Colonoscopy rescreening could be extended for those with negative results, low CRC risk
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Key takeaways:
- Negative colonoscopy screening results were linked to lower long-term CRC incidence and mortality.
- These findings support extending the 10-year recommended rescreening interval for those at low risk for CRC.
Individuals with negative colonoscopy screening results had lower long-term risk for colorectal cancer and related mortality, with researchers suggesting the recommended 10-year rescreening interval may be extended for this population.
“Among average-risk individuals undergoing colonoscopy screening, most have negative examination findings and are free of any neoplasia,” Markus Dines Knudsen, PhD, a postdoctoral researcher at the University of Oslo and Harvard T.H. Chan School of Public Health, and colleagues wrote in JAMA Oncology. “These individuals are generally recommended by U.S. and European guidelines to undergo rescreening in 10 years.”
They continued, “Some studies have indicated that individuals with a negative colonoscopy screening (NCS) result have a lower risk of developing colorectal neoplasia and CRC during a longer period than the recommended 10 years, some suggesting for up to 20 years.”
To investigate long-term CRC incidence based on NCS results and risk profiles, Knudsen and colleagues gathered data for up to 32 years on colonoscopy, CRC incidence, risk factors and mortality from the Nurses’ Health Study, Nurses’ Health Study II and Health Professionals Follow-up Study. They also used 2017-’18 data from the National Health and Nutrition Examination Survey to compare risk profiles with those of the general population, assigning low-, intermediate- and high-risk scores based on established CRC risk factors.
Of the 195,453 included individuals (median age at baseline, 44 years; 81% women), 81,151 had NCS results and 114,302 did not have an endoscopy. The median follow-up was 12 years. The researchers reported 394 incident CRC cases among individuals with NCS results vs. 2,229 among those without an endoscopy, as well as 167 and 637 CRC deaths, respectively. The researchers also noted a higher prevalence of family history of CRC among those with NCS results compared with those without endoscopy.
Further, individuals with NCS results had a lower CRC risk, which “persisted throughout the entire follow-up and remained after multivariable adjustment,” with an HR of 0.51 (95% CI, 0.44-0.58). Similarly, those with NCS results had a lower risk for mortality (HR = 0.56; 95% CI, 0.46-0.7).
When utilizing the 10-year cumulative CRC incidence as a benchmark, the researchers reported a 10-year CRC incidence of 0.78% among high-risk individuals, 0.48% among those with intermediate risk and 0.21% among those with low risk. The intermediate- and low-risk groups did not reach the high-risk group’s 10-year CRC incidence until 16 and 25 years, respectively, following NCS results.
“In this cohort study, individuals with NCS results had a persistently lower risk of CRC incidence and mortality for at least 20 years compared with individuals without NCS results,” Knudsen and colleagues wrote. “Individuals with NCS results may consider, through discussion with physicians, extending their surveillance interval beyond the currently recommended 10 years, particularly for those who have a low-risk profile based on known CRC risk factors.”
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