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#Grand Rounds

Is 10 Years Between Screening Colonoscopies a Safe Interval in a Low Risk Population?

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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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