Prevalence of Colorectal Cancers Low 10 Years Following Negative Screening Test

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The prevalence of advanced colorectal neoplasms was higher in men and older individuals.

New research shows low rates of advanced colorectal neoplasms 10 years following a negative colonoscopy screening.

A team, led by Thomas Heisser, MSc, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, assessed the prevalence of advanced colorectal neoplasms at least 10 years following a negative screening colonoscopy in a very large cohort of repeated screening colonoscopy participants in Germany.


Colonoscopies are currently recommended every 10 years for individuals 45 years or older who are not at a high risk of colorectal cancer in the US.

“Screening colonoscopy has been shown to reduce colorectal cancer (CRC) incidence and mortality by enabling detection and removal of precancerous lesions,” the authors wrote.

However, there is high demands on capacities and costs associated with frequent colonoscopies, with very little data available for findings of screenings conducted 10 or more years following a negative colonoscopies and it is unclear whether screening colonoscopy intervals could possibly be prolonged.

Exploring German Data

In the registry-based, cross-sectional study, the investigators explored data from the German screening coloscopy registry between January2013 and December 2019. This included data on screening colonoscopies that were offered to the general population in Germany aged 55 years or older since 2002.

Nearly all of the colonoscopies completed were covered by the Statutory Health Insurance, equating to a total of 120,298 repeat screening colonoscopy participants aged 65 years or older who had a previous negative screening colonoscopy at least 10 years prior. The patient population was 60.1% (n = 72,349) women.

The investigators compared the results with all screening colonoscopies conducted at 65 years or older during the same period, equaling 1.25 million individuals.

The team sought main outcomes of the prevalence of colorectal cancers and advanced adenomas and cancers.

The results show advanced colorectal neoplasms was 3.6% in women and 5.2% in men 10 years after a negative screening colonoscopy. These rates gradually increased to 4.9% in women and 6.6% in men among those who had a negative colonoscopy 14 years or longer prior, compared to 7.1% and 11.6% among all screening colonoscopies.

The investigators also found sex-specific and age-specific prevalence of advanced colorectal neoplasms at repeated colonoscopies conducted 10 or more years following a negative colonoscopy were consistently at least 40% lower among women than men, as well as lower at younger ages compared to older ages. The prevalence was also much lower than among all screening colonoscopies (standardized prevalence ratios for cancers: 0.22-0.38 among women, 0.15-0.24 among men; standardized prevalence ratios for advanced colorectal neoplasms: 0.49-0.62 among women, 0.50-0.56 among men).

“The results of this cross-sectional study suggest that AND prevalence at screening colonoscopies conducted 10 or more years after a negative screening colonoscopy is low,” the authors wrote. “Extension of the currently recommended 10-year screening intervals may be warranted, especially for female and younger participants without gastrointestinal symptoms.”

The study, “Prevalence of Colorectal Neoplasia 10 or More Years After a Negative Screening Colonoscopy in 120,000 Repeated Screening Colonoscopies,” was published online in JAMA Internal Medicine.