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Some people may lengthen the time between colonoscopies, study suggests

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

The study, published in JAMA Internal Medicine, looked at 120,000 people age 65 and older in Germany from 2013 to 2019 who had a colonoscopy 10 years or more after a negative initial screening and compared them to all colonoscopy screenings performed on people aged 65. years or more. in that time period – most of which were being tracked for the first time.

It found that the presence of precancerous or cancerous tumors was 40% to 50% lower among repeat screeners, finding advanced tumors or cancers in just 4% to 5% of women and 5% to 7% of men aged 10 or more. after a negative colonoscopy examination.

The researchers also looked at whether the number of abnormal growths differed between men and women, finding a 40% higher prevalence in men.

When looking by age, detection rates were highest among individuals aged 75 and over.

The authors conclude that the current 10-year screening intervals for colonoscopies are safe and also suggest that extending intervals may be warranted in some cases, especially for women and younger people without GI symptoms.

“For example, women at younger screening ages with no initial colonoscopy findings could be screened at extended intervals or, alternatively, receive less invasive methods such as stool tests, maintaining the 10-year interval for men and women at older ages. . ages,” 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 cancers with effective screening tests like colonoscopies that can detect the disease early.

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

Current guidelines recommend screening for colorectal cancer in all adults aged 45 to 75 years. Recommendations were recently changed to start screening at age 45 instead of age 50 in response to cancer diagnosis at younger ages. If the screen is negative, patients do not need another one for 10 years.

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

“(Colorectal cancer) is not like other cancers where there is potentially great damage due to over-screening. Here they are small, but they are not zero, and they come from the 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 into extending screening intervals, as would Dr. Robert Bresalier, professor of gastrointestinal oncology at the MD Anderson Cancer Center.

“There is good evidence that screening colonoscopy in asymptomatic individuals at 10-year intervals is effective and cost-effective. And I don’t think I’m ready to change. I wouldn’t be ready to change practice in terms of extending the range based on the study, but it’s reassuring and provides additional data to strengthen the concept of adherence to these guidelines,” said Bresalier. “The overall message from this study is that we can be comfortable with current guidelines.”

The study authors note that the study’s findings do not extend to individuals who may need to undergo a colonoscopy at earlier intervals to assess for symptoms they may be experiencing, such as rectal bleeding, or individuals at increased risk for colorectal cancer. They say generalizing their findings should be done with caution.

Experts say colonoscopies are one of the most important preventive services and for all eligible groups to be tested.

“(This study) supports the importance of colon cancer screening and that there are many ways, 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 be tracked. It doesn’t matter if you use a stool test or have a colonoscopy, choose one. Pick the one that best fits your preferences, but do it,” Owens said.

More than a quarter of eligible Americans are not screened for colorectal cancer, and public health advocates are urging Americans to be screened.

“Right now, the biggest impact we can have – and relevant to this discussion – is triage. Therefore, if you have not been screened and you are in this relevant age range, you should be screened. And that clearly has a bigger impact, and the biggest impact we can make right now in terms of influencing death from colorectal cancer,” said Bresalier.