Colorectal cancer following negative colonoscopy: is 5-year screening the correct interval to recommend?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Despite the high sensitivity of screening colonoscopy, polyps and cancers can still go undetected. With the polyp-to-cancer transformation cycle averaging 7–10 years, present guidelines recommend repeat colonoscopy within 10 years after negative screening. However, not all colorectal malignancies follow this decade-long progression. This study evaluates the incidence and pathology of colorectal cancers following a previous negative screening colonoscopy.
Records of patients who underwent a colectomy at our institution, from 1998 to 2009, were reviewed retrospectively. A total of 1,784 patient records were screened using exclusion criteria for inclusion in this study. The patients were divided as follows: Group 1 included patients with a negative colonoscopy within the previous 5 years; Group 2 included patients without a previous colonoscopy or with a previous colonoscopy more than 5 years prior. Group 1 patients were evaluated by colonoscopy for anemia, diverticulitis, signs of obstruction, and bleeding. Age, tumor location, operation performed, and pathology findings were recorded. The χ2 test and paired t test were used for statistical analysis.
A total of 233 patients were included in this study. Group 1 contained 43 patients with a mean age of 73 years (range = 35–94, median = 75). Group 2 had 190 patients with a mean age of 68 years (range = 19–91, median = 70). Group 1 consisted of 18 male and 25 female patients, and Group 2 included 94 male and 96 female patients. Both groups were further classified into the following age categories: <50 years, 50–80 years, and >80 years. Eighteen percent of the total study population had newly discovered colorectal cancer within a 5-year colonoscopy screening period. There were no significant differences in the distribution of the T and N stages between the two groups and no statistically significant differences when the rate of lymphovascular invasion (19 vs. 17 %; p = 0.39) and perineural invasion (7 vs. 11 %; p = 0.58) were compared.
Within 5 years, 18 % of our study population developed colorectal cancer. Most of these malignancies were found within the 50–80-year age group and located predominantly in the right colon and distally in the sigmoid and rectum. While distal cancers may be visualized by flexible sigmoidoscopy, those located more proximally may be missed, necessitating the need for a full colonoscopy. Although staging was similar between the two groups, Group 1 tumors were less aggressive despite having appeared within 5 years. As a result of our incidence of colorectal cancer within a 5-year interval, a shorter period for routine colonoscopy may be considered.
- U.S. Cancer Statistics Working Group (2010) United States Cancer Statistics: 1999–2007 Incidence and Mortality Web-based Report. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute, Atlanta. http://www.prevent-cancer.org/ColorectalCancerInformation.aspx
- Smith RA, Cokkinides V, Brawley OW (2008) Cancer screening in the United States, 2008: a review of current American Cancer Society guidelines and cancer screening issues. CA Cancer J Clin 58:161–179 CrossRef
- Whitlock EP, Lin JS, Liles E, Beil TL, Fu R (2008) Screening for colorectal cancer: a targeted, updated systematic review of the U.S. Preventative Services Task Force. Ann Intern Med 149:638–658
- Walsh JM, Terdiman JP (2003) Colorectal cancer screening: a scientific review. JAMA 289:1288–1296 CrossRef
- Lieberman D (2006) Screening for colorectal cancer in average-risk populations. Am J Med 119:728–735 CrossRef
- Hosokawa O, Shirasaki S, Kaizaki Y, Hayashi H, Douden K, Hattori M (2003) Invasive colorectal cancer detected up to 3 years after a colonoscopy negative for cancer. Endoscopy 35(6):506–510 CrossRef
- Brenner H, Chang-Claude J, Seiler CM, Hoffmeister M (2011) Long-term risk of colorectal cancer after negative colonoscopy. J Clin Oncol 29:3761–3767 CrossRef
- Loeve F, Boer R, Zauber AG, van Ballegooijen M, van Oortmarssen GJ, Winawer SJ (2004) National polyp study data: evidence for regression of adenomas. Int J Cancer 111(4):633–639 CrossRef
- Butterly LF (2006) What is the clinical importance of small polyps with regard to colorectal cancer screening? Clin Gastroenterol Hepatol 4:343–348 CrossRef
- Davis DM, Marcet JE, Frattini JC, Prather AD, Mateka J, Nfonsam VN (2011) Is it time to lower the recommended screening age for colorectal cancer? J Am Coll Surg 2(13):352–361 CrossRef
- Robertson DJ, Greenberg ER, Beach M et al (2005) Colorectal cancer in patients under close colonoscopic surveillance. Gastroenterology 129(1):34–41 CrossRef
- Strock P, Mossong J, Scheiden R, Weber J, Heieck F, Kerschen A (2011) Colorectal cancer incidence is low in patients following a colonoscopy. Dig Liver Dis 43:899–904 CrossRef
- Bressler B, Paszat LF, Vinden C, Li C, He J, Rabeneck L (2004) Colonoscopic miss rates for right-sided colon cancer: a population-based analysis. Gastroenterology 127(2):452–456 CrossRef
- Soetikno RM, Kaltenbach T, Rouse RV et al (2008) Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA 299(9):1027–1035 CrossRef
- Brenner H, Hoffmeister M, Arndt V, Stegmaier C, Altenhofen L, Haug U (2010) Protection from right- and left-sided colorectal neoplasms after colonoscopy: population-based study. J Natl Cancer Inst 102(2):89–95 CrossRef
- Heresbach D, Barrioz T, Lapalus MG, Coumaros D, Bauret P, Potier P (2008) Miss rate for colorectal neoplastic polyps: a prospective multicenter study of back-to-back video colonoscopies. Endoscopy 40(4):284–290 CrossRef
- Brenner H, Chang-Claude J, Seiler CM, Rickert A, Hoffmeister M (2011) Protection from colorectal cancer after colonoscopy. Ann Intern Med 154:22–30
- Kaminski MF, Regula J, Kraszewska E, Polkowski M, Wajciechowska U, Didkowska J, Zweirko M, Rupinski M, Nowacki MP, Butruk E (2010) Quality indicators for colonoscopy and the risk of interval cancer. N Engl J Med 362:1795–1803 CrossRef
- Singh H, Nugent Z, Mahmud SM, Demers AA, Bernstein CN (2010) Predictors of colorectal cancer after negative colonoscopy: a population-based study. Am J Gastroenterol 105:663–673 CrossRef
- Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L (2009) Association of colonoscopy and death from colorectal cancer. Ann Intern Med 150:1–8
- Sugai T, Habano W, Jiao YF et al (2006) Analysis of molecular alterations in left- and right-sided colorectal carcinomas reveals distinct pathways of carcinogenesis: proposal for new molecular profile of colorectal carcinomas. J Mol Diagn 8(2):193–201 CrossRef
- Azzoni C, Bottarelli L, Campanini N et al (2007) Distinct molecular patterns based on proximal and distal sporadic colorectal cancer: arguments for different mechanisms in the tumorigenesis. Int J Colorectal Dis 22(2):115–126 CrossRef
- Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L (2007) Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 132(1):96–102 CrossRef
- Colorectal cancer following negative colonoscopy: is 5-year screening the correct interval to recommend?
Volume 27, Issue 3 , pp 768-773
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Colorectal cancer
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, Abington Memorial Hospital, Abington, PA, USA
- 2. Department of Surgery, Division of Colorectal Surgery, Colon and Rectal Associates, 1235 Old York Road, Suite G20, Abington, PA, 19001, USA