Long-Term Colorectal Cancer Incidence and Mortality After a Single Negative Screening Colonoscopy
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Visual Abstract. Long-Term CRC Incidence and Mortality After Negative Screening Colonoscopy
The current colorectal cancer (CRC) screening guidelines recommend colonoscopy every 10 years for an average-risk population. However, this recommendation is based on limited, indirect evidence. This study aimed to quantify the long-term risk for CRC incidence and mortality after a single negative result on screening colonoscopy. It also evaluated the associations between the quality of the baseline colonoscopy and the subsequent risk for CRC incidence and mortality.
Abstract
Background:
Current guidelines recommend a 10-year interval between screening colonoscopies, but evidence is limited.
Objective:
To assess the long-term risk for colorectal cancer (CRC) and death from CRC after a high- and low-quality single negative screening colonoscopy.
Design:
Observational study.
Setting:
Polish Colonoscopy Screening Program.
Participants:
Average-risk individuals aged 50 to 66 years who had a single negative colonoscopy (no neoplastic findings).
Measurements:
Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) of CRC after high- and low-quality single negative screening colonoscopy. High-quality colonoscopy included a complete examination, with adequate bowel preparation, performed by endoscopists with an adenoma detection rate of 20% or greater.
Results:
Among 165 887 individuals followed for up to 17.4 years, CRC incidence (0.28 [95% CI, 0.25 to 0.30]) and mortality (0.19 [CI, 0.16 to 0.21]) were 72% and 81% lower, respectively, than in the general population. High-quality examination resulted in 2-fold lower CRC incidence (SIR, 0.16 [CI, 0.13 to 0.20]) and mortality (SMR, 0.10 [CI, 0.06 to 0.14]) than low-quality examination (SIR, 0.32 [CI, 0.29 to 0.35]; SMR, 0.22 [CI, 0.18 to 0.25]). In multivariable analysis, the hazard ratios for CRC incidence after high-quality versus low-quality colonoscopy were 0.55 (CI, 0.35 to 0.86) for 0 to 5 years, 0.54 (CI, 0.38 to 0.77) for 5.1 to 10 years, and 0.46 (CI, 0.25 to 0.86) for 10 to 17.4 years. Only after high-quality colonoscopy did the SIR and SMR for 10.1 to 17.4 years of follow-up not differ compared with earlier observation periods.
Limitation:
The general population was used as the comparison group.
Conclusion:
A single negative screening colonoscopy was associated with reduced CRC incidence and mortality for up to 17.4 years. Only high-quality colonoscopy yielded profound and stable reductions in CRC incidence and mortality throughout the entire follow-up.
Primary Funding Source:
Polish Ministry of Health.
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Information & Authors
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Published In
Annals of Internal Medicine
Volume 173 • Number 2 • 21 July 2020
Pages: 81 - 91
History
Published online: 26 May 2020
Published in issue: 21 July 2020
Keywords
Copyright
© 2020 American College of Physicians.
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Long-Term Colorectal Cancer Incidence and Mortality After a Single Negative Screening Colonoscopy. Ann Intern Med.2020;173:81-91. [Epub 26 May 2020]. doi:10.7326/M19-2477
Long-Term Colorectal Cancer Incidence and Mortality After a Single Negative Screening Colonoscopy. Ann Intern Med.2020;173:81-91. [Epub 26 May 2020]. doi:10.7326/M19-2477
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