Clinical Question

Can the 10-year interval for repeat colonoscopies be extended for patients with no findings?

Bottom Line

Following a high-quality colonoscopy (adequate bowel preparation, full visualization, and high rates of detection by the colonoscopist), patients at average risk with no neoplasm found on examination had the same rate of developing colorectal cancer or dying from it in the 10- to 17-year interval compared with the first five-year interval and the five- to 10-year interval. (Level of Evidence = 1b)

Synopsis

The study, conducted in Poland, included 165,887 patients 50 to 66 years of age without a family history of colorectal cancer who had a negative result from a single screening colonoscopy. Although the patients had access to a subsequent colonoscopy after 10 years, more than 97% did not receive one, providing the opportunity to determine the natural history of colorectal cancer in this nationwide group. Outcomes were assessed through administrative records. For up to 17.4 years after an initial negative colonoscopy result, colorectal cancer incidence and related mortality were 72% and 81% lower than in the general population. Incidence of cancer was lower in patients with high-quality colonoscopy compared with low-quality colonoscopy. The rates of subsequent colorectal cancer and related mortality in patients receiving the high-quality colonoscopy were not different in the 10- to 17-year interval compared with the zero- to five-year and five- to 10-year intervals.

Study design: Cohort (prospective)

Funding source: Government

Setting: Population-based

Reference: Pilonis ND, Bugajski M, Wieszczy P, et al. Long-term colorectal cancer incidence and mortality after a single negative screening colonoscopy. Ann Intern Med. 2020;173(2):81–91.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.