New Colonoscopy Surveillance Guidelines

The U.S. Multi-Society Task Force on Colorectal Cancer has released a consensus update regarding colonoscopy surveillance—and the guidelines indicate that average-risk patients who have a clean colonoscopy can wait 10 years between exams.

Colorectal cancer is the second leading cause of cancer death in the United States. Colorectal cancer often begins with the development of an adenomatous polyp. These polyps often take 10 to 15 years to transform into cancer. Because this development phase is so long, screening and early detection can play a role in the prevention of colorectal cancer, as detection and removal of the polyps can prevent the development of the disease.

For people at average risk of colorectal cancer, the American Cancer Society recommends that routine screening begin at age 50. There are many screening tests available, but colonoscopy remains the gold standard. During a colonoscopy, a physician examines the full length of the large intestine and removes polyps.

The recommended interval between colonoscopies—sometimes referred to as surveillance—varies depending on the individual results of the test. In general, a higher rate of polyps leads to a recommendation for shorter screening intervals. Guidelines for colorectal cancer surveillance were published in 2006. The U.S. Multisociety Task Force—which is comprised of representatives of the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy—recently evaluated those guidelines to determine if they should change based on new data. What they found was that new evidence supported the existing guidelines.

Although the guidelines will continue to be evaluated as new evidence becomes available, for now the task force recommends the following surveillance schedule:

If the initial exam finds:	Then, the next colonoscopy should take place in:
No polyps or small (<10 mm) hyperplastic polyps in the rectum or sigmoid colon	10 years
Low-risk adenomas defined as 1-2 tubular adenomas <10mm	5-10 years
Serrated lesion <10mm, non-dysplastic	5 years
Benign, but high-risk neoplastic polyps, including: adenoma >10mm, or with villous histology, high grade dysplasia; three or more adenomas; sessile serrated lesions which are dysplastic and/or >10mm	3 years

The full guidelines are quite detailed and provide thorough advice on all aspects of colorectal cancer screening. Some other highlights:

If the patient’s bowel is not properly prepared for colonoscopy, repeat the exam within one year.
Surveillance colonoscopy need not be modified based on race, ethnicity, or sex—despite data indicating that African-Americans are at higher risk for colorectal cancer.
Surveillance intervals should not be changed due to use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). These drugs have been shown to reduce the risk of polyps—but there is no evidence to indicate that their use should result in shorter screening intervals.
Surveillance colonoscopy in the elderly should be determined on an individualized basis.

Reference:

Lieberman DA, Rex, DK, Winawer SJ, et al. Guidelines for Colonoscopy Surveillance After Screening and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; September; 143(3): 844-857.

Tags: Colon Cancer, News Tips and Features, Rectal Cancer, Screening/Prevention Colon Cancer, Screening/Prevention Rectal Cancer