Examining the Efficacy of 10-Year Colonoscopy Rescreening Guidelines
Posted: Tuesday, February 12, 2019
Average-risk patients who had a negative colonoscopy result from screening were at a lower risk of colorectal cancer and related deaths than unscreened patients for more than 12 years after the examination, according to a study by Jeffrey K. Lee, MD, MAS, of Kaiser Permanente in California, and colleagues. These results, which may inform future assessment of the costs and benefits of earlier versus later rescreening intervals, were published in JAMA Internal Medicine.
“These findings suggest that physicians can feel confident following the guideline-recommended 10-year rescreening interval after a negative colonoscopy in which no colorectal cancer or polyps were found,” Dr. Lee said in a Kaiser Permanente press release. “There is now solid evidence supporting that recommendation.”
The study focused on 1,251,318 average-risk screening-eligible participants. The cohort, which was 49% male and 57% white, had a median age of 55.6 years. In the unscreened group, the colorectal cancer incidence rates increased from 62.9 to 224.8 per 100,000 person-years between years 1 and > 12. The incidence increased from 16.6 per 100,000 person-years to a high of 133.2 per 100,000 person-years in year 10 for the negative colonoscopy group.
Compared with the unscreened group, the covariate-adjusted risks of colorectal cancer in the group with a negative colonoscopy result were reduced by 46% to 95% across more than 12 years of follow-up, with hazard ratios ranging from 0.05 at up to 1 year to 0.54 at year 10. There was also a statistically significant lower adjusted risk of proximal colorectal cancer, distal cancer, early-stage colorectal cancer, and advanced-stage colorectal cancer. In addition, in those who had a negative colonoscopy result, covariate-adjusted risks of colorectal cancer mortality were reduced by 29% to 96% across follow-up, with annual rates statistically significant up to year 11. Hazard ratios ranged from 0.04 at up to 1 year to 0.71 at year 12. The risk at year 10, the guideline-recommended rescreening interval, remained significantly reduced by 88%.
Disclosure: The study authors’ disclosure information may be found at jamanetwork.com.