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Patients with advanced adenomas are advised to undergo intensive surveillance for colorectal cancer (CRC).1Pinsky P.F. Schoen R.E. Contribution of Surveillance Colonoscopy to Colorectal Cancer Prevention.Clin Gastroenterol Hepatol. 2020; 18: 2937-2944.e1Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar This recommendation is primarily based on their high risk of developing colorectal neoplasia but fails to account for potential risk of non-CRC-related mortality. In this multicenter retrospective cohort study from 13 Veterans Affairs’ Medical Centers in USA, Kahi and colleagues derived a risk prediction model to inform tailored colorectal cancer surveillance in patients with advanced adenomas.2Kahi C.J. Myers L.J. Stump T.E. Imler T.D. Sherer E.A. Larson J. Imperiale T.F. Tailoring Surveillance Colonoscopy in Patients With Advanced Adenomas.Clin Gastroenterol Hepatol. 2022; 20: 847-854Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar In 2,943 patients with advanced adenomas, 16.7% died within 5 years and ∼99% of these deaths were from non-CRC causes. The authors derived a risk prediction model based on age, comorbidity burden (Charlson’s comorbidity index and APACHE score) and specific comorbidities (congestive heart failure, stroke, cirrhosis and end-stage renal disease). This model stratified patients at low-, intermediate- and high-risk of non-CRC-related mortality, with 5-year risk of 6.5%, 14.1% and 33.2%, respectively. Using the low-risk category as the reference group, the odds of non-CRC-mortality were 2.4 and 7.2 for the intermediate- and high-risk categories, respectively. Foregoing surveillance colonoscopy for patients in high-risk categories would have reduced colonoscopy utilization by 27%. With validation, such a risk prediction model may be helpful to identify patients with advanced adenomas who are least likely to benefit from intensive colonoscopy-based surveillance due to high risk of competing mortality; this strategy can also improve colonoscopy efficiency and utilization. See page 847 Alcohol misuse is becoming one of the leading causes of liver disease.3Moon A.M. Singal A.G. Tapper E.B. Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis.Clin Gastroenterol Hepatol. 2020; 18: 2650-2666Abstract Full Text Full Text PDF PubMed Scopus (207) Google Scholar Alcohol use has been associated with increased risk of certain cancers, but there are limited data whether alcohol-related liver disease increases risk of cancers. In this population-based cohort study, Hagström and colleagues studied cancer risk in 3,410 patients with biopsy-proven alcoholic liver disease (60% with cirrhosis) in Sweden.4Hagström H. Thiele M. Sharma R. Simon T.G. Roelstraete B. Söderling J. Ludvigsson J.F. Risk of Cancer in Biopsy-Proven Alcohol-Related Liver Disease: A Population-Based Cohort Study of 3410 Persons.Clin Gastroenterol Hepatol. 2022; 20: 918-929Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar In a competing risk analysis, they observed that risk of cancer in patients with alcoholic liver disease was only modestly higher compared with matched, general population, that too in a subset who survived the first year after diagnosis of alcoholic liver disease. Risk of hepatocellular cancer (HCC) specifically was ∼13-times higher; advanced age and concomitant diabetes conferred higher risk. Cumulative risk of HCC at 10 years was 3.7% in all patients with alcoholic liver disease and 5.0% in those with alcoholic cirrhosis. However, the risk of HCC did not meet established cost-effectiveness thresholds for initiating HCC surveillance in all patients with alcoholic cirrhosis. Overall, this study highlights that risk of all cancers, including HCC, in patients with alcoholic liver diseases may not necessarily warrant intensive surveillance. This may be driven by high risk of non-HCC-related mortality in these patients. See page 918 Risk of Cancer in Biopsy-Proven Alcohol-Related Liver Disease: A Population-Based Cohort Study of 3410 PersonsClinical Gastroenterology and HepatologyVol. 20Issue 4PreviewPersons with alcohol-related liver disease (ALD) are at an increased risk of death and liver-related endpoints, but the association with incident cancer is not well understood, and whether it differs across histopathological subgroups is undefined. Full-Text PDF Open AccessTailoring Surveillance Colonoscopy in Patients With Advanced AdenomasClinical Gastroenterology and HepatologyVol. 20Issue 4PreviewPatients with advanced colorectal adenomas (AAs) are directed to undergo intensive surveillance. However, the benefit derived from surveillance may be outweighed by the risk of death from non-colorectal cancer (CRC) causes, leading to uncertainty on how best to individualize follow-up. The aim of this study was to derive a risk prediction model and risk index that estimate and stratify the risk for non-CRC cancer mortality (NCM) subsequent to diagnosis and removal of AA. Full-Text PDF