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1 to 2 adenomas at baseline linked with lower advanced neoplasia risk
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Colonoscopy findings at baseline screening are associated with advanced neoplasia within 10 years, and patients with just one or two adenomas at baseline are at lower risk, according to research published in Gastroenterology.
“Because surveillance exposes participants to the risks inherent to invasive procedures and higher resource utilization, further studies are needed investigating the outcomes of surveillance across various risk groups with different baseline colonoscopy findings in a true screening population,” Dawn Provenzale, MD, MS, director of the cooperative studies program epidemiology center at Durham Veterans Affairs Health Care Systems, and colleagues wrote. “Long-term outcomes of participants who have screening followed by surveillance could identify those participants most likely to benefit from surveillance.”
Researchers analyzed data from the Department of Veterans Affairs Cooperative Studies Program Study on asymptomatic veterans aged between 50 and 75 years who underwent a screening colonoscopy and were followed for 10 years or until they died. They included 1,915 patients with at least one surveillance colonoscopy in their analysis to estimate the cumulative incidence of advanced neoplasia.
Through 10 years of follow-up, investigators identified 146 individuals with at least one incident advanced neoplasia.
Patients with baseline CRC had the highest 10-year incidence of advanced neoplasia (43.7%; 95% CI, 13%–74.4%), followed by patients with baseline advanced adenoma (21.9%; 95% CI, 15.7%–28.1%).
Patients with one to two adenomas had a cumulative 10-year incidence of advanced neoplasia of 6.3% (95% CI, 4.1%–8.5%), while patients without any neoplasia had an incidence of 4.1% (95% CI, 2.7%–5.4%).
Provenzale and colleagues found that patients with one or two adenomas at baseline were not at increased risk for advanced neoplasia compared with patients without any neoplasia at baseline (OR = 0.96; 95% CI, 0.67–1.41).
“This low risk group may also represent an opportunity to consider alternative approaches to surveillance, such as the use of non-invasive CRC screening modalities,” they wrote. “The lower sensitivity of FIT or stool DNA testing for initial CRC screening may be offset during surveillance in these individuals, particularly if there has been an adequate exam within a few years of baseline to clear any missed lesions.” – by Alex Young
Disclosures: Provenzale reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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