Low Risk of Colorectal Cancer and Advanced Adenomas more than 10 Years after Negative Colonoscopy

Hermann Brenner; Ulrike Haug; Volker Arndt; Christa Stegmaier; Lutz Altenhofen; Michael Hoffmeister

Disclosures

Gastroenterology. 2010;138(3):870-876. 

In This Article

Abstract and Introduction

Abstract

Background & aims: Screening colonoscopy is an effective method to reduce the incidence of and mortality from colorectal cancer (CRC). There is little empirical evidence available about the optimal interval for screening, making this a subject of debate. We associated the prevalence of advanced colorectal neoplasms with time since negative colonoscopies.
Methods: In a study of participants in the German colonoscopy screening program, we determined the prevalence of colorectal neoplasias detected at screening colonoscopy among subjects who had undergone a previous colonoscopy without detection of polyps (negative colonoscopy). Data were compared with that from subjects who had not received colonoscopies.
Results: No CRCs were detected in participants who had a previous negative colonoscopy an average of 11.9 years previously (n = 553), compared with the 8.4 CRC cases expected based on age- and gender-specific prevalences among participants who had not received a colonoscopy (n = 2701; standardized prevalence ratio [SPR] = 0.00; 95% confidence interval [CI]: 0.00−0.55). Prevalence of advanced adenoma was also much lower among subjects who had previous colonoscopies (SPR = 0.42; 95% CI: 0.25−0.68). Adjusted prevalence ratios (95% CIs) for detecting an advanced adenoma were 0.38 (95% CI: 0.16−0.90), 0.34 (95% CI: 0.15−0.74), 0.38 (95% CI: 0.16−0.90), and 0.53 (95% CI: 0.27−1.04) among participants with a negative colonoscopy conducted 1−5, 6−10, 11−15, and >16 years ago, respectively, compared to participants with no previous colonoscopy.
Conclusions: The low risk of CRC and advanced adenomas after a negative colonoscopy supports suggestions that screening intervals be extended to ≥10 years.

Introduction

With >1 million new cases and >500,000 deaths each year, colorectal cancer (CRC) is the 3rd most common cancer and the 4th most common cancer cause of death globally.[1] Colonoscopy, which enables detection and removal of precancerous lesions, is an effective method for CRC prevention. The National Polyp Study demonstrated a 76%−90% risk reduction of CRC among carriers of colorectal polyps.[2] On the basis of this and other accumulating evidence, colonoscopy is recommended for early detection and prevention of CRC by expert committees in various countries.[3,4] However, there still remains uncertainty with respect to necessary screening intervals, mainly because of the sparseness of pertinent empirical evidence.

Recently, a large prospective study among 1256 screening participants has shown that the prevalence of CRC and of advanced adenomas 5 years after a negative colonoscopy (ie, a colonoscopy without detection of polyps) is extremely small, which led to the conclusion that a negative colonoscopy does not need to be repeated within 5 years.[5] How far the surveillance interval can be extended beyond 5 years is much less clear.[6] Several case-control studies have suggested that risk of CRC remains very low for up to 20 years or longer,[7–9] but pertinent data with respect to advanced adenomas, the primary target for preventive colonoscopy, are lacking.[6]

To provide additional data on optimal colonoscopy screening intervals, we assessed prevalence of CRC, advanced colorectal adenomas, and other adenomas, according to time since prior negative colonoscopy in a large population of participants of screening colonoscopy in Germany.

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