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Background The appropriate interval for endoscopic rescreening after a negative colonoscopic examination is uncertain.
Methods We identified persons with no adenomas on baseline screening colonoscopy who returned at 5 years for follow-up colonoscopy. Findings were categorized according to the most advanced lesion present: no polyp, a hyperplastic polyp, a tubular adenoma less than 1 cm in diameter, an advanced adenoma (a tubular adenoma
Results Baseline screening colonoscopy had identified 2436 persons with no adenomas; 1256 of them (51.6%) were rescreened a mean (±SD) of 5.34±1.34 years later. The mean age of this group at baseline was 56.7 years; 56.7% of its members were men. No cancers were found on rescreening (95% confidence interval [CI] for the detection rate, 0 to 0.24%). One or more adenomas were found in 201 persons (16.0%). A total of 19 advanced adenomas, of which 10 (52.6%) were distal to the splenic flexure, were found in 16 persons (1.3%). The risk of an advanced adenoma did not differ significantly between persons with no polyps at baseline and those with hyperplastic polyps at baseline (1.1% [12 of 1057] and 2.0% [4 of 199], respectively; P=0.30). Men were more likely than women to have any adenoma (tubular less than 1 cm in diameter or advanced) (relative risk, 1.88; 95% CI, 1.42 to 2.51) and to have an advanced adenoma (relative risk, 3.31; 95% CI, 1.02 to 10.8).
Conclusions Among persons with no colorectal neoplasia on initial screening colonoscopy, the 5-year risk of colorectal cancer is extremely low. The risk of advanced adenoma is also low, although it is higher among men than among women. Our findings support a rescreening interval of 5 years or longer after a normal colonoscopic examination.
1 cm in diameter or a polyp with villous histologic features or high-grade dysplasia), or a cancer.
Source Information
From the Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine (T.F.I., C.L.-C.); the Regenstrief Institute (T.F.I.); the Indianapolis Gastroenterology Research Foundation (E.A.G., J.D.R.); and Eli Lilly (G.N.L.) — all in Indianapolis; and the Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (D.F.R.).
Address reprint requests to Dr. Imperiale at the Regenstrief Institute, Indiana University Medical Center, 1050 Wishard Blvd., 6th Fl., Indianapolis, IN 46202-5121.
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Five-Year Risk of Colorectal Neoplasia after Negative Colonoscopy
Schoen R. E., Pinsky P. F., Brenner H., Haug U., Hoffmeister M., Maisonneuve P., Eng. , Botteri E., Lowenfels A. B., Imperiale T. F., Ransohoff D. F.
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N Engl J Med 2008;
359:2611-2612, Dec 11, 2008.
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