CNN
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A new study raises the question of whether some people may wait longer than the recommended 10 years to repeat a colonoscopy after an initial negative colorectal cancer screen.
The study, published in JAMA Internal Medicine, looked at 120,000 people aged 65 and older in Germany from 2013 to 2019 who had a colonoscopy 10 years or more after an initial negative screen, and compared them to all screenings by colonoscopy performed on people 65 years of age or older. during this period – most of whom were being screened 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 cancers in only 4% to 5% of women and 5% to 7% of men over 10 years. or more after a negative screen. colonoscopy.
The researchers also assessed whether the number of abnormal growths differed between men and women, finding the prevalence 40% higher in men.
Looking by age, detection rates were highest in people aged 75 or older.
The authors conclude that the current 10-year screening intervals for colonoscopies are safe, and they also suggest that longer intervals may be warranted in some cases, particularly for women and young people without gastrointestinal symptoms.
“For example, women at younger screening ages without finding at index colonoscopy could possibly be screened at extended intervals or, alternatively, be offered less invasive methods, such as stool testing, while maintaining the 10-year interval for older male and female ages,” the study authors wrote.
Colorectal cancer is the second leading cause of cancer death in the United States. It is also one of the most preventable cancers thanks to effective screening tests like colonoscopies which can detect disease early.
Colorectal cancer death rates have declined over the past few decades, largely due to colonoscopies.
Current guidelines recommend screening for colorectal cancer in all adults between the ages of 45 and 75. Recommendations were recently changed to begin screening at age 45 instead of 50 in response to more cancers being diagnosed at younger ages. If the screen is negative, patients do not need another one for 10 years.
Dr Douglas Owens, professor of health policy at Stanford University and former chair of the US Task Force on Preventive Services, which makes recommendations on cancer screening in the US, said the results were promising .
“(Colorectal cancer) is not like other cancers where there’s potentially big damage from overscreening. Here it’s small, but it’s not zero, and it’s coming from 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 screening intervals, as would Dr. Robert Bresalier, professor of gastrointestinal oncology at MD Anderson Cancer Center.
“There is good evidence that colonoscopy screening of asymptomatic people at 10-year intervals is effective and cost-effective. And I think I’m not ready to change. I wouldn’t be willing to change the practice in terms of interval lengthening based on the study, but it’s comforting and provides additional data to reinforce the concept of adherence to these guidelines,” Bresalier said. “The general message of this study is that we can feel comfortable with the current guidelines.”
The study authors note that the study results do not extend to people who may need to have colonoscopies at more frequent intervals to assess any symptoms they may have, such as rectal bleeding, or people who are at higher risk for colorectal cancer. They say that generalizing their findings should be done with caution.
Experts argue that colonoscopies are one of the most important preventive services and that all eligible groups should get tested.
“(This study) supports the importance of colon cancer screening and that there are many, 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 get tested. It doesn’t matter if you use a stool test or have a colonoscopy, choose one. Pick the one that suits your preferences, but do it,” Owens said.
More than a quarter of eligible Americans are not getting screened for colorectal 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 testing. So if you haven’t been tested and you’re in this age group, you should get tested. And that clearly has a bigger impact, and the biggest impact we can make right now in terms of influencing death from colorectal cancer,” Bresalier said.
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