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Colorectal Neoplasia Prevalence at ≥10-Year Follow-Up Screening Colonoscopy
For the average-risk person with negative findings at colorectal cancer screening colonoscopy, guidelines recommend follow-up screening colonoscopy in 10 years (NEJM JW Gen Med Jun 15 2021 and JAMA 2021; 325:1978). However, this recommendation is based on limited evidence. In this cross-sectional study, researchers used a large German screening colonoscopy registry and determined the prevalence of advanced neoplasm (i.e., advanced adenoma or cancer) ≥10 years after a negative screening colonoscopy. Advanced adenoma was defined as >1 cm in size, villous components, or high-grade dysplasia.
From a total of 1.2 million older people (age, ≥65) who underwent screening colonoscopy, researchers identified 120,000 who underwent repeat screening colonoscopy ≥10 years after previous negative colonoscopy. Prevalences of advanced neoplasms were 3.6% in women and 5.2% in men at 10 years after negative colonoscopy and 4.9% in women and 6.6% in men ≥14 years after negative colonoscopy, compared with 7.1% in women and 11.6% in men for all screening colonoscopies. The prevalence of advanced neoplasm at repeat colonoscopy increased with older age but was much lower in all age groups than the prevalence among all colonoscopies. The prevalence of colorectal cancer at repeat colonoscopy was ≤0.5% in all groups.
This study supports a strategy of follow-up screening colonoscopy 10 years after negative screening colonoscopy. It also supports extending the follow-up screening interval beyond 10 years, guided by sex and age. However, the study doesn't address the optimal age when screening no longer makes sense: At some point in an aging population, removing advanced polyps is unlikely to lower morbidity and mortality.
Heisser T et al.
Title: Prevalence of colorectal neoplasia 10 or more years after a negative screening colonoscopy in 120 000 repeated screening colonoscopies.
Source: JAMA Intern Med 2023 Jan 17; [e-pub]. (Abstract/FREE Full Text)