Disclosures: The study was supported by the Polish Ministry of Health, the Medical Center for Postgraduate Education in Warsaw (grant 5011091217/18), and the Polish Foundation of Gastroenterology. Please see the full study for all authors’ relevant financial disclosures.
May 26, 2020
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Negative screening colonoscopy linked with reduced CRC, mortality

Disclosures: The study was supported by the Polish Ministry of Health, the Medical Center for Postgraduate Education in Warsaw (grant 5011091217/18), and the Polish Foundation of Gastroenterology. Please see the full study for all authors’ relevant financial disclosures.
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A single negative screening colonoscopy correlated with reduced colorectal cancer incidence and mortality for up to 17.4 years, according to a study published in Annals of Internal Medicine.

“Only high-quality colonoscopy provided a profound and stable reduction in both CRC incidence and mortality throughout follow-up,” Nastazja Dagny Pilonis, MD, from the department of gastroenterology at The Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland, and colleagues wrote. “These results suggest that the currently recommended 10-year interval for screening colonoscopy is safe and could potentially be extended, provided that quality metrics are universally assessed, and the baseline examination meets recommended standards.”

Pilonis and colleagues assessed 165,887 patients from the Polish Colonoscopy Screening program who had a single negative colonoscopy. Patients were followed for 17.4 years. Measurements included standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) of CRC after high- and low-quality single negative screening colonoscopy. Investigators considered a high-quality colonoscopy as one performed by an endoscopist and consisting of a complete examination, with adequate bowel preparation and a 20% or greater adenoma detection rate.

Results showed CRC incidence (0.28; 95% CI, 0.25 to 0.3) was 72% lower compared with the general population, and mortality (0.19; 95% CI, 0.16 to 0.21]) was 81% lower. Investigators found that high-quality examination resulted in a twofold lower CRC incidence (SIR, 0.16; 95% CI, 0.13 to 0.2) and mortality (SMR, 0.1; 95% CI, 0.06 to 0.14]) mortality compared with a low-quality examination (SIR, 0.32; 95% CI, 0.29 to 0.35; SMR, 0.22; 95% CI, 0.18 to 0.25).

According to multivariable analysis, the hazard ratios for CRC incidence after high-quality colonoscopy compared with a low-quality colonoscopy were 0.55 (95% CI, 0.35 to 0.86) for 0 to 5 years, 0.54 (95% CI, 0.38 to 0.77) for 5.1 to 10 years, and 0.46 (95% CI, 0.25 to 0.86) for 10 to 17.4 years.

“Only after high-quality colonoscopy did the SIR and SMR for 10.1 to 17.4 years of follow-up not differ compared with earlier observation periods,” the researchers wrote. – by Monica Jaramillo