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Risk of second primary colorectal cancer with particular reference to age at diagnosis

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Patients with a history of colorectal cancer are considered at increased risk of second metachronous colorectal cancer (SM-CRC), for which they frequently receive intensive colonoscopic surveillance. In view of the ambiguous nature of the existing evidence and the growing interest in targeted surveillance, we sought to quantify long-term risk with particular reference to age at diagnosis. Method: 

The Surveillance Epidemiology and End Results database was used to estimate risk of SM-CRC after first incident colorectal cancer diagnosed between 1975 and 1999. We calculated time-dependent rates using Kaplan–Meier estimates and relative risk compared with the US general population. Results: 

From 311 689 eligible patients, there were 6387 SM-CRCs. At 15-years following initial diagnosis, the SM-CRC rate was 6.3% (95% CI, 6.1–6.5). For patients with synchronous primary cancers (n = 9936, 3.2%), the 15-year SM-CRC rate increased to 10.5% (95% CI, 9.1–12.2). Younger age predicted for increased relative risks but absolute cumulative rates at 15 years were low (Table). Conclusion: 

The long-term cumulative risk of SM-CRCs after first colorectal cancer is low, even among younger age patients. These data do not support the routine use of high-frequency colonoscopy surveillance in patients with a history of colorectal cancer.
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Document Type: Abstract

Affiliations: 1: Department of Surgery, Christie Hospital NHS Trust, Manchester, UK 2: Institute for Social and Preventive Medicine, University of Berne, Berne, Switzerland

Publication date: 01 November 2006

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