Key points Could the currently recommended 10-year screening colonoscopy intervals be extended? Findings In this cross-sectional, registry-based study, prevalences of advanced neoplasms were 40% to 50% lower among 120,098 participants who underwent repeat screening colonoscopy 10 years or more after a negative colonoscopy than among all colonoscopy s of detection (1.25 million). The prevalence of advanced neoplasms was at least 40% lower in women than in men, and particularly low for repeat colonoscopy performed in those under 75 years of age. Meaning The study results suggest that extending the currently recommended 10-year screening intervals may be justified, especially for women and younger participants. |
Screening colonoscopy has been shown to reduce the incidence and mortality of colorectal cancer (CRC) by allowing the detection and removal of precancerous lesions.
However, the available evidence on the optimal screening interval is limited. A systematic review and meta-analysis of 28 studies published in 2019 found that detection of advanced neoplasms within 10 years of a negative index colonoscopy is rare.
However, as most of the studies identified by the review had low sample sizes (mostly limited to several hundred people), more studies involving larger groups of participants are needed to strengthen the empirical basis for more relevant recommendations. . Furthermore, uncertainty remains regarding a possible expansion of the 10-year period , since, to our knowledge, the evidence for longer intervals between colonoscopic examinations is very scarce. More targeted screening offerings would potentially reduce the burden of testing and demand for capabilities and costs associated with colonoscopy, thereby also counteracting the frequently reported overuse and underuse of screening in considerable proportions of the population. population.
To strengthen the evidence base for current recommendations, as well as to generate more information on a possible prolongation of colonoscopy screening intervals and the possible benefit of risk stratification, we evaluated the prevalence of colorectal neoplasms at least 10 years later. of a negative index colonoscopy as stratified by interval, sex, and age in a very large cohort of repeat screening colonoscopy participants in Germany.
Importance
Repeat screening colonoscopy is recommended to prevent and early detect colorectal cancer at 10-year intervals, which goes hand in hand with high demands on capabilities and costs. Evidence for findings in screening colonoscopy performed 10 years or more after a negative colonoscopy result is scarce, and it is not yet clear whether screening colonoscopy intervals could be prolonged.
Aim
To evaluate the prevalence of advanced colorectal neoplasms (DNA) at least 10 years after a negative screening colonoscopy in a very large cohort of repeat screening colonoscopy participants in Germany.
Design, environment and participants
This cross-sectional, registry-based study on screening colonoscopy findings reported to the German Screening Colonoscopy Registry during January 2013 to December 2019 included data on screening colonoscopy offered to the German general population aged 55 years and older. since 2002; Virtually all screening colonoscopy among people covered by Mandatory Health Insurance (approximately 90% of eligible adults) is reported to the national registry.
A total of 120,298 repeat screening colonoscopy participants aged 65 years or older who had had a prior negative screening colonoscopy at least 10 years prior were identified . The findings were compared to all screening colonoscopy performed at age 65 or older during the same period (1.25 million). Data was analyzed from March to July 2022.
Main results and measures
Prevalence of colorectal cancers and DNA (adenomas and advanced cancers).
Results
Of 120,298 participants, 72,349 (60.1%) were women. DNA prevalence was 3.6% and 5.2% among women and men 10 years after a negative screening colonoscopy and gradually increased to 4.9% and 6.6%, respectively, among those who had a negative colonoscopy 14 or more years earlier compared to 7.1% and 11.6% among all screening colonoscopy.
Sex- and age-specific DNA prevalence at repeat colonoscopy performed 10 years or more after a negative colonoscopy was consistently at least 40% lower among women than among men, lower at younger ages than at younger ages. older and much lower than among all screening colonoscopy (standardized prevalence ratios for cancers: 0.22-0.38 among women, 0.15-0.24 among men; standardized prevalence ratios for DNA: 0 .49-0.62 among women, 0.50-0.56 among men).
Conclusions In this large cross-sectional study of repeat screening colonoscopy participants, we found a sustained low DNA prevalence of approximately 6% to 7% in men and 4% to 5% in women, even more than 10 years after a negative colonoscopy. The prevalence of advanced neoplasms was consistently at least 40% higher in men than in women, regardless of the interval between examinations, and the sex difference was more pronounced at younger ages. The study results provide evidence that, for asymptomatic patients with a negative initial screening , the currently recommended screening colonoscopy intervals are safe and suggest that sex and age could guide the potential extension of risk-adapted screening intervals. beyond 10 years, especially for women and younger participants. |
