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Negative colonoscopy result predicts no colon cancer for more than 10 years
Question clinique
Can the 10-year interval for repeat colonoscopies be extended for patients with no findings?
L’Essentiel
Most of us have a "number bias," a preference for certain numbers over others. Every 10 years seems reasonable, whereas, say, every 17 years feels weird. However, the 10-year rule for a repeat colonoscopy looks like it could be stretched a bit. 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 as compared with the first 5-year interval and the 5- to 10-year interval. 1b
Référence
Plan de l'etude: Cohort (prospective)
Financement: Government
Cadre: Population-based
Sommaire
The study, conducted in Poland, included 165,887 patients aged 50 years to 66 years 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% didn't receive one, providing the opportunity to determine the natural history of colorectal cancer in this nationwide group. Outcomes were assessed through administrative records. As expected, 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 as compared with low-quality colonoscopy. The rates of subsequent colorectal cancer and related mortality in the high-quality colonoscopy patients were not different in the 10- to 17-year interval as compared with the 0- to 5-year and 5- to 10-year intervals.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
time intervals
it is hard to put a 17 year reminder on your EMR
COLONOSCOPY
It is important to utilize optimum timing for colonoscopy simply because the screening ties up so much in the way of resources. It is no doubt very important to do timely rechecks but if less frequent screening has the same beneficial effect it will take pressure off the rather backlogged rosters in our province.
Colonoscopy
This article speaks to me mainly on the issue of getting a high quality colonoscopy, be that in terms of prep, or physician technique.
screening colonoscopy
I never have seen numbers of morbidity and even mortality in colonoscopy to be included in the risk analysis for screening : there is mortality with this procedure !
Why not here?
Very needed and useful information. No similar data available in North America probably due to financial interest of colonoscopists and better access.