Five or Ten Year Colonoscopy for 1-2 Non-Advanced Adenomatous Polyps
Purpose
This trial examines colorectal cancer incidence in participants with 1 to 2 non-advanced adenomas randomized to surveillance colonoscopy at 10 years compared to participants randomized to surveillance colonoscopy at 5 and 10 years.
Conditions
- Adenocarcinoma of the Colon
- Adenocarcinoma of the Rectum
Eligibility
- Eligible Ages
- Between 45 Years and 70 Years
- Eligible Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- The participant must have signed and dated an IRB-approved consent form that conforms to federal and institutional guidelines. - Participants greater than or equal to 45 and less than 70 years of age at the time of colonoscopy. - Participants with a first-time diagnosis of 1-2 non-advanced tubular adenomas (less than 10 mm without tubulovillous or villous changes or high grade or severe dysplasia) from the qualifying colonoscopy within 4 years prior to randomization. - Sessile serrated polyps/adenomas, as long as they do not meet the criteria for advanced adenomas, will be considered as non-advanced adenomas. - Qualifying colonoscopy must be a complete colonoscopy with visualization of the cecum and with adequate cleansing within 4 years prior to randomization. - Complete excision of all observed polyps in qualifying colonoscopy - Participants must be able to read or understand English or Spanish.
Exclusion Criteria
- • Prior history of colorectal cancer or colorectal adenomas including sessile serrated polyps/adenomas excluding those found on the qualifying colonoscopy. - Prior history of a hyperplastic polyp measuring greater than or equal to 1 cm in size. - Traditional serrated adenomas found on the qualifying colonoscopy. - Hyperplastic polyp measuring greater than or equal to 1 cm in size found on the qualifying colonoscopy. - Previous malignancies unless the patient has been disease-free for 5 or more years prior to randomization and is deemed by the physician to be at low risk for recurrence. Patients with the following cancers are eligible if diagnosed and treated within the past 5 years: all in situ cancers and basal cell and squamous cell carcinoma of the skin. - Colonoscopy performed after the qualifying colonoscopy but prior to randomization. - Incomplete qualifying colonoscopy (e.g., cecum not visualized). - Incomplete endoscopic excision of adenomatous polyps based on colonoscopist impression at qualifying colonoscopy. (Excision of all hyperplastic rectosigmoid polyps is not required.) - Sub-total colectomy or total proctocolectomy. (Segmental resections are allowed.) - Family history of CRC diagnosed at less than or equal to 60 years of age in a first degree relative (mother, father, child, sibling) or in two first degree relatives with CRC at any age. - Participants with a clinical diagnosis of a significant heritable risk for colorectal cancer (Familial Adenomatous Polyposis, Hereditary Nonpolyposis Colorectal Cancer [Lynch Syndrome]). - Participants tested positive for a Familial Adenomatous Polyposis, Hereditary Nonpolyposis Colorectal Cancer [Lynch Syndrome] genetic mutation that increases risk of colorectal cancer. - Inflammatory bowel disease (e.g., Crohn's Disease, ulcerative colitis). - Life expectancy less than 10 years due to comorbid conditions in the opinion of the investigator. - Other comorbid conditions that would prevent the participant from having colonoscopies or would prevent required follow-up.
Study Design
- Phase
- N/A
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Intervention Model Description
- Surveillance
- Primary Purpose
- Other
- Masking
- None (Open Label)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Experimental Arm 1 |
5-Year and 10-Year Surveillance Colonoscopy after Qualifying Colonoscopy |
|
|
Experimental Arm 2 |
10-Year Surveillance Colonoscopy after Qualifying Colonoscopy |
|
Recruiting Locations
CTCA at Western Regional Medical Center
Goodyear, Arizona 85338
Goodyear, Arizona 85338
Contact:
Site Public Contact
623-207-3000
Site Public Contact
623-207-3000
Kingman Regional Medical Center
Kingman, Arizona 86401
Kingman, Arizona 86401
Cancer Center at Saint Joseph's
Phoenix, Arizona 85004
Phoenix, Arizona 85004
University of Arizona Cancer Center - Prevention Research Clinic
Tucson, Arizona 85719
Tucson, Arizona 85719
Mercy Hospital Fort Smith
Fort Smith, Arkansas 72903
Fort Smith, Arkansas 72903
Contact:
Site Public Contact
800-378-9373
Site Public Contact
800-378-9373
CARTI Cancer Center
Little Rock, Arkansas 72205
Little Rock, Arkansas 72205
Kaiser Permanente-Anaheim
Anaheim, California 92806
Anaheim, California 92806
Mission Hope Medical Oncology - Arroyo Grande
Arroyo Grande, California 93420
Arroyo Grande, California 93420
PCR Oncology
Arroyo Grande, California 93420
Arroyo Grande, California 93420
Kaiser Permanente-Baldwin Park
Baldwin Park, California 91706
Baldwin Park, California 91706
Kaiser Permanente-Bellflower
Bellflower, California 90706
Bellflower, California 90706
Mercy Cancer Center - Carmichael
Carmichael, California 95608
Carmichael, California 95608
Mercy San Juan Medical Center
Carmichael, California 95608
Carmichael, California 95608
Mercy Cancer Center - Elk Grove
Elk Grove, California 95758
Elk Grove, California 95758
Kaiser Permanente-Fontana
Fontana, California 92335
Fontana, California 92335
Kaiser Permanente South Bay
Harbor City, California 90710
Harbor City, California 90710
Kaiser Permanente-Irvine
Irvine, California 92618
Irvine, California 92618
Kaiser Permanente Los Angeles Medical Center
Los Angeles, California 90027
Los Angeles, California 90027
Kaiser Permanente West Los Angeles
Los Angeles, California 90034
Los Angeles, California 90034
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles, California 90095
Los Angeles, California 90095
Contact:
Site Public Contact
888-798-0719
Site Public Contact
888-798-0719
Contra Costa Regional Medical Center
Martinez, California 94553-3156
Martinez, California 94553-3156
Contact:
Site Public Contact
925-957-5400
Site Public Contact
925-957-5400
Mercy Cancer Center
Merced, California 95340
Merced, California 95340
Kaiser Permanente-Ontario
Ontario, California 91761
Ontario, California 91761
Stanford Cancer Institute Palo Alto
Palo Alto, California 94304
Palo Alto, California 94304
Kaiser Permanente - Panorama City
Panorama City, California 91402
Panorama City, California 91402
Kaiser Permanente-Riverside
Riverside, California 92505
Riverside, California 92505
Mercy Cancer Center - Rocklin
Rocklin, California 95765
Rocklin, California 95765
Mercy Cancer Center - Sacramento
Sacramento, California 95816
Sacramento, California 95816
Kaiser Permanente-San Diego Mission
San Diego, California 92108
San Diego, California 92108
Kaiser Permanente-San Diego Zion
San Diego, California 92120
San Diego, California 92120
Pacific Central Coast Health Center-San Luis Obispo
San Luis Obispo, California 93401
San Luis Obispo, California 93401
Kaiser Permanente-San Marcos
San Marcos, California 92078
San Marcos, California 92078
Mission Hope Medical Oncology - Santa Maria
Santa Maria, California 93444
Santa Maria, California 93444
Saint Joseph's Medical Center
Stockton, California 95204
Stockton, California 95204
Contact:
Site Public Contact
209-461-5257
Site Public Contact
209-461-5257
Kaiser Permanente-Vallejo
Vallejo, California 94589
Vallejo, California 94589
BASS Medical Group - Lennon
Walnut Creek, California 94598
Walnut Creek, California 94598
Woodland Memorial Hospital
Woodland, California 95695
Woodland, California 95695
Kaiser Permanente-Woodland Hills
Woodland Hills, California 91367
Woodland Hills, California 91367
Rocky Mountain Cancer Centers-Aurora
Aurora, Colorado 80012
Aurora, Colorado 80012
Rocky Mountain Regional VA Medical Center
Aurora, Colorado 80045
Aurora, Colorado 80045
Contact:
Site Public Contact
888-336-8262
Site Public Contact
888-336-8262
UCHealth University of Colorado Hospital
Aurora, Colorado 80045
Aurora, Colorado 80045
Contact:
Site Public Contact
720-848-0650
Site Public Contact
720-848-0650
Boulder Community Foothills Hospital
Boulder, Colorado 80303
Boulder, Colorado 80303
Rocky Mountain Cancer Centers-Boulder
Boulder, Colorado 80304
Boulder, Colorado 80304
Rocky Mountain Cancer Centers - Centennial
Centennial, Colorado 80112
Centennial, Colorado 80112
Penrose-Saint Francis Healthcare
Colorado Springs, Colorado 80907
Colorado Springs, Colorado 80907
Rocky Mountain Cancer Centers-Penrose
Colorado Springs, Colorado 80907
Colorado Springs, Colorado 80907
Saint Francis Cancer Center
Colorado Springs, Colorado 80923
Colorado Springs, Colorado 80923
Kaiser Permanente-Franklin
Denver, Colorado 80205
Denver, Colorado 80205
The Women's Imaging Center
Denver, Colorado 80209
Denver, Colorado 80209
Colorado Blood Cancer Institute
Denver, Colorado 80218
Denver, Colorado 80218
Presbyterian - Saint Lukes Medical Center - Health One
Denver, Colorado 80218
Denver, Colorado 80218
Rocky Mountain Cancer Centers-Midtown
Denver, Colorado 80218
Denver, Colorado 80218
Rocky Mountain Cancer Centers-Rose
Denver, Colorado 80220
Denver, Colorado 80220
CommonSpirit Cancer Center Mercy
Durango, Colorado 81301
Durango, Colorado 81301
Mercy Medical Center
Durango, Colorado 81301
Durango, Colorado 81301
Rocky Mountain Cancer Centers - Swedish
Englewood, Colorado 80113
Englewood, Colorado 80113
The Melanoma and Skin Cancer Institute
Englewood, Colorado 80113
Englewood, Colorado 80113
Kaiser Permanente-Rock Creek
Lafayette, Colorado 80026
Lafayette, Colorado 80026
Rocky Mountain Cancer Centers-Lakewood
Lakewood, Colorado 80228
Lakewood, Colorado 80228
Saint Anthony Hospital
Lakewood, Colorado 80228
Lakewood, Colorado 80228
Rocky Mountain Cancer Centers-Littleton
Littleton, Colorado 80120
Littleton, Colorado 80120
Kaiser Permanente-Lone Tree
Lone Tree, Colorado 80124
Lone Tree, Colorado 80124
Rocky Mountain Cancer Centers-Sky Ridge
Lone Tree, Colorado 80124
Lone Tree, Colorado 80124
Longmont United Hospital
Longmont, Colorado 80501
Longmont, Colorado 80501
Rocky Mountain Cancer Centers-Longmont
Longmont, Colorado 80501
Longmont, Colorado 80501
Saint Mary Corwin Medical Center
Pueblo, Colorado 81004
Pueblo, Colorado 81004
Rocky Mountain Cancer Centers-Thornton
Thornton, Colorado 80260
Thornton, Colorado 80260
Saint Anthony North Hospital
Westminster, Colorado 80023
Westminster, Colorado 80023
Yale University
New Haven, Connecticut 06520
New Haven, Connecticut 06520
Veterans Affairs Connecticut Healthcare System-West Haven Campus
West Haven, Connecticut 06516
West Haven, Connecticut 06516
Contact:
Site Public Contact
203-937-3421
Site Public Contact
203-937-3421
Kaiser Permanente-Capitol Hill Medical Center
Washington D.C., District of Columbia 20002
Washington D.C., District of Columbia 20002
MedStar Georgetown University Hospital
Washington D.C., District of Columbia 20007
Washington D.C., District of Columbia 20007
Contact:
Site Public Contact
202-444-2223
Site Public Contact
202-444-2223
George Washington University Medical Center
Washington D.C., District of Columbia 20037
Washington D.C., District of Columbia 20037
Contact:
Site Public Contact
202-741-2210
Site Public Contact
202-741-2210
Mount Sinai Comprehensive Cancer Center at Aventura
Aventura, Florida 33180
Aventura, Florida 33180
Bay Pines VA Healthcare System
Bay Pines, Florida 33744
Bay Pines, Florida 33744
Malcom Randall Veterans Administration Medical Center
Gainesville, Florida 32610
Gainesville, Florida 32610
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida 33136
Miami, Florida 33136
Contact:
Site Public Contact
305-243-2647
Site Public Contact
305-243-2647
Gastro Health - Galloway
Miami, Florida 33176
Miami, Florida 33176
Mount Sinai Medical Center
Miami Beach, Florida 33140
Miami Beach, Florida 33140
Augusta University Medical Center
Augusta, Georgia 30912
Augusta, Georgia 30912
Low Country Cancer Care
Savannah, Georgia 31404
Savannah, Georgia 31404
Memorial Health University Medical Center
Savannah, Georgia 31404
Savannah, Georgia 31404
Kootenai Health - Coeur d'Alene
Coeur d'Alene, Idaho 83814
Coeur d'Alene, Idaho 83814
Kootenai Clinic Cancer Services - Post Falls
Post Falls, Idaho 83854
Post Falls, Idaho 83854
Kootenai Clinic Cancer Services - Sandpoint
Sandpoint, Idaho 83864
Sandpoint, Idaho 83864
OSF Saint Anthony's Health Center
Alton, Illinois 62002
Alton, Illinois 62002
Contact:
Site Public Contact
618-463-5623
Site Public Contact
618-463-5623
Northwestern University
Chicago, Illinois 60611
Chicago, Illinois 60611
John H Stroger Jr Hospital of Cook County
Chicago, Illinois 60612
Chicago, Illinois 60612
Contact:
Site Public Contact
312-864-5204
Site Public Contact
312-864-5204
Loyola University Medical Center
Maywood, Illinois 60153
Maywood, Illinois 60153
Contact:
Site Public Contact
708-226-4357
Site Public Contact
708-226-4357
SSM Health Good Samaritan
Mount Vernon, Illinois 62864
Mount Vernon, Illinois 62864
Mercyhealth Cancer Institute - Rockford
Rockford, Illinois 61114
Rockford, Illinois 61114
Midwestern Regional Medical Center
Zion, Illinois 60099
Zion, Illinois 60099
Contact:
Site Public Contact
844-793-0745
Site Public Contact
844-793-0745
Northwest Cancer Center - Main Campus
Crown Point, Indiana 46307
Crown Point, Indiana 46307
Contact:
Site Public Contact
219-310-2550
Site Public Contact
219-310-2550
Northwest Oncology LLC
Dyer, Indiana 46311
Dyer, Indiana 46311
Contact:
Site Public Contact
219-924-8178
Site Public Contact
219-924-8178
Northwest Cancer Center - Hobart
Hobart, Indiana 46342
Hobart, Indiana 46342
Contact:
Site Public Contact
219-947-1795
Site Public Contact
219-947-1795
Saint Mary Medical Center
Hobart, Indiana 46342
Hobart, Indiana 46342
Saint Catherine Hospital
Indianapolis, Indiana 46312
Indianapolis, Indiana 46312
The Community Hospital
Munster, Indiana 46321
Munster, Indiana 46321
Contact:
Site Public Contact
219-836-3349
Site Public Contact
219-836-3349
Women's Diagnostic Center - Munster
Munster, Indiana 46321
Munster, Indiana 46321
Northwest Cancer Center - Valparaiso
Valparaiso, Indiana 46383
Valparaiso, Indiana 46383
University of Kansas Clinical Research Center
Fairway, Kansas 66205
Fairway, Kansas 66205
Central Care Cancer Center - Garden City
Garden City, Kansas 67846
Garden City, Kansas 67846
Central Care Cancer Center - Great Bend
Great Bend, Kansas 67530
Great Bend, Kansas 67530
University of Kansas Cancer Center
Kansas City, Kansas 66160
Kansas City, Kansas 66160
University of Kansas Hospital-Indian Creek Campus
Overland Park, Kansas 66211
Overland Park, Kansas 66211
Labette Health
Parsons, Kansas 67357
Parsons, Kansas 67357
Contact:
Site Public Contact
620-421-4881
Site Public Contact
620-421-4881
Mercy Hospital Pittsburg
Pittsburg, Kansas 66762
Pittsburg, Kansas 66762
Contact:
Site Public Contact
888-446-3729
Site Public Contact
888-446-3729
Cotton O'Neil Cancer Center / Stormont Vail Health
Topeka, Kansas 66606
Topeka, Kansas 66606
Contact:
Site Public Contact
785-270-4939
Site Public Contact
785-270-4939
University of Kansas Hospital-Westwood Cancer Center
Westwood, Kansas 66205
Westwood, Kansas 66205
Robert J Dole VA Medical Center
Wichita, Kansas 67218
Wichita, Kansas 67218
Contact:
Site Public Contact
316-685-2221
Site Public Contact
316-685-2221
Flaget Memorial Hospital
Bardstown, Kentucky 40004
Bardstown, Kentucky 40004
Commonwealth Cancer Center-Corbin
Corbin, Kentucky 40701
Corbin, Kentucky 40701
Saint Elizabeth Healthcare Edgewood
Edgewood, Kentucky 41017
Edgewood, Kentucky 41017
Saint Elizabeth Healthcare Fort Thomas
Fort Thomas, Kentucky 41075
Fort Thomas, Kentucky 41075
Saint Joseph Hospital
Lexington, Kentucky 40504
Lexington, Kentucky 40504
Saint Joseph Radiation Oncology Resource Center
Lexington, Kentucky 40504
Lexington, Kentucky 40504
Saint Joseph Hospital East
Lexington, Kentucky 40509
Lexington, Kentucky 40509
Saint Joseph London
London, Kentucky 40741
London, Kentucky 40741
Saint Joseph Mount Sterling
Mount Sterling, Kentucky 40353
Mount Sterling, Kentucky 40353
Mercy Health - Paducah Cancer Center
Paducah, Kentucky 42003
Paducah, Kentucky 42003
LSU Health Sciences Center at Shreveport
Shreveport, Louisiana 71103
Shreveport, Louisiana 71103
MaineHealth Maine Medical Center- Scarborough
Scarborough, Maine 04074
Scarborough, Maine 04074
Kaiser Permanente-Woodlawn Medical Center
Baltimore, Maryland 21244
Baltimore, Maryland 21244
Kaiser Permanente-Gaithersburg Medical Center
Gaithersburg, Maryland 20879
Gaithersburg, Maryland 20879
Kaiser Permanente - Kensington Medical Center
Kensington, Maryland 20895
Kensington, Maryland 20895
Kaiser Permanente - Largo Medical Center
Largo, Maryland 20774
Largo, Maryland 20774
Kaiser Permanente Lutherville - Timonium Medical Center
Lutherville, Maryland 21093
Lutherville, Maryland 21093
Massachusetts General Hospital Cancer Center
Boston, Massachusetts 02114
Boston, Massachusetts 02114
Contact:
Site Public Contact
877-726-5130
Site Public Contact
877-726-5130
Boston Veteran's Affairs Medical Center
Jamaica Plain, Massachusetts 02130
Jamaica Plain, Massachusetts 02130
Bronson Battle Creek
Battle Creek, Michigan 49017
Battle Creek, Michigan 49017
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids, Michigan 49503
Grand Rapids, Michigan 49503
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids, Michigan 49503
Grand Rapids, Michigan 49503
Trinity Health Grand Rapids Hospital
Grand Rapids, Michigan 49503
Grand Rapids, Michigan 49503
Bronson Methodist Hospital
Kalamazoo, Michigan 49007
Kalamazoo, Michigan 49007
West Michigan Cancer Center
Kalamazoo, Michigan 49007
Kalamazoo, Michigan 49007
Beacon Kalamazoo Cancer Center
Kalamazoo, Michigan 49009
Kalamazoo, Michigan 49009
Contact:
Site Public Contact
574-647-7370
Site Public Contact
574-647-7370
Beacon Kalamazoo
Kalamazoo, Michigan 49048
Kalamazoo, Michigan 49048
Contact:
Site Public Contact
574-647-7370
Site Public Contact
574-647-7370
Trinity Health Muskegon Hospital
Muskegon, Michigan 49444
Muskegon, Michigan 49444
Corewell Health Lakeland Hospitals - Niles Hospital
Niles, Michigan 49120
Niles, Michigan 49120
Contact:
Site Public Contact
616-391-1230
Site Public Contact
616-391-1230
Cancer and Hematology Centers of Western Michigan - Norton Shores
Norton Shores, Michigan 49444
Norton Shores, Michigan 49444
Corewell Health Reed City Hospital
Reed City, Michigan 49677
Reed City, Michigan 49677
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
Saint Joseph, Michigan 49085
Saint Joseph, Michigan 49085
Corewell Health Lakeland Hospitals - Saint Joseph Hospital
Saint Joseph, Michigan 49085
Saint Joseph, Michigan 49085
Munson Medical Center
Traverse City, Michigan 49684
Traverse City, Michigan 49684
University of Michigan Health - West
Wyoming, Michigan 49519
Wyoming, Michigan 49519
Riverwood Healthcare Center
Aitkin, Minnesota 56431
Aitkin, Minnesota 56431
Essentia Health - Baxter Clinic
Baxter, Minnesota 56425
Baxter, Minnesota 56425
Contact:
Site Public Contact
218-828-2880
Site Public Contact
218-828-2880
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota 56601
Bemidji, Minnesota 56601
Essentia Health Saint Joseph's Medical Center
Brainerd, Minnesota 56401
Brainerd, Minnesota 56401
Minnesota Oncology - Burnsville
Burnsville, Minnesota 55337
Burnsville, Minnesota 55337
Cambridge Medical Center
Cambridge, Minnesota 55008
Cambridge, Minnesota 55008
Mercy Hospital
Coon Rapids, Minnesota 55433
Coon Rapids, Minnesota 55433
Essentia Health - Saint Joseph's Crosslake Clinic
Crosslake, Minnesota 56442
Crosslake, Minnesota 56442
Contact:
Site Public Contact
218-692-1010
Site Public Contact
218-692-1010
Essentia Health - Deer River Clinic
Deer River, Minnesota 56636
Deer River, Minnesota 56636
Essentia Health Saint Mary's - Detroit Lakes Clinic
Detroit Lakes, Minnesota 56501
Detroit Lakes, Minnesota 56501
Essentia Health Cancer Center
Duluth, Minnesota 55805
Duluth, Minnesota 55805
Essentia Health Saint Mary's Medical Center
Duluth, Minnesota 55805
Duluth, Minnesota 55805
Miller-Dwan Hospital
Duluth, Minnesota 55805
Duluth, Minnesota 55805
Fairview Southdale Hospital
Edina, Minnesota 55435
Edina, Minnesota 55435
Essentia Health - Ely Clinic
Ely, Minnesota 55731
Ely, Minnesota 55731
Contact:
Site Public Contact
218-365-7900
Site Public Contact
218-365-7900
Essentia Health - Fosston
Fosston, Minnesota 56542
Fosston, Minnesota 56542
Essentia Health Hibbing Clinic
Hibbing, Minnesota 55746
Hibbing, Minnesota 55746
Contact:
Site Public Contact
218-786-3308
Site Public Contact
218-786-3308
Essentia Health - International Falls Clinic
International Falls, Minnesota 56649
International Falls, Minnesota 56649
Contact:
Site Public Contact
218-283-9431
Site Public Contact
218-283-9431
Fairview Clinics and Surgery Center Maple Grove
Maple Grove, Minnesota 55369
Maple Grove, Minnesota 55369
Minnesota Oncology Hematology PA-Maplewood
Maplewood, Minnesota 55109
Maplewood, Minnesota 55109
Saint John's Hospital - Healtheast
Maplewood, Minnesota 55109
Maplewood, Minnesota 55109
Abbott-Northwestern Hospital
Minneapolis, Minnesota 55407
Minneapolis, Minnesota 55407
Hennepin County Medical Center
Minneapolis, Minnesota 55415
Minneapolis, Minnesota 55415
Minneapolis VA Medical Center
Minneapolis, Minnesota 55417
Minneapolis, Minnesota 55417
Contact:
Site Public Contact
612-467-2800
Site Public Contact
612-467-2800
Health Partners Inc
Minneapolis, Minnesota 55454
Minneapolis, Minnesota 55454
Monticello Cancer Center
Monticello, Minnesota 55362
Monticello, Minnesota 55362
Essentia Health - Moose Lake Clinic
Moose Lake, Minnesota 55767
Moose Lake, Minnesota 55767
Contact:
Site Public Contact
218-485-4481
Site Public Contact
218-485-4481
New Ulm Medical Center
New Ulm, Minnesota 56073
New Ulm, Minnesota 56073
Essentia Health - Park Rapids
Park Rapids, Minnesota 56470
Park Rapids, Minnesota 56470
Essentia Health - Saint Joseph's Pequot Lakes Clinic
Pequot Lakes, Minnesota 56472
Pequot Lakes, Minnesota 56472
Contact:
Site Public Contact
218-568-4416
Site Public Contact
218-568-4416
Essentia Health - Saint Joseph's Pine River Clinic
Pine River, Minnesota 56474
Pine River, Minnesota 56474
Contact:
Site Public Contact
218-587-4416
Site Public Contact
218-587-4416
Fairview Northland Medical Center
Princeton, Minnesota 55371
Princeton, Minnesota 55371
North Memorial Medical Health Center
Robbinsdale, Minnesota 55422
Robbinsdale, Minnesota 55422
Mayo Clinic in Rochester
Rochester, Minnesota 55905
Rochester, Minnesota 55905
Contact:
Site Public Contact
855-776-0015
Site Public Contact
855-776-0015
Park Nicollet Clinic - Saint Louis Park
Saint Louis Park, Minnesota 55416
Saint Louis Park, Minnesota 55416
Regions Hospital
Saint Paul, Minnesota 55101
Saint Paul, Minnesota 55101
United Hospital
Saint Paul, Minnesota 55102
Saint Paul, Minnesota 55102
Essentia Health Sandstone
Sandstone, Minnesota 55072
Sandstone, Minnesota 55072
Saint Francis Regional Medical Center
Shakopee, Minnesota 55379
Shakopee, Minnesota 55379
Essentia Health - Saint Joseph's Staples Clinic
Staples, Minnesota 56479
Staples, Minnesota 56479
Contact:
Site Public Contact
218-894-7870
Site Public Contact
218-894-7870
Lakeview Hospital
Stillwater, Minnesota 55082
Stillwater, Minnesota 55082
Sanford Thief River Falls Medical Center
Thief River Falls, Minnesota 56701
Thief River Falls, Minnesota 56701
Contact:
Site Public Contact
605-312-3320
Site Public Contact
605-312-3320
Essentia Health Virginia Clinic
Virginia, Minnesota 55792
Virginia, Minnesota 55792
Ridgeview Medical Center
Waconia, Minnesota 55387
Waconia, Minnesota 55387
Rice Memorial Hospital
Willmar, Minnesota 56201
Willmar, Minnesota 56201
Minnesota Oncology Hematology PA-Woodbury
Woodbury, Minnesota 55125
Woodbury, Minnesota 55125
Fairview Lakes Medical Center
Wyoming, Minnesota 55092
Wyoming, Minnesota 55092
Mercy Oncology and Hematology - Clayton-Clarkson
Ballwin, Missouri 63011
Ballwin, Missouri 63011
Contact:
Site Public Contact
888-446-3729
Site Public Contact
888-446-3729
Central Care Cancer Center - Bolivar
Bolivar, Missouri 65613
Bolivar, Missouri 65613
Cox Cancer Center Branson
Branson, Missouri 65616
Branson, Missouri 65616
Contact:
Site Public Contact
417-269-4520
Site Public Contact
417-269-4520
Mercy Cancer Center - Cape Girardeau
Cape Girardeau, Missouri 63703
Cape Girardeau, Missouri 63703
Contact:
Site Public Contact
888-446-3729
Site Public Contact
888-446-3729
Freeman Health System
Joplin, Missouri 64804
Joplin, Missouri 64804
Mercy Hospital Joplin
Joplin, Missouri 64804
Joplin, Missouri 64804
Kansas City Veterans Affairs Medical Center
Kansas City, Missouri 64128
Kansas City, Missouri 64128
Contact:
Site Public Contact
800-525-1483
Site Public Contact
800-525-1483
Lake Regional Hospital
Osage Beach, Missouri 65065
Osage Beach, Missouri 65065
Mercy Clinic-Rolla-Cancer and Hematology
Rolla, Missouri 65401
Rolla, Missouri 65401
Contact:
Site Public Contact
573-458-6379
Site Public Contact
573-458-6379
Phelps Health Delbert Day Cancer Institute
Rolla, Missouri 65401
Rolla, Missouri 65401
Heartland Regional Medical Center
Saint Joseph, Missouri 64506
Saint Joseph, Missouri 64506
Mercy Hospital Springfield
Springfield, Missouri 65804
Springfield, Missouri 65804
Contact:
Site Public Contact
417-269-4520
Site Public Contact
417-269-4520
CoxHealth South Hospital
Springfield, Missouri 65807
Springfield, Missouri 65807
Contact:
Site Public Contact
417-269-4520
Site Public Contact
417-269-4520
Mercy Infusion Center - Chippewa
St Louis, Missouri 63109
St Louis, Missouri 63109
Contact:
Site Public Contact
888-446-3729
Site Public Contact
888-446-3729
Mercy Hospital South
St Louis, Missouri 63128
St Louis, Missouri 63128
Mercy Hospital Saint Louis
St Louis, Missouri 63141
St Louis, Missouri 63141
Contact:
Site Public Contact
314-251-7066
Site Public Contact
314-251-7066
Mercy Hospital Washington
Washington, Missouri 63090
Washington, Missouri 63090
Contact:
Site Public Contact
636-390-1600
Site Public Contact
636-390-1600
Community Hospital of Anaconda
Anaconda, Montana 59711
Anaconda, Montana 59711
Billings Clinic Cancer Center
Billings, Montana 59101
Billings, Montana 59101
Bozeman Health Deaconess Hospital
Bozeman, Montana 59715
Bozeman, Montana 59715
Benefis Sletten Cancer Institute
Great Falls, Montana 59405
Great Falls, Montana 59405
Great Falls Clinic
Great Falls, Montana 59405
Great Falls, Montana 59405
Hi-Line Sletten Cancer Center
Havre, Montana 59501
Havre, Montana 59501
Benefis Helena Specialty Center
Helena, Montana 59601
Helena, Montana 59601
Logan Health Medical Center
Kalispell, Montana 59901
Kalispell, Montana 59901
Community Medical Center
Missoula, Montana 59804
Missoula, Montana 59804
CHI Health Saint Francis
Grand Island, Nebraska 68803
Grand Island, Nebraska 68803
CHI Health Good Samaritan
Kearney, Nebraska 68847
Kearney, Nebraska 68847
Alegent Health Immanuel Medical Center
Omaha, Nebraska 68122
Omaha, Nebraska 68122
Alegent Health Bergan Mercy Medical Center
Omaha, Nebraska 68124
Omaha, Nebraska 68124
Alegent Health Lakeside Hospital
Omaha, Nebraska 68130
Omaha, Nebraska 68130
Creighton University Medical Center
Omaha, Nebraska 68131
Omaha, Nebraska 68131
Carson Tahoe Regional Medical Center
Carson City, Nevada 89703
Carson City, Nevada 89703
Cancer and Blood Specialists-Henderson
Henderson, Nevada 89052
Henderson, Nevada 89052
Comprehensive Cancer Centers of Nevada - Henderson
Henderson, Nevada 89052
Henderson, Nevada 89052
Comprehensive Cancer Centers of Nevada-Horizon Ridge
Henderson, Nevada 89052
Henderson, Nevada 89052
OptumCare Cancer Care at Seven Hills
Henderson, Nevada 89052
Henderson, Nevada 89052
Comprehensive Cancer Centers of Nevada-Southeast Henderson
Henderson, Nevada 89074
Henderson, Nevada 89074
Las Vegas Urology - Green Valley
Henderson, Nevada 89074
Henderson, Nevada 89074
Oncology Las Vegas - Henderson
Henderson, Nevada 89074
Henderson, Nevada 89074
Urology Specialists of Nevada - Green Valley
Henderson, Nevada 89074
Henderson, Nevada 89074
OptumCare Cancer Care at Charleston
Las Vegas, Nevada 89102
Las Vegas, Nevada 89102
University Medical Center of Southern Nevada
Las Vegas, Nevada 89102
Las Vegas, Nevada 89102
Hope Cancer Care of Nevada
Las Vegas, Nevada 89103
Las Vegas, Nevada 89103
Radiation Oncology Centers of Nevada Central
Las Vegas, Nevada 89106
Las Vegas, Nevada 89106
Urology Specialists of Nevada - Central
Las Vegas, Nevada 89106
Las Vegas, Nevada 89106
Women's Cancer Center of Nevada
Las Vegas, Nevada 89106
Las Vegas, Nevada 89106
Contact:
Site Public Contact
702-851-4672
Site Public Contact
702-851-4672
Sunrise Hospital and Medical Center
Las Vegas, Nevada 89109
Las Vegas, Nevada 89109
Las Vegas Prostate Cancer Center
Las Vegas, Nevada 89113
Las Vegas, Nevada 89113
Urology Specialists of Nevada - Southwest
Las Vegas, Nevada 89113
Las Vegas, Nevada 89113
Radiation Oncology Centers of Nevada Southeast
Las Vegas, Nevada 89119
Las Vegas, Nevada 89119
Comprehensive Cancer Centers of Nevada - Northwest
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Las Vegas Urology - Cathedral Rock
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Las Vegas Urology - Smoke Ranch
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Oncology Las Vegas - Tenaya
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
OptumCare Cancer Care at MountainView
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Urology Specialists of Nevada - Northwest
Las Vegas, Nevada 89128
Las Vegas, Nevada 89128
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas, Nevada 89135
Las Vegas, Nevada 89135
Comprehensive Cancer Centers of Nevada - Town Center
Las Vegas, Nevada 89144
Las Vegas, Nevada 89144
Comprehensive Cancer Centers of Nevada-Summerlin
Las Vegas, Nevada 89144
Las Vegas, Nevada 89144
Summerlin Hospital Medical Center
Las Vegas, Nevada 89144
Las Vegas, Nevada 89144
Comprehensive Cancer Centers of Nevada
Las Vegas, Nevada 89148
Las Vegas, Nevada 89148
OptumCare Cancer Care at Fort Apache
Las Vegas, Nevada 89148
Las Vegas, Nevada 89148
Comprehensive Cancer Centers of Nevada - Central Valley
Las Vegas, Nevada 89169
Las Vegas, Nevada 89169
University Cancer Center
Las Vegas, Nevada 89169
Las Vegas, Nevada 89169
Hope Cancer Care of Nevada-Pahrump
Pahrump, Nevada 89048
Pahrump, Nevada 89048
Renown Regional Medical Center
Reno, Nevada 89502
Reno, Nevada 89502
Saint Mary's Regional Medical Center
Reno, Nevada 89503
Reno, Nevada 89503
Radiation Oncology Associates
Reno, Nevada 89509
Reno, Nevada 89509
Morristown Medical Center
Morristown, New Jersey 07960
Morristown, New Jersey 07960
Contact:
Site Public Contact
973-971-5900
Site Public Contact
973-971-5900
University of New Mexico Cancer Center
Albuquerque, New Mexico 87106
Albuquerque, New Mexico 87106
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York 10016
New York, New York 10016
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York 10032
New York, New York 10032
Southeastern Medical Oncology Center-Clinton
Clinton, North Carolina 28328
Clinton, North Carolina 28328
Southeastern Medical Oncology Center-Goldsboro
Goldsboro, North Carolina 27534
Goldsboro, North Carolina 27534
Southeastern Medical Oncology Center-Jacksonville
Jacksonville, North Carolina 28546
Jacksonville, North Carolina 28546
Sanford Bismarck Medical Center
Bismarck, North Dakota 58501
Bismarck, North Dakota 58501
Essentia Health Cancer Center-South University Clinic
Fargo, North Dakota 58103
Fargo, North Dakota 58103
Sanford South University Medical Center
Fargo, North Dakota 58103
Fargo, North Dakota 58103
Contact:
Site Public Contact
701-234-6161
Site Public Contact
701-234-6161
Southpointe-Sanford Medical Center Fargo
Fargo, North Dakota 58103
Fargo, North Dakota 58103
Contact:
Site Public Contact
605-312-3320
Site Public Contact
605-312-3320
Sanford Medical Center Fargo
Fargo, North Dakota 58104
Fargo, North Dakota 58104
Contact:
Site Public Contact
800-437-4010
Site Public Contact
800-437-4010
Sanford Broadway Medical Center
Fargo, North Dakota 58122
Fargo, North Dakota 58122
Sanford Roger Maris Cancer Center
Fargo, North Dakota 58122
Fargo, North Dakota 58122
Essentia Health - Jamestown Clinic
Jamestown, North Dakota 58401
Jamestown, North Dakota 58401
UHHS-Chagrin Highlands Medical Center
Beachwood, Ohio 44122
Beachwood, Ohio 44122
Miami Valley Hospital South
Centerville, Ohio 45459
Centerville, Ohio 45459
Good Samaritan Hospital - Cincinnati
Cincinnati, Ohio 45220
Cincinnati, Ohio 45220
Bethesda North Hospital
Cincinnati, Ohio 45242
Cincinnati, Ohio 45242
TriHealth Cancer Institute-Westside
Cincinnati, Ohio 45247
Cincinnati, Ohio 45247
TriHealth Cancer Institute-Anderson
Cincinnati, Ohio 45255
Cincinnati, Ohio 45255
Case Western Reserve University
Cleveland, Ohio 44106
Cleveland, Ohio 44106
Louis Stokes Cleveland VA Medical Center
Cleveland, Ohio 44106
Cleveland, Ohio 44106
Ohio State University Comprehensive Cancer Center
Columbus, Ohio 43210
Columbus, Ohio 43210
Miami Valley Hospital
Dayton, Ohio 45409
Dayton, Ohio 45409
Premier Blood and Cancer Center
Dayton, Ohio 45409
Dayton, Ohio 45409
Contact:
Site Public Contact
937-276-8320
Site Public Contact
937-276-8320
Miami Valley Hospital North
Dayton, Ohio 45415
Dayton, Ohio 45415
Atrium Medical Center-Middletown Regional Hospital
Franklin, Ohio 45005-1066
Franklin, Ohio 45005-1066
Miami Valley Cancer Care and Infusion
Greenville, Ohio 45331
Greenville, Ohio 45331
Contact:
Site Public Contact
937-569-7515
Site Public Contact
937-569-7515
Upper Valley Medical Center
Troy, Ohio 45373
Troy, Ohio 45373
UHHS-Westlake Medical Center
Westlake, Ohio 44145
Westlake, Ohio 44145
Veterans Administration Medical Center - Oklahoma City
Oklahoma City, Oklahoma 73104
Oklahoma City, Oklahoma 73104
Mercy Hospital Oklahoma City
Oklahoma City, Oklahoma 73120
Oklahoma City, Oklahoma 73120
Contact:
Site Public Contact
405-752-3402
Site Public Contact
405-752-3402
Oregon Health and Science University
Portland, Oregon 97239
Portland, Oregon 97239
Portland VA Medical Center
Portland, Oregon 97239
Portland, Oregon 97239
Contact:
Site Public Contact
800-949-1004
Site Public Contact
800-949-1004
Geisinger Medical Center
Danville, Pennsylvania 17822
Danville, Pennsylvania 17822
Geisinger Medical Center-Cancer Center Hazleton
Hazleton, Pennsylvania 18201
Hazleton, Pennsylvania 18201
Geisinger Medical Oncology-Lewisburg
Lewisburg, Pennsylvania 17837
Lewisburg, Pennsylvania 17837
UPMC-Presbyterian Hospital
Pittsburgh, Pennsylvania 15213
Pittsburgh, Pennsylvania 15213
Contact:
Site Public Contact
412-647-2811
Site Public Contact
412-647-2811
Geisinger Cancer Services-Pottsville
Pottsville, Pennsylvania 17901
Pottsville, Pennsylvania 17901
Community Medical Center
Scranton, Pennsylvania 18510
Scranton, Pennsylvania 18510
Geisinger Wyoming Valley/Henry Cancer Center
Wilkes-Barre, Pennsylvania 18711
Wilkes-Barre, Pennsylvania 18711
Providence Veterans Administration Hospital
Providence, Rhode Island 02908
Providence, Rhode Island 02908
Contact:
Site Public Contact
866-590-2976
Site Public Contact
866-590-2976
Ralph H Johnson VA Medical Center
Charleston, South Carolina 29401
Charleston, South Carolina 29401
Gibbs Cancer Center-Gaffney
Gaffney, South Carolina 29341
Gaffney, South Carolina 29341
Prisma Health Greenville Memorial Hospital
Greenville, South Carolina 29605
Greenville, South Carolina 29605
Gibbs Cancer Center-Pelham
Greer, South Carolina 29651
Greer, South Carolina 29651
North Grove Medical Park
Spartanburg, South Carolina 29303
Spartanburg, South Carolina 29303
Contact:
Site Public Contact
864-560-6812
Site Public Contact
864-560-6812
Spartanburg Medical Center
Spartanburg, South Carolina 29303
Spartanburg, South Carolina 29303
Spartanburg Medical Center - Mary Black Campus
Spartanburg, South Carolina 29307
Spartanburg, South Carolina 29307
Contact:
Site Public Contact
864-560-6812
Site Public Contact
864-560-6812
SMC Center for Hematology Oncology Union
Union, South Carolina 29379
Union, South Carolina 29379
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota 57104
Sioux Falls, South Dakota 57104
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota 57117-5134
Sioux Falls, South Dakota 57117-5134
Baptist Memorial Hospital and Cancer Center-Memphis
Memphis, Tennessee 38120
Memphis, Tennessee 38120
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas 75390
Dallas, Texas 75390
Audie L Murphy VA Hospital
San Antonio, Texas 78229
San Antonio, Texas 78229
Contact:
Site Public Contact
877-469-5300
Site Public Contact
877-469-5300
George E Wahlen Department of Veterans Affairs Medical Center
Salt Lake City, Utah 84148
Salt Lake City, Utah 84148
Contact:
Site Public Contact
801-582-1565
Site Public Contact
801-582-1565
Kaiser Permanente-Burke Medical Center
Burke, Virginia 22015
Burke, Virginia 22015
Kaiser Permanente Tysons Corner Medical Center
McLean, Virginia 22102
McLean, Virginia 22102
VCU Massey Cancer Center at Stony Point
Richmond, Virginia 23235
Richmond, Virginia 23235
VCU Massey Comprehensive Cancer Center
Richmond, Virginia 23298
Richmond, Virginia 23298
Carilion Roanoke Memorial Hospital
Roanoke, Virginia 24033
Roanoke, Virginia 24033
Contact:
Site Public Contact
540-981-7377
Site Public Contact
540-981-7377
Kaiser Permanente-Caton Hill Medical Center
Woodbridge, Virginia 22192
Woodbridge, Virginia 22192
Jefferson Healthcare
Port Townsend, Washington 98368
Port Townsend, Washington 98368
Contact:
Site Public Contact
360-344-3091
Site Public Contact
360-344-3091
Valley Medical Center
Renton, Washington 98055
Renton, Washington 98055
Saint Michael Cancer Center
Silverdale, Washington 98383
Silverdale, Washington 98383
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
Yakima, Washington 98902
Yakima, Washington 98902
United Hospital Center
Bridgeport, West Virginia 26330
Bridgeport, West Virginia 26330
WVUH-Berkely Medical Center
Martinsburg, West Virginia 25401
Martinsburg, West Virginia 25401
West Virginia University Healthcare
Morgantown, West Virginia 26506
Morgantown, West Virginia 26506
Camden Clark Medical Center
Parkersburg, West Virginia 26101
Parkersburg, West Virginia 26101
Princeton Community Hospital
Princeton, West Virginia 24740
Princeton, West Virginia 24740
Contact:
Site Public Contact
304-487-7515
Site Public Contact
304-487-7515
Wheeling Hospital/Schiffler Cancer Center
Wheeling, West Virginia 26003
Wheeling, West Virginia 26003
Contact:
Site Public Contact
304-243-6442
Site Public Contact
304-243-6442
Duluth Clinic Ashland
Ashland, Wisconsin 54806
Ashland, Wisconsin 54806
Northwest Wisconsin Cancer Center
Ashland, Wisconsin 54806
Ashland, Wisconsin 54806
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin 54701
Eau Claire, Wisconsin 54701
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin 54301
Green Bay, Wisconsin 54301
Saint Vincent Hospital Cancer Center at Saint Mary's
Green Bay, Wisconsin 54303
Green Bay, Wisconsin 54303
Essentia Health-Hayward Clinic
Hayward, Wisconsin 54843
Hayward, Wisconsin 54843
Tamarack Health Hayward Medical Center
Hayward, Wisconsin 54843
Hayward, Wisconsin 54843
Contact:
Site Public Contact
218-568-4416
Site Public Contact
218-568-4416
Mercyhealth Hospital and Cancer Center - Janesville
Janesville, Wisconsin 53548
Janesville, Wisconsin 53548
William S Middleton VA Medical Center
Madison, Wisconsin 53705
Madison, Wisconsin 53705
Contact:
Site Public Contact
608-256-1901
Site Public Contact
608-256-1901
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin 54449
Marshfield, Wisconsin 54449
Zablocki Veterans Administration Medical Center
Milwaukee, Wisconsin 53295
Milwaukee, Wisconsin 53295
Contact:
Site Public Contact
888-469-6614
Site Public Contact
888-469-6614
Marshfield Medical Center - Minocqua
Minocqua, Wisconsin 54548
Minocqua, Wisconsin 54548
Cancer Center of Western Wisconsin
New Richmond, Wisconsin 54017
New Richmond, Wisconsin 54017
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin 54868
Rice Lake, Wisconsin 54868
Essentia Health-Spooner Clinic
Spooner, Wisconsin 54801
Spooner, Wisconsin 54801
Marshfield Medical Center-River Region at Stevens Point
Stevens Point, Wisconsin 54482
Stevens Point, Wisconsin 54482
Essentia Health Saint Mary's Hospital - Superior
Superior, Wisconsin 54880
Superior, Wisconsin 54880
Contact:
Site Public Contact
701-364-6272
Site Public Contact
701-364-6272
Marshfield Clinic-Wausau Center
Wausau, Wisconsin 54401
Wausau, Wisconsin 54401
Marshfield Medical Center - Weston
Weston, Wisconsin 54476
Weston, Wisconsin 54476
Memorial Hospital of Laramie County
Cheyenne, Wyoming 82001
Cheyenne, Wyoming 82001
Billings Clinic-Cody
Cody, Wyoming 82414
Cody, Wyoming 82414
Cancer Center-Metro Medical Center Bayamon
Bayamón, Puerto Rico 00959-5060
Bayamón, Puerto Rico 00959-5060
Contact:
Site Public Contact
787-395-7085
Site Public Contact
787-395-7085
Puerto Rico Hematology Oncology Group
Bayamón, Puerto Rico 00961
Bayamón, Puerto Rico 00961
Contact:
Site Public Contact
787-780-2865
Site Public Contact
787-780-2865
Pan American Center for Oncology Trials LLC - Dorado
Dorado, Puerto Rico 00646
Dorado, Puerto Rico 00646
Doctors Cancer Center
Manatí, Puerto Rico 00674
Manatí, Puerto Rico 00674
Contact:
Site Public Contact
787-621-4397
Site Public Contact
787-621-4397
Pan American Center for Oncology Trials LLC
San Juan, Puerto Rico 00902
San Juan, Puerto Rico 00902
Pan American Center for Oncology Trials LLC - Ciudadela
San Juan, Puerto Rico 00909
San Juan, Puerto Rico 00909
San Juan Community Oncology Group
San Juan, Puerto Rico 00917
San Juan, Puerto Rico 00917
Contact:
Site Public Contact
787-274-3387
Site Public Contact
787-274-3387
San Juan Veterans Affairs Medical Center
San Juan, Puerto Rico 00921-3201
San Juan, Puerto Rico 00921-3201
Centro Comprensivo de Cancer de UPR
San Juan, Puerto Rico 00927
San Juan, Puerto Rico 00927
PROncology
San Juan, Puerto Rico 00927
San Juan, Puerto Rico 00927
San Juan City Hospital
San Juan, Puerto Rico 00936
San Juan, Puerto Rico 00936
Contact:
Site Public Contact
787-763-1296
Site Public Contact
787-763-1296
More Details
- Status
- Recruiting
- Sponsor
- NRG Oncology
Detailed Description
Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer death among men and women in the United States (US). The lifetime risk of colorectal cancer in both men and women in the US is approximately 6%. About 93% of colorectal cancer (CRC) diagnoses are in patients older than 50 years (Siegel 2014). Randomized controlled trials show that screening for CRC significantly decreases CRC incidence and mortality (Schoen 2012, Atkin 2010, Mandel 1999, Mandel 2000). CRC screening has received a Grade A recommendation from the US Preventive Services Task Force. In the U.S., colonoscopy is the most utilized screening modality for CRC. On a population basis, screening rates, which were around 40-50%, have now increased to 65%, and a goal to increase to 80% compliance is being promoted (CDC 2011, CDC 2013, Meester 2015). Adenomatous polyps are the acknowledged precursors of colorectal cancer. Identification and removal of adenomas is the mechanism by which screening is effective in reducing CRC incidence and subsequent mortality. "Advanced" adenomas are adenomas which are greater than or equal to 1 cm, or have a "villous" component (tubulovillous or villous), or have foci of high grade dysplasia. Advanced adenomas are associated with increased long-term risk of cancer, even years after colonoscopy (Click 2018). The prevalence of advanced adenomas at screening colonoscopy is 5-10% (Ferlitsch 2011, Imperiale 2014). Non-advanced adenomas are adenomas greater than 1 cm with neither villous components nor high grade dysplasia. Non-advanced adenomas are much more common than advanced adenomas, present in around 30% of colonoscopy exams (Ferlitsch 2011, Imperiale 2014). After detection of adenomas, patients are advised to return periodically for surveillance colonoscopy. Patients with 1-2 non-advanced adenomas are recommended by guidelines to return in 5 - 10 years for follow-up surveillance colonoscopy (Lieberman 2012). However, there are no guidelines on how to triage individuals to 5 as opposed to 10 years. Furthermore, there is limited evidence supporting the effectiveness of surveillance colonoscopy in reducing CRC incidence. A retrospective study in patients with advanced adenomas demonstrated benefit (Atkin 2017), but the study was not randomized and did not include patients with 1-2 non-advanced adenomas. The only randomized trial of surveillance colonoscopy was reported in the early 1990's, when participants were randomized to 3 vs. 1- and 3- year surveillance (Winawer 1993). No difference in advanced adenoma detection was observed when comparing participants examined at the two screening intervals, and as a result, guidelines were modified with participants advised to return every 3 years after adenomatous polyp detection. The recommended interval for non-advanced adenomas was gradually lengthened to the current standard, but there is no randomized, controlled data to support that interval. Furthermore, observational data of surveillance colonoscopy practice in the U.S. demonstrate that recommended intervals are often not adhered to, and individuals return for repeat testing well ahead of guideline recommendations (Schoen 2010, Lieberman 2014). Furthermore, if anything, retrospective, natural history studies of non-advanced adenomas do not support the association of non-advanced adenoma with a higher risk of subsequent colorectal cancer (Atkin 1992, Spencer 1984, Loberg 2014). For example, in a classic study from the United Kingdom, patients with small rectosigmoid adenomas, even if multiple, did not have an increased risk of CRC compared to the general population, over a 14-year mean follow-up time (Atkin 1992). In a recent observational study from Norway, participants with a low-risk adenoma followed over a median of 7.7 years (maximum 19 years) without subsequent surveillance colonoscopy, had a lower CRC mortality than the general population (Loberg 2014), implying that although the initial colonoscopy may be protective, subsequent follow-up colonoscopy was not required. More recently, several studies have reported that individuals with non-advanced adenomas do not have an increased risk of colorectal cancer compared to those with no adenomas (Click 2018, Lieberman 2019, Lee 2019). Another recent major development affecting screening is that practitioners of colonoscopy are now recommended to monitor and insure their adenoma detection rates are high. Data from Poland (Kaminski 2010) and Kaiser Permanente in California (Corley 2014) have demonstrated that a higher adenoma detection rate (ADR) is associated with a lower long-term risk of interval CRC, or cancer occurring after colonoscopy. Our understanding of these observations is premised on the notion that leaving pre-neoplastic tissue (adenomas) in situ, (such as what occurs with a lower ADR), increases the chance that an adenoma left behind will subsequently transform into cancer. The concern over interval cancers has stimulated quality concerns about the practice of colonoscopy. Guidelines for a recommended ADR at screening colonoscopy are rising, from the initial targets of 15% in women and 25% in men (Lieberman 2012) to 20% in women and 30% in men or 25% overall. ADRs in clinical studies are now commonly over 30% and some practitioners report rates exceeding 50%. However, adenomas that are detected when the ADR is high or as it increases over time are generally small, non-advanced adenomas. Current clinical practice favoring colonoscopy-based screening with increased emphasis on detection of adenomas, most of which will turn out to be small, non-advanced adenomas, will greatly increase demand for utilization of surveillance colonoscopy exams in the coming decades. Yet, the evidence for determining the benefit, optimal timing, and recommended frequency of surveillance colonoscopy is unknown. A randomized, clinical trial to demonstrate the difference in yield between 5- or 10-year surveillance for participants with non-advanced adenoma is needed to guide clinical practice. Only a randomized trial will be authoritative enough to define good clinical practice and directly influence clinical care.