BACKGROUND AND PURPOSE:

• Justification and reasoning behind the ’10 year’ colonoscopy screening has not been clearly validated
• Heisser et al. (BMJ, 2019) sought to determine the prevalence of colorectal adenomas and cancers at a follow-up screening colonoscopy following a previous negative screen

METHODS:

• Systematic review and meta-analysis
• Data sources
  • PubMed, Web of Science, and Embase
• Inclusion criteria
  • Studies that assessed the outcome of follow-up colonoscopy
• Participants
  • Average risk for colorectal cancer with a negative previous colonoscopy (including no adenomas)
  • Study design
• Two investigators independently extracted characteristics and results of identified studies and performed standardized quality ratings
  • Prevalence of colorectal adenomas and cancers at follow up were stratified based on colonoscopy interval and sex

RESULTS:

• 28 studies were used in the review
  • 17 studies reported findings for 1 to 5 year interval | 16 reported for 5 to 10 year interval | 3 studies reported for >10 year interval
  • 7 studies reported stratified by sex
• Prevalence of neoplasm overall
  • 1 to 5 year follow up: 20.7% (95% CI, 15.8% to 25.5%)
  • 5 to 10 year interval: 23.0% (95% CI, 18.0% to 28.0%)
  • >10 year interval: 21.9% (95% CI, 14.9% to 29.0%)
• Prevalence of advanced neoplasm
  • 1 to 5 year follow up: 2.8% (95% CI, 2.0% to 3.7%)
  • 5 to 10 year interval: 3.2% (95% CI, 2.2% to 4.1%)
  • >10 year interval: 7.0% (95% CI, 5.3% to 8.7%)
• Stratification by interval and sex
  • Overall prevalence of neoplasm and advanced neoplasm was consistently higher for men vs women “suggesting a tendency towards more (advanced) neoplasms in men”
  • Authors caution that data was limited due to few studies that included women and therefore the calculated estimates for women are highly uncertain

CONCLUSION:

• Neoplasm detection within 5 years of a negative screening colonoscopy occurred in more than 20% of participants but finding an advanced neoplasm with 10 years was a relatively rare event
• The authors conclude that

This finding suggests that recommendations of 10 year intervals for colonoscopy screening in this low risk group may be adequate

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Learn More – Primary Sources:

Outcomes at follow-up of negative colonoscopy in average risk population: systematic review and meta-analysis

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