Dubai, United Arab Emirates (CNN) — A new study raises the question of whether some people can wait longer than the recommended 10 years to undergo a colonoscopy, following an initial screening test negative for colorectal cancer.
The study, published in JAMA Internal Medicine, looked at 120,000 people aged 65 and older in Germany between 2013 and 2019 who had undergone colonoscopies 10 or more years following their initial negative screening.
The study compared this to all colonoscopies performed on people 65 and older in that time period, the majority of whom were having the screening for the first time.
And it turned out that the presence of pre-cancerous tumors, or already cancerous tumors, was 40% to 50% less among the people who underwent examination frequently, and advanced tumors or cancers were present in a rate ranging between 4% and 5% of women only, and between 5% and 7%. % of men 10 years or more following a negative test result.
The researchers also assessed whether the number of abnormal growths was different between men and women, and found that the prevalence was 40% higher in men.
When considered by age, detection rates were highest among individuals 75 years of age or older.
The authors conclude that the current 10-year colonoscopy intervals are safe, and suggest that extending the intervals may be justified in some settings, particularly among females and young adults without gastrointestinal symptoms.
Current colonoscopy recommendations
Colorectal cancer is the second leading cause of cancer deaths in the United States, and it is one of the most preventable types of cancer through effective screening tests, such as colonoscopy, which can detect early disease.
Mortality rates from colorectal cancer have declined in recent decades, largely due to colonoscopies.
Current guidelines recommend colorectal cancer screening for all adults ages 45 to 75.
And recently changed guidelines to start screening at age 45 instead of age 50 in response to more cancers being diagnosed among younger people.
If the test result is negative, patients will not need to undergo another test for 10 years.
Dr. Douglas Owens, professor of health policy at Stanford University and former head of the US Preventive Services Task Force, sees the results as promising.
Owens said colorectal cancer “is not like other cancers where over-screening has the potential to cause significant harm. It’s small here, but it’s not out of the question, and it comes from colonoscopies. So if you can get the same benefit with fewer colonoscopies, That would be a win.”
Owens would like to see more research on extending the intervals between exams, much like MD Anderson Cancer Center professor of gastroenterology Dr. Robert Bresalier does.
“There is strong evidence that it is cost-effective to perform colonoscopies in asymptomatic people every 10 years,” Bresalier said. On reassurance, and the availability of additional data to enhance the concept of adherence to these guidelines.
“The whole message of this study is that we can feel comfortable with the current guidelines,” Bresalier added.
The study authors note that its findings do not apply to individuals who may need to undergo an early colonoscopy to assess symptoms they may be experiencing, such as rectal bleeding, or individuals at high risk of colorectal cancer.
The authors noted the need for caution when generalizing their findings.
Although colonoscopy is considered the gold standard for colon cancer screening, there are alternatives available, and other screening options include annual blood tests in the stool.
“The main idea is that you get screened,” Owens said.
