Colonoscopy screening gap ‘could potentially be extended’ to 15 years for average-risk CRC
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Key takeaways:
- Risks for CRC and CRC-specific death were lower for 15 years in the group with a negative first colonoscopy.
- Extending the screening interval may miss the early detection of just two cases per 1,000 individuals.
The 10-year interval between screening colonoscopies “could potentially be extended” to 15 years among patients without a family history of colorectal cancer and negative findings for CRC at the first colonoscopy, researchers reported.
“For individuals without a family history of CRC, rescreening 10 years after the first normal colonoscopy examination is suggested by many widely used guidelines,” Qunfeng Liang, MSc, a PhD student at the German Cancer Research Center and Heidelberg University, and colleagues wrote in JAMA Oncology. “However, there is limited evidence supporting this specific time interval for repeat colonoscopy. Emerging studies indicate that the currently recommended 10-year colonoscopy screening interval could probably be extended.”
In a matched cohort study, researchers used the nationwide Swedish family-cancer datasets to analyze CRC diagnoses and CRC-specific mortality among individuals without a family history of CRC. The sample included an exposure group of 110,074 individuals aged 45 to 69 years who had findings negative for CRC on a first colonoscopy between 1990 and 2016 and 1,981,332 controls matched for sex, birth year and baseline age. Across groups, the median age was 59 years and 59.2% were women.
Researchers followed all individuals from 1990 to 2018. During that time, they reported 484 incident cases of CRC and 112 CRC-specific deaths in the exposure group and 21,778 CRC cases and 5,521 CRC-specific deaths in the control group. Those with long-term follow-up, defined as 10 years or more, included 26% and 28% from each group, respectively.
According to results, at year 15 after a negative first colonoscopy, the 10-year standardized incident ratio was 0.72 (95% CI, 0.54-0.94) and the 10-year standard mortality ratio was 0.55 (95% CI, 0.29-0.94) — 10-year cumulative risks in the exposure group of 72% and 55% that of the control group, respectively.
Further, results demonstrated that extending the colonoscopy screening interval from 10 to 15 years among those with a negative first colonoscopy could miss the early detection of just two more cases of CRC per 1,000 individuals and prevent one CRC-specific death per 1,000 individuals. Increasing this interval also may avoid 1,000 unnecessary colonoscopies.
“The findings of this cohort study suggest that for people without a family history of CRC and a first colonoscopy with findings negative for CRC, the recommended 10-year interval between colonoscopy screenings could potentially be extended to 15 years,” Liang and colleagues wrote. “A longer interval between colonoscopy screenings could be beneficial in avoiding unnecessary invasive examinations.”
Perspective
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Adrienna Jirik, MD
The current recommendation for screening colonoscopy in patients considered average risk for CRC is starting at age 45 years and subsequently every 10 years with normal findings or low-risk findings of small hyperplastic polyps in the rectum/sigmoid colon or one to two small tubular adenomas in a high-quality colonoscopy.Average-risk individuals may include adults with no underlying history of hereditary cancer syndromes, inflammatory bowel disease or serrated polyposis syndrome or no personal or family history.
This screening interval recommendation is based on studies suggesting that the adenoma-to-carcinoma sequence takes approximately 10 years. However, it is important to keep in mind that there will be deviations of progression risk based on polyp type.
This cohort study suggests increasing the screening interval from every 10 years to 15 years after a baseline normal colonoscopy. Given the data presented, this may be reasonable for some but certainly not all patients. As with any medical test, screening recommendations should be individualized based not only on personal or familial risk factors but also environmental and lifestyle risk factors, as well as the quality of the baseline colonoscopy.
In patients who have anatomic or medical issues that increase the risk for potential complications from an optical colonoscopy, noninvasive tests such as a fecal immunological test or a stool DNA-based screening test can be considered before a colonoscopy.
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