We have shown that patients with an initial adenoma had a 4.4- and 8.8-fold increased risk of developing a new adenoma at the second and the third colonoscopy, respectively, while patients with a normal initial colonoscopy and persistently elevated IGF1 levels had 7.5-fold risk of a subsequent adenoma, compared to those with a normal colonoscopy at the initial screening and inactive disease (13). The gene discussed is IGF1; the disease is adenoma.