Low Risk of Colorectal Cancer and Advanced Adenomas More Than 10 Years After Negative Colonoscopy

Background & Aims

Screening colonoscopy is an effective method to reduce the incidence of and mortality from colorectal cancer (CRC). There is little empirical evidence available about the optimal interval for screening, making this a subject of debate. We associated the prevalence of advanced colorectal neoplasms with time since negative colonoscopies.

Methods

In a study of participants in the German colonoscopy screening program, we determined the prevalence of colorectal neoplasias detected at screening colonoscopy among subjects who had undergone a previous colonoscopy without detection of polyps (negative colonoscopy). Data were compared with that from subjects who had not received colonoscopies.

Results

No CRCs were detected in participants who had a previous negative colonoscopy an average of 11.9 years previously (n = 553), compared with the 8.4 CRC cases expected based on age- and gender-specific prevalences among participants who had not received a colonoscopy (n = 2701; standardized prevalence ratio [SPR] = 0.00; 95% confidence interval [CI]: 0.00−0.55). Prevalence of advanced adenoma was also much lower among subjects who had previous colonoscopies (SPR = 0.42; 95% CI: 0.25−0.68). Adjusted prevalence ratios (95% CIs) for detecting an advanced adenoma were 0.38 (95% CI: 0.16−0.90), 0.34 (95% CI: 0.15−0.74), 0.38 (95% CI: 0.16−0.90), and 0.53 (95% CI: 0.27−1.04) among participants with a negative colonoscopy conducted 1−5, 6−10, 11−15, and >16 years ago, respectively, compared to participants with no previous colonoscopy.

Conclusions

The low risk of CRC and advanced adenomas after a negative colonoscopy supports suggestions that screening intervals be extended to ≥10 years.

Keywords: Colonoscopy, Colorectal Cancer, Screening

Abbreviations used in this paper: CI, confidence interval, CRC, colorectal cancer, SPR, standardized prevalence ratio