Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 3
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Pence, Barbara C. Belasco, Eric J. and Lyford, Conrad P. 2012. Prevention of Colorectal Cancer by Aspirin and/or Calcium: Efficacy, Mechanisms, and Cost Effectiveness. Current Colorectal Cancer Reports, Vol. 8, Issue. 1, p. 51.

    Saini, Sameer D. Schoenfeld, Philip and Vijan, Sandeep 2010. Surveillance Colonoscopy Is Cost-Effective for Patients With Adenomas Who Are at High Risk of Colorectal Cancer. Gastroenterology, Vol. 138, Issue. 7, p. 2292.

    Omidvari, Amir-Houshang Meester, Reinier G.S. and Lansdorp-Vogelaar, Iris 2016. Cost Effectiveness of Surveillance in GI practice. Best Practice & Research Clinical Gastroenterology,

  • International Journal of Technology Assessment in Health Care, Volume 25, Issue 2
  • April 2009, pp. 222-231

Can calcium chemoprevention of adenoma recurrence substitute or serve as an adjunct for colonoscopic surveillance?

  • Aasma Shaukat (a1), Murtaza Parekh (a2), Joseph Lipscomb (a3) and Uri Ladabaum (a2)
  • DOI:
  • Published online: 01 April 2009

Objectives: The aim of this study was to examine the potential cost-effectiveness of calcium chemoprevention post-polypectomy as a substitute or adjunct for surveillance.

Methods: We constructed a Markov model of post-polypectomy adenoma recurrence and colorectal cancer (CRC) development, calibrated to data from prospective chemoprevention trials of fiber, calcium, antioxidants, and aspirin. We modeled four scenarios for 50-year-old patients immediately after polypectomy: (i) natural history with no further intervention; (ii) elemental calcium 1,200 mg/day from age 50–80; (iii) surveillance colonoscopy from age 50–80 every 5 years, or 3 years for large adenoma; (iv) calcium + surveillance. Patients were followed up until age 100 or death.

Results: Calcium was cost-effective compared to natural history ($49,900/life-year gained). However, surveillance was significantly more effective than calcium (18.729 versus 18.654 life-years/patient; 76 percent versus 14 percent reduction in CRC incidence) at an incremental cost of $15,900/life-year gained. Calcium + surveillance yielded a very small benefit (0.0003 incremental life-years/patient) compared with surveillance alone, at a substantial incremental cost of $3,090,000/life-year gained.

Conclusion: Post-polypectomy calcium chemoprevention is unlikely to be a reasonable substitute for surveillance. It may be cost-effective in patients unwilling or unable to undergo surveillance.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.DS Alberts , ME Martinez , DJ Roe , Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians’ Network. N Engl J Med. 2000;342:11561162.

2.WF Anderson , A Umar , JL Viner , ET Hawk . The role of cyclooxygenase inhibitors in cancer prevention. Curr Pharm Des. 2002;8:10351062.

3.MR Arguedas , GR Heudebert , CM Wilcox . Surveillance colonoscopy or chemoprevention with COX-2 inhibitors in average-risk post-polypectomy patients: A decision analysis. Aliment Pharmacol Ther. 2001;15:631638.

4.JA Baron , M Beach , JS Mandel , Calcium supplements for the prevention of colorectal adenomas. Calcium Polyp Prevention Study Group [see comment]. N Engl J Med. 1999;340:101107.

5.JA Baron , B F Cole , RS Sandler , A randomized trial of aspirin to prevent colorectal adenomas [see comment]. N Engl J Med. 2003;348:891899.

7.JH Bond . Polyp guideline: Diagnosis, treatment, and surveillance for patients with colorectal polyps. Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 2000;95:30533063.

8.C Bonithon-Kopp , F Piard , C Fenger , Colorectal adenoma characteristics as predictors of recurrence. Dis Colon Rectum. 2004;47:323333.

9.ML Brown , GF Riley , AL Potosky , RD Etzioni . Obtaining long-term disease specific costs of care: Application to Medicare enrollees diagnosed with colorectal cancer. Med Care. 1999;37:12491259.

11.S Cotton , L Sharp , J Little . The adenoma-carcinoma sequence and prospects for the prevention of colorectal neoplasia. Crit Rev Oncog. 1996;7:293342.

12.DM Eddy . Screening for colorectal cancer. Ann Intern Med. 1990;113:373384.

13.DM Eddy , FW Nugent , JF Eddy , Screening for colorectal cancer in a high-risk population. Results of a mathematical model. Gastroenterology. 1987;92:682692.

15.AL Frazier , GA Colditz , CS Fuchs , KM Kuntz . Cost-effectiveness of screening for colorectal cancer in the general population. JAMA. 2000;284:19541961.

16.E Giovannucci . Modifiable risk factors for colon cancer. Gastroenterol Clin North Am. 2002;31:925943.

17.MV Grau , JA Baron , EL Barry , Interaction of calcium supplementation and nonsteroidal anti-inflammatory drugs and the risk of colorectal adenomas. Cancer Epidemiol Biomarkers Prev. 2005;14:2353–1258.

18.ER Greenberg , JA Baron , TD Tosteson , A clinical trial of antioxidant vitamins to prevent colorectal adenoma. Polyp Prevention Study Group. N Engl J Med. 1994;331:141147.

19.RT Greenlee , T Murray , S Bolden , PA Wingo . Cancer statistics, 2000. CA Cancer J Clin. 2000;50:733.

20.ET Hawk , PJ Limburg , JL Viner . Epidemiology and prevention of colorectal cancer. Surg Clin North Am. 2002;82:905941.

21.RP Heaney , MS Dowell , J Bierman , CA Hale , A Bendich . Absorbability and cost effectiveness in calcium supplementation. J Am Coll Nutr. 2001;20:239246.

23.JL Keller , A Lanou , ND Barnard . The consumer cost of calcium from food and supplements. J Am Diet Assoc. 2002;102:16691671.

24.RK Khandker , JD Dulski , JB Kilpatrick , A decision model and cost-effectiveness analysis of colorectal cancer screening and surveillance guidelines for average-risk adults. Int J Technol Assess Health Care. 2000;16:799810.

25.U Ladabaum , CL Chopra , G Huang , Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer. A cost-effectiveness analysis. Ann Intern Med. 2001;135:769781.

26.U Ladabaum , JM Scheiman , AM Fendrick . Potential effect of cyclooxygenase-2-specific inhibitors on the prevention of colorectal cancer: A cost-effectiveness analysis. Am J Med. 2003;114:546554.

27.U Ladabaum , K Song . Projected national impact of colorectal cancer screening on clinical and economic outcomes and health services demand [see comment]. Gastroenterology. 2005;129:11511162.

28.U Ladabaum , K Song , AM Fendrick . Colorectal neoplasia screening with virtual colonoscopy: When, at what cost, and with what national impact? Clin Gastroenterol Hepatol. 2004;2:554563.

29.SA Lamprecht , M Lipkin . Chemoprevention of colon cancer by calcium, vitamin D and folate: Molecular mechanisms. Nat Rev Cancer. 2003;3:601614.

30.DI Levenson , RS Bockman . A review of calcium preparations [erratum appears in Nutr Rev. 1994;52:364]. Nutr Rev. 1994;52:221232.

32.M Lipkin , B Reddy , H Newmark , SA Lamprecht . Dietary factors in human colorectal cancer. Annu Rev Nutr. 1999;19:545586.

33.ME Martinez , R Sampliner , JR Marshall , Adenoma characteristics as risk factors for recurrence of advanced adenomas. Gastroenterology. 2001;120:10771083.

35.BC Morson . The evolution of colorectal carcinoma. Clin Radiol. 1984;35:425431.

37.AI Neugut , JS Jacobson , H Ahsan , Incidence and recurrence rates of colorectal adenomas: A prospective study. Gastroenterology. 1995;108:402408.

38.KC Noshirwani , RU van Stolk , LA Rybicki , GJ Beck . Adenoma size and number are predictive of adenoma recurrence: Implications for surveillance colonoscopy. Gastrointest Endosc. 2000;51 (pt 1):433437.

39.DM Parkin , F Bray , J Ferlay , P Pisani . Estimating the world cancer burden: Globocan 2000. Int J Cancer. 2001;94:153156.

40.DM Parkin , P Pisani , J Ferlay . Global cancer statistics. CA Cancer J Clin. 1999;49:3364.

41.BC Pence . Role of calcium in colon cancer prevention: Experimental and clinical studies. Mutat Res. 1993;290:8795.

42.PJ Pickhardt , JR Choi , I Hwang , Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003;349:21912200.

45.DK Rex , CS Cutler , GT Lemmel , Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies. Gastroenterology. 1997;112:2428.

47.DJ Robertson , ER Greenberg , M Beach , Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology. 2005;129:3441.

48.AJ Rosner , DT Grima , GW Torrance , Cost effectiveness of multi-therapy treatment strategies in the prevention of vertebral fractures in postmenopausal women with osteoporosis. Pharmacoeconomics. 1998;14:559573.

49.RS Sandler , S Halabi , JA Baron , A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer [see comment][erratum appears in N Engl J Med. 2003;348:1939]. N Engl J Med. 2003;348;883890.

50.A Schatzkin , E Lanza , D Corle , Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. Polyp Prevention Trial Study Group. N Engl J Med. 2000;342:11491155.

51.RE Schoen . Surveillance after positive and negative colonoscopy examinations: Issues, yields, and use. Am J Gastroenterol. 2003;98:12371246.

52.A Shaukat , N Scouras , HJ Schunemann . Role of supplemental calcium in the recurrence of colorectal adenomas: A metaanalysis of randomized controlled trials [see comment]. Am J Gastroenterol. 2005;100:390394.

54.K Song , AM Fendrick , U Ladabaum . Fecal DNA testing compared with conventional colorectal cancer screening methods: A decision analysis. Gastroenterology. 2004;126:12701279.

55.A Sonnenberg , F Delco , JM Inadomi . Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med. 2000;133:573584.

56.S Suleiman , DK Rex , A Sonnenberg . Chemoprevention of colorectal cancer by aspirin: A cost-effectiveness analysis [see comment]. Gastroenterology. 2002;122:7884.

57.SH Taplin , W Barlow , N Urban , Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst. 1995;87 (6):417426.

58.P Terry , JA Baron , L Bergkvist , L Holmberg , A Wolk . Dietary calcium and vitamin D intake and risk of colorectal cancer: A prospective cohort study in women. Nutr Cancer. 2002;43:3946.

59.S Vijan , EW Hwang , TP Hofer , RA Hayward . Which colon cancer screening test? A comparison of costs, effectiveness, and compliance. Am J Med. 2001;111:593601.

60.J Wactawski-Wende , JM Kotchen , GL Anderson , Calcium plus vitamin D supplementation and the risk of colorectal cancer [see comment][erratum appears in N Engl J Med. 2006;354:1102]. N Engl J Med. 2006;354:684696.

62.M Wegener , G Borsch , G Schmidt . Colorectal adenomas. Distribution, incidence of malignant transformation, and rate of recurrence. Dis Colon Rectum. 1986;29:383387.

63.SJ Winawer , RH Fletcher , L Miller , Colorectal cancer screening: Clinical guidelines and rationale. Gastroenterology. 1997;112:594642.

64.S Winawer , R Fletcher , D Rex , Colorectal cancer screening and surveillance: Clinical guidelines and rationale-Update based on new evidence. Gastroenterology. 2003;124:544560.

65.SJ Winawer , AG Zauber , MN Ho , Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:19771981.

66.SJ Winawer , AG Zauber , MJ O'Brien , Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med. 1993;328:901906.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary Materials

Shaukat supplementary material

 Unknown (37 KB)
37 KB
Supplementary Materials

Shaukat supplementary material
Supplementary figure 1

 Unknown (147 KB)
147 KB