Anderson JC, et al. - Data from people who participated in the statewide, population-based New Hampshire Colonoscopy Registry was analyzed by the researchers in order to investigate the influence of having small (5-9 mm) vs diminutive (<5 mm) adenomas on the future risk of advanced adenomas within the categories for polyps <1 cm currently used in the United States, ie, 1 to 2 and 3 or more tubular adenomas. In comparison with those who had 1 to 2 diminutive adenomas, having 1 to 2 adenomas with at least one 5 to 9 mm adenoma, 3 to 10 diminutive adenomas, 3 to 10 adenomas <1 cm ) or advanced adenomas (AAs) were correlated with an elevated risk for metachronous AA. Those with exactly 2 small adenomas had an absolute risk of future AA of 7.6% (11/144), greater than the absolute risk in the 1 to 2 diminutive polyp group, and similar to the risk for 3 to 10 adenomas of 8.2%. Hence, having at least 1 small adenoma increased the metachronous risk of AA for subjects with 1 to 2 adenomas <1 cm vs those having only diminutive adenomas. The subset with 2 small adenomas had a risk of future AA related to the risk for 3 to 10 adenomas. For future AAs, subjects with at least 1 small adenoma may be at greater risk and hence, need closer follow-up than in contrast to those with only diminutive adenomas. Moreover, for the creation of future surveillance recommendations, the findings may be worthwhile to the guideline committee.