A study found that some people may be able to extend the time between colonoscopies


A new study raises the question of whether some people can wait longer than the recommended 10 years for a repeat colonoscopy after an initial negative screening for colorectal cancer.

The study published in JAMA Internal Medicinelooked at 120,000 people aged 65 and older in Germany from 2013 to 2019 who had had colonoscopies 10 or more years after the initial negative screening, and compared them to all colonoscopies performed on people 65 and older in That time period – most of them were first screened.

found that precancerous or precancerous tumors were 40% to 50% lower among repeat screeners, and advanced adenomas or carcinomas were found in only 4% to 5% of women and 5% to 7% of men after 10 or more years of negative results . Colonoscopy.

The researchers also evaluated whether the number of abnormal growths differed between men and women, and found the prevalence to be 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 screening intervals for colonoscopies are safe, and also suggest that extending the intervals may be justified in some cases, particularly for females and young adults without gastrointestinal symptoms.

“For example, women of younger screening age could be screened without an index colonoscopy finding at extended intervals or, alternatively, less invasive methods, such as stool tests, could be offered while maintaining a 10-year interval for men and women at older ages,” she says. The study authors wrote.

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

Death rates from colorectal cancer have declined over recent decades, largely due to colonoscopies.

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

The findings are promising, said Dr. Douglas Owens, a professor of health policy at Stanford University and former chair of the US Preventive Services Task Force, which makes recommendations for cancer screening in the United States.

“(Colorectal cancer) is not like other cancers where there is significant harm from potential over-screening. It’s small here, but it’s not zero, and it comes from colonoscopies. So if you could get the same benefit in fewer colonoscopies , that would be a win.

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

“There is good evidence that screening colonoscopies in asymptomatic individuals at 10-year intervals is effective and cost-effective. And I think I’m not ready to change. I wouldn’t be ready to change practice in terms of extending the time period based on the study, but it is convenient and provides data.” further to reinforce the concept of adhering to these guidelines,” Bresalier said. “The overall message from this study is that we can feel comfortable with the current guidelines.”

The study authors note that the study’s findings do not extend to individuals who may need to undergo colonoscopies in their early periods to evaluate symptoms they may be experiencing, such as rectal bleeding, or individuals who are at high risk for colorectal cancer. They say generalizing their findings should be done with caution.

Experts stress that colonoscopy is one of the most important preventive services and that all eligible groups undergo testing.

“(This study) supports the importance of colon cancer screening and that there are many, many effective ways to do this,” 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, which look for blood in the stool.

“The main thing is to get screened. It doesn’t matter if you use a stool test or are going to have a colonoscopy, pick one. Pick whichever suits your preferences, but do it,” Owens said.

More than a quarter of Americans who qualify are not being 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 that discussion — is screening. So if you haven’t been screened and you’re in that relevant age group, you should get screened. And that obviously has a bigger impact, the biggest impact we can do Its now in terms of impact on colorectal cancer deaths,” Bresalier said.

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