Serrated polyposis syndrome (SPS) is associated with an increased risk of colorectal cancer. In a new retrospective study published in Gut, IJspeert and colleagues found that the 5-year cumulative incidence of colorectal cancer during surveillance in patients who had all SPS lesions cleared (n = 260) was 1.5%, lower than the 6.5% cumulative incidence the authors had reported in a previous smaller study. In addition, the researchers found that a history of smoking was associated with a reduced risk of colorectal cancer (OR 0.36, P <0.001).