baseline CRC were at highest risk of developing AN. Those with advanced adenoma or 3-10 adenomas were at moderate risk. Those with no neoplasia or 1-2 small adenomas were at lowest risk. Except for those with baseline CRC, all risk groups showed a dramatic decline in CRC incidence after 3 years, with 10-year CRC risk similar to those with no neoplasia at baseline.

Conclusion: 1) Baseline colonoscopy result is a predictor of future risk for AN. 2) Those with baseline CRC remain at risk for recurrence. Intensive surveillance is warranted. 3) Those with 1-2 small adenomas or no adenomas at baseline have a low risk of AN after 2-3 years, and may not need surveillance. 4) Those with baseline advanced adenoma or > 3 adenomas show a dramatic decline in CRC risk after 3 years, suggesting that frequent surveillance may only be necessary in the first 5 years.

Background: CSP 380-Risk Factors for Large Colonic Adenomas, a screening colonoscopy study, enrolled 3,121 patients from 1994-97 at 13 VA sites. We report 10 year outcomes based on risk group after baseline colonoscopy.

Methods: Asymptomatic veterans age 50-75 who had not undergone colorectal cancer (CRC) screening in the prior 10 years underwent colonoscopy and were classified into 6 risk groups: no neoplasia, 1-2 small adenomas, 3-10 adenomas, > 10 adenomas, advanced adenoma (polyp ≥ 1 cm, villous histology, or high grade dysplasia), and CRC. Subjects were followed for 10 years until death or last colonoscopy. We report the proportions who developed advanced neoplasia (AN, defined as advanced adenoma or CRC) and CRC.

Results: Of the patients enrolled, 1,917 had at least one follow-up colonoscopy. Of these 1,917, 933 had no neoplasia at baseline; 4.0% developed AN, including 0.8% with CRC. At baseline, 560 patients had 1-2 small adenomas; 5.9% developed AN, including 0.9% with CRC. For those with 3-10 adenomas (134), 15.7% developed AN, including 0.7% with CRC. Two had > 10 adenomas; neither developed AN or CRC. At baseline, 265 patients had advanced adenoma; 19.2% developed AN, including 1.9% with CRC. Twenty-three patients had baseline CRC; 34.8% developed AN, including 21.7% with CRC. Patients with baseline CRC were at highest risk of developing AN. Those with advanced adenoma or 3-10 adenomas were at moderate risk. Those with no neoplasia or 1-2 small adenomas were at lowest risk. Except for those with baseline CRC, all risk groups showed a dramatic decline in CRC incidence after 3 years, with 10-year CRC risk similar to those with no neoplasia at baseline.

Conclusion: 1) Baseline colonoscopy result is a predictor of future risk for AN. 2) Those with baseline CRC remain at risk for recurrence. Intensive surveillance is warranted. 3) Those with 1-2 small adenomas or no adenomas at baseline have a low risk of AN after 2-3 years, and may not need surveillance. 4) Those with baseline advanced adenoma or > 3 adenomas show a dramatic decline in CRC risk after 3 years, suggesting that frequent surveillance may only be necessary in the first 5 years.

Background: Colorectal cancer (CRC) screening guidelines in the U.S. recommend genetic evaluation for individuals with ≥ 10 cumulative colorectal adenomas, as they are thought to have an increased risk for underlying hereditary CRC syndromes. However, little is known about the prevalence, clinical characteristics, and long-term outcomes of patients with ≥ 10 cumulative adenomas.

Aims: To estimate the proportion of patients in a screening cohort who are found to have ≥ 10 cumulative adenomas, examine the demographic and baseline clinical risk factors associated with having ≥ 10 cumulative adenomas, and describe the prevalence of advanced neoplasia (AN) and CRC in these patients.

Patients and Methods: The CSP 380 cohort comprises 3,121 asymptomatic veterans aged 50-75 from 13 VA sites who underwent a screening colonoscopy from 1994-97 and were followed for 10 years until death or last colonoscopy. Of these 3,121 patients, 3,089 did not have CRC at baseline. We identified patients with ≥ 10 cumulative adenomas and compared baseline factors (gender, race, family history of CRC, age, BMI, tobacco use, and alcohol use) in patients with and without ≥ 10 cumulative adenomas. We then estimated the age to ≥ 10 cumulative adenomas. Finally, we calculated the prevalence of AN (polyp ≥ 1 cm, villous histology, high grade dysplasia, or CRC) in patients with ≥ 10 adenomas and those with 0-9 adenomas.

Results: Ten or more cumulative adenomas were found in 66 (2.1%) of the 3089 patients in a 10-year period. Age 60-69 is the single baseline risk factor associated with this outcome. Of the 3,023 patients with 0-9 cumulative adenomas, 348 (11.5%) developed AN, including 23 (0.8%) with CRC. Of the 66 patients with ≥ 10 adenomas, 42 (63.6%) developed AN, including 2 (3.0%) with CRC.

Conclusion: The prevalence of ≥ 10 cumulative adenomas was 2% in this screening population, with few cases before age 60. Few patients with this outcome, however, develop CRC within a 10-year period. Future work could identify additional risk factors associated with the development of ≥ 10 cumulative adenomas in order to create a risk stratification tool that may lead to the earlier detection of patients at high risk for hereditary CRC syndromes, AN, and CRC.

Background: Colorectal cancer (CRC) screening guidelines in the U.S. recommend genetic evaluation for individuals with ≥ 10 cumulative colorectal adenomas, as they are thought to have an increased risk for underlying hereditary CRC syndromes. However, little is known about the prevalence, clinical characteristics, and long-term outcomes of patients with ≥ 10 cumulative adenomas.

Aims: To estimate the proportion of patients in a screening cohort who are found to have ≥ 10 cumulative adenomas, examine the demographic and baseline clinical risk factors associated with having ≥ 10 cumulative adenomas, and describe the prevalence of advanced neoplasia (AN) and CRC in these patients.

Patients and Methods: The CSP 380 cohort comprises 3,121 asymptomatic veterans aged 50-75 from 13 VA sites who underwent a screening colonoscopy from 1994-97 and were followed for 10 years until death or last colonoscopy. Of these 3,121 patients, 3,089 did not have CRC at baseline. We identified patients with ≥ 10 cumulative adenomas and compared baseline factors (gender, race, family history of CRC, age, BMI, tobacco use, and alcohol use) in patients with and without ≥ 10 cumulative adenomas. We then estimated the age to ≥ 10 cumulative adenomas. Finally, we calculated the prevalence of AN (polyp ≥ 1 cm, villous histology, high grade dysplasia, or CRC) in patients with ≥ 10 adenomas and those with 0-9 adenomas.

Results: Ten or more cumulative adenomas were found in 66 (2.1%) of the 3089 patients in a 10-year period. Age 60-69 is the single baseline risk factor associated with this outcome. Of the 3,023 patients with 0-9 cumulative adenomas, 348 (11.5%) developed AN, including 23 (0.8%) with CRC. Of the 66 patients with ≥ 10 adenomas, 42 (63.6%) developed AN, including 2 (3.0%) with CRC.

Conclusion: The prevalence of ≥ 10 cumulative adenomas was 2% in this screening population, with few cases before age 60. Few patients with this outcome, however, develop CRC within a 10-year period. Future work could identify additional risk factors associated with the development of ≥ 10 cumulative adenomas in order to create a risk stratification tool that may lead to the earlier detection of patients at high risk for hereditary CRC syndromes, AN, and CRC.

Background: Colorectal cancer (CRC) screening guidelines in the U.S. recommend genetic evaluation for individuals with ≥ 10 cumulative colorectal adenomas, as they are thought to have an increased risk for underlying hereditary CRC syndromes. However, little is known about the prevalence, clinical characteristics, and long-term outcomes of patients with ≥ 10 cumulative adenomas.

Aims: To estimate the proportion of patients in a screening cohort who are found to have ≥ 10 cumulative adenomas, examine the demographic and baseline clinical risk factors associated with having ≥ 10 cumulative adenomas, and describe the prevalence of advanced neoplasia (AN) and CRC in these patients.

Patients and Methods: The CSP 380 cohort comprises 3,121 asymptomatic veterans aged 50-75 from 13 VA sites who underwent a screening colonoscopy from 1994-97 and were followed for 10 years until death or last colonoscopy. Of these 3,121 patients, 3,089 did not have CRC at baseline. We identified patients with ≥ 10 cumulative adenomas and compared baseline factors (gender, race, family history of CRC, age, BMI, tobacco use, and alcohol use) in patients with and without ≥ 10 cumulative adenomas. We then estimated the age to ≥ 10 cumulative adenomas. Finally, we calculated the prevalence of AN (polyp ≥ 1 cm, villous histology, high grade dysplasia, or CRC) in patients with ≥ 10 adenomas and those with 0-9 adenomas.

Results: Ten or more cumulative adenomas were found in 66 (2.1%) of the 3089 patients in a 10-year period. Age 60-69 is the single baseline risk factor associated with this outcome. Of the 3,023 patients with 0-9 cumulative adenomas, 348 (11.5%) developed AN, including 23 (0.8%) with CRC. Of the 66 patients with ≥ 10 adenomas, 42 (63.6%) developed AN, including 2 (3.0%) with CRC.

Conclusion: The prevalence of ≥ 10 cumulative adenomas was 2% in this screening population, with few cases before age 60. Few patients with this outcome, however, develop CRC within a 10-year period. Future work could identify additional risk factors associated with the development of ≥ 10 cumulative adenomas in order to create a risk stratification tool that may lead to the earlier detection of patients at high risk for hereditary CRC syndromes, AN, and CRC.

Purpose: Our objective is to comprehensively describe cancer incidence as reported in the VA Central Cancer Registry (VACCR).

Background: Approximately 3% of US cancer cases are diagnosed and treated in the VA healthcare system each year. These cancer cases are reported in the VACCR. In 2012, we published the first comprehensive description of cancer incidence as reported in the VACCR for patients diagnosed in 2007. In our current analysis, we provide an updated description of cancer incidence as reported in the VACCR for patients diagnosed in 2010.

Methods: This was a retrospective, cross-sectional study. We obtained data from 2 sources: (1) VACCR for incident cancer cases; (2) VHA Support Service Center (VSSC) for underlying population of VA healthcare system users.

Data Analysis: Analyses focused on diagnoses in 2010. Noninvasive cancers and those missing TNM stage were excluded from analyses. Cancer incidence among VA patients was descriptively
compared to the general US cancer population.

Results: In 2010, 49,857 cases were reported in VACCR. We excluded non-invasive cases (n = 3,687) and those with missing/unknown stage (n = 8,645). There were 37,525 reported invasive, incident cancers, and 97% (n = 36,454) of those were diagnosed among men. Almost 80% (n = 29,364) of newly diagnosed patients were white, 20% (n = 7,293) were black, and less than 2% (n = 450) were another race. The median age at diagnosis was 64 years. The six most frequently diagnosed cancers were prostate (33%, n = 12,431), lung/bronchus (19%, n = 7,159), colon/rectum (9%, n = 3,419), kidney/renal pelvis (4%, n = 1,657), and urinary bladder (4%, n = 1,427) and skin melanomas (4%, n = 1,421). The most common cancers reported in VACCR have remained stable from 2007 to 2010. Approximately 87% (n = 10,845) of prostate, 33% (n = 2,391) of lung/bronchus, and 59% (n = 2,013) of colon/rectum cancers were diagnosed with early stage (stage I or II) disease. Compared to SEER, cases reported in the VACCR tend to be diagnosed at earlier stages. The overall cancer incidence rate among VA users was 414.8 per 100,000 person-years.

Implications: The VA continues to be a large provider of cancer care in the US. VACCR data indicate that incident cancers in VA in 2010 approximately mirrored those observed among US men.

Purpose: Our objective is to comprehensively describe cancer incidence as reported in the VA Central Cancer Registry (VACCR).

Background: Approximately 3% of US cancer cases are diagnosed and treated in the VA healthcare system each year. These cancer cases are reported in the VACCR. In 2012, we published the first comprehensive description of cancer incidence as reported in the VACCR for patients diagnosed in 2007. In our current analysis, we provide an updated description of cancer incidence as reported in the VACCR for patients diagnosed in 2010.

Methods: This was a retrospective, cross-sectional study. We obtained data from 2 sources: (1) VACCR for incident cancer cases; (2) VHA Support Service Center (VSSC) for underlying population of VA healthcare system users.

Data Analysis: Analyses focused on diagnoses in 2010. Noninvasive cancers and those missing TNM stage were excluded from analyses. Cancer incidence among VA patients was descriptively
compared to the general US cancer population.

Results: In 2010, 49,857 cases were reported in VACCR. We excluded non-invasive cases (n = 3,687) and those with missing/unknown stage (n = 8,645). There were 37,525 reported invasive, incident cancers, and 97% (n = 36,454) of those were diagnosed among men. Almost 80% (n = 29,364) of newly diagnosed patients were white, 20% (n = 7,293) were black, and less than 2% (n = 450) were another race. The median age at diagnosis was 64 years. The six most frequently diagnosed cancers were prostate (33%, n = 12,431), lung/bronchus (19%, n = 7,159), colon/rectum (9%, n = 3,419), kidney/renal pelvis (4%, n = 1,657), and urinary bladder (4%, n = 1,427) and skin melanomas (4%, n = 1,421). The most common cancers reported in VACCR have remained stable from 2007 to 2010. Approximately 87% (n = 10,845) of prostate, 33% (n = 2,391) of lung/bronchus, and 59% (n = 2,013) of colon/rectum cancers were diagnosed with early stage (stage I or II) disease. Compared to SEER, cases reported in the VACCR tend to be diagnosed at earlier stages. The overall cancer incidence rate among VA users was 414.8 per 100,000 person-years.

Implications: The VA continues to be a large provider of cancer care in the US. VACCR data indicate that incident cancers in VA in 2010 approximately mirrored those observed among US men.

Purpose: Our objective is to comprehensively describe cancer incidence as reported in the VA Central Cancer Registry (VACCR).

Background: Approximately 3% of US cancer cases are diagnosed and treated in the VA healthcare system each year. These cancer cases are reported in the VACCR. In 2012, we published the first comprehensive description of cancer incidence as reported in the VACCR for patients diagnosed in 2007. In our current analysis, we provide an updated description of cancer incidence as reported in the VACCR for patients diagnosed in 2010.

Methods: This was a retrospective, cross-sectional study. We obtained data from 2 sources: (1) VACCR for incident cancer cases; (2) VHA Support Service Center (VSSC) for underlying population of VA healthcare system users.

Data Analysis: Analyses focused on diagnoses in 2010. Noninvasive cancers and those missing TNM stage were excluded from analyses. Cancer incidence among VA patients was descriptively
compared to the general US cancer population.

Results: In 2010, 49,857 cases were reported in VACCR. We excluded non-invasive cases (n = 3,687) and those with missing/unknown stage (n = 8,645). There were 37,525 reported invasive, incident cancers, and 97% (n = 36,454) of those were diagnosed among men. Almost 80% (n = 29,364) of newly diagnosed patients were white, 20% (n = 7,293) were black, and less than 2% (n = 450) were another race. The median age at diagnosis was 64 years. The six most frequently diagnosed cancers were prostate (33%, n = 12,431), lung/bronchus (19%, n = 7,159), colon/rectum (9%, n = 3,419), kidney/renal pelvis (4%, n = 1,657), and urinary bladder (4%, n = 1,427) and skin melanomas (4%, n = 1,421). The most common cancers reported in VACCR have remained stable from 2007 to 2010. Approximately 87% (n = 10,845) of prostate, 33% (n = 2,391) of lung/bronchus, and 59% (n = 2,013) of colon/rectum cancers were diagnosed with early stage (stage I or II) disease. Compared to SEER, cases reported in the VACCR tend to be diagnosed at earlier stages. The overall cancer incidence rate among VA users was 414.8 per 100,000 person-years.

Implications: The VA continues to be a large provider of cancer care in the US. VACCR data indicate that incident cancers in VA in 2010 approximately mirrored those observed among US men.