Some people may want to extend the time between colonoscopies, study suggests

Some people may want to extend the time between colonoscopies, study suggests


A new study questions whether some people may wait longer than the recommended 10 years to have a repeat colonoscopy after a negative initial colon cancer screening.

The study, published in JAMA Internal Medicineexamined 120,000 people aged 65 and over in Germany from 2013 to 2019 who had a colonoscopy 10 years or more after an initial negative screening, and compared them with all colonoscopy screenings performed on people aged 65 and over in that period – most of which were shown for the first time.

It found that the presence of precancerous or cancerous growths was 40% to 50% lower among repeat screenings, finding advanced growths or cancer in only 4% to 5% of women and 5% to 7% of men 10 or more years after a negative test. colonoscopy.

The researchers also assessed whether the number of abnormal growths differed between men and women, finding that the prevalence was 40% higher in men.

When looked at by age, detection rates were highest among people over 75 years of age.

The authors conclude that the current 10-year screening intervals for colonoscopies are safe, and also suggest that extending the interval may be warranted in some cases, especially for women and younger people without gastrointestinal symptoms.

“For example, women at a younger screening age without index colonoscopy findings could possibly be screened at longer intervals or, alternatively, offered less invasive methods, such as stool tests, while maintaining the 10-year interval for men and women in old age. age”, wrote the authors of the study.

Colon cancer is the second leading cause of cancer death in the United States. It is also one of the most preventable cancers with effective screening tests such as colonoscopy that can detect early disease.

Death rates from colon cancer have decreased over the past few decades, largely thanks to colonoscopies.

Current guidelines recommend colorectal cancer screening in all adults aged 45 to 75 years. Recommendations have recently changed to start screening at age 45 instead of age 50 in response to more cancers being diagnosed at younger ages. If the screening is negative, patients do not need another for 10 years.

dr. Douglas Owens, a professor of health policy at Stanford University and former chairman of the US Preventive Services Task Force, which makes recommendations for cancer screening in the US, said the results are promising.

“(Colorectal cancer) is not like other cancers where there is great harm from over-screening. Here they are small, but not zero, and it comes from a colonoscopy. So if you could get the same benefit with fewer colonoscopies, that would be a win,” Owens said.

Owens would like to see more research on extending the screening interval, as would Dr. Robert Bresalier, professor of gastrointestinal oncology at MD Anderson Cancer Center.

“There is good evidence that screening colonoscopy in asymptomatic individuals at 10-year intervals is effective and cost-effective. And I don’t think I’m ready to change. I would not be willing to change practice in terms of lengthening the interval based on the study, but it is comforting and provides additional data to reinforce the concept of adherence to these guidelines,” said Bresalier. “The overall message of this study is that we can feel comfortable with the current guidelines.”

The study authors note that the study findings do not apply to individuals who may need to undergo colonoscopy at earlier intervals to evaluate symptoms they may have, such as rectal bleeding, or to individuals who are at higher risk of colon cancer. They say that generalizing their findings should be cautious.

Experts believe that colonoscopy is one of the most important preventive services for all groups that have the right to be tested.

“(This study) supports the importance of colon cancer screening and that there are many ways, many effective ways to do it,” Owens said.

Although colonoscopy is considered the gold standard for colon cancer screening, there are alternatives. Other screening options include annual fecal occult blood tests that look for blood in the stool.

“The main thing is to pass the examination. It doesn’t matter if you’re using a stool test or going for a colonoscopy, choose one. Choose whichever one suits your preferences, but do it,” Owens said.

More than a quarter of eligible Americans don’t get screened for colon cancer, and public health advocates are urging Americans to get screened.

“Right now, the biggest impact we can have—and relevant to this discussion—is screening. So if you haven’t been screened and you belong to that age group, you should be screened. And that obviously has a bigger impact, and it’s the biggest impact that we can make right now in terms of impacting colon cancer deaths,” Bresalier said.


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