Advanced colorectal neoplasia prevalence remains low 10 years after negative colonoscopy
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Researchers reported low prevalence for advanced colorectal neoplasms at screening colonoscopies conducted at least 10 years after a negative index colonoscopy, especially among women younger than 75 years.
“Screening colonoscopy has been shown to reduce colorectal cancer incidence and mortality by enabling detection and removal of precancerous lesions,” Thomas Heisser, MSc, of the division of clinical epidemiology and aging research at the German Cancer Research Center, and colleagues wrote in JAMA Internal Medicine. “However, the available evidence about the optimal screening interval is limited.”
Citing a systematic review and meta-analysis of 28 studies published in 2019, which found that detection of advanced neoplasms within 10 years after a negative index colonoscopy is rare, researchers continued, “This suggests that 10-year intervals for screening colonoscopy, as currently recommended by major U.S. and international guidelines, may be adequate.”
In a cross-sectional study, Heisser and colleagues assessed the prevalence of advanced colorectal neoplasms (ADNs) at least 10 years after a negative screening colonoscopy among 120,298 participants aged 65 years and older (60.1% women) from the German screening colonoscopy registry. Researchers compared findings from this cohort with all screening colonoscopies conducted in a similarly aged population in Germany (n = 1.25 million) between January 2013 and December 2019.
Results showed the 10-year prevalence of ADN was 3.6% among women and 5.2% among men, which increased to 4.6% and 6.6% at intervals of 14 years or longer compared with 7.1% and 11.6% among all screening colonoscopies. The total detection rates of cancers ranged from 0.2% to 0.9% among those who underwent repeat colonoscopy and 0.6% to 3% among all screening colonoscopies.
Further analysis yielded consistently lower standardized prevalence ratios (SPR) for cancers and ADNs at repeated colonoscopies at least 10 years after negative colonoscopy among women compared with men and among younger vs. older participants (SPR for cancers = 0.22-0.38 among women vs. 0.15-0.24 among men and SPR for ADNs = 0.49-0.62 vs. 0.5-0.65, respectively). Researchers also reported this prevalence was “much lower” compared with all screening colonoscopies.
“We found a sustained low prevalence of ADN of approximately 6% to 7% in men and 4% to 5% in women even longer than 10 years after a negative colonoscopy,” Heisser and colleagues wrote. “The prevalence of advanced neoplasms was consistently at least 40% higher in men vs. women, regardless of the interval between examinations, and the sex difference was most pronounced at younger ages.
“The study results provide evidence that, for asymptomatic patients with a negative baseline examination, the currently recommended screening colonoscopy intervals are safe and suggest that sex and age could guide potential risk-adapted extension of screening intervals beyond 10 years, especially for female and younger participants.”
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