Some People May Safely Extend Colonoscopy Screenings to Every 15 Years, Research Shows But new research found certain low-risk people may be able to safely wait 15 years between their first and second colonoscopy
Current U.S guidelines recommend people ages 45 to 75 get a colonoscopy every 10 years
- Most U.S. health experts recommend people get colonoscopies every 10 years.
- Researchers in a new study suggest people with a negative colonoscopy and no family history of colon cancer may be able to wait as long as 15 years between colonoscopies.
- Changing guidelines in the U.S. from 10 years to 15 years would likely require additional research and further discussions on the benefits and risks.
In the U.S., most screening guidelines recommend people get a colonoscopy every 10 years to check for colorectal cancer. But a new study suggests that certain groups may be able to wait even longer between colonoscopy appointments.
The new research—published in JAMA Oncology on May 2— looked at a large cohort of people who tested negative on their first colonoscopy, and who had no family history of the disease. They found that this group may be able to wait 15 years, rather than 10 years, to get their second colonoscopy done.
Colonoscopies are recommended for people ages 45 to 75, so under current guidelines, people would need four over the course of their lifetime if they’re at average risk for colorectal cancer.
Like other screening tests, colonoscopies help doctors detect cancer or any growths that may need to be removed. However, colonoscopies are invasive procedures, require a fair amount of preparation, and come with risks.
“There was limited real-world evidence to support this specific [10-year] timeframe,” Mahdi Fallah, MD, PhD, senior study author and leader of the Risk Adapted Prevention group at the German Cancer Research Center (DKFZ), told Health. “This study aimed to investigate whether this interval could be safely extended.”
Here’s what experts had to say about the new research, and how to determine the best colorectal cancer screening for you.
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New Study Provides an Argument for Less Frequent Colonoscopies
For this study, Fallah and his colleagues looked at a group of over 110,000 Swedish adults, 59% of whom were assigned female at birth. Participants were between ages 45 and 69 when they had their first colonoscopy—all tested negative. Researchers compared this group to a control population, who either tested positive on their colonoscopy or never returned for another screening during the study period.
After tracking both groups’ incidence of colorectal cancer diagnosis and death over 29 years, study authors found that for the group that originally tested negative, “a repeat colonoscopy 15 years later could be just as effective as the current 10-year recommendation with minimal toll,” Fallah said.
Extending this colonoscopy interval to 15 years would lead to only a small number of additional deadly colorectal cancer cases (about 1 per 1,000 people) while avoiding a high number of screenings.
“This minimal increase in missed fatal cancers may be outweighed by the benefit of avoiding unnecessary colonoscopies,” Fallah explained.
Though this wasn’t included in the scope of the study, Fallah said potentially using cheaper, non-invasive screening methods—such as at-home stool test kits—during years 10 to 15 after a person’s first colonoscopy could “significantly reduce or even eliminate this small number of missed cases.”
Colonoscopy is an extremely helpful tool to prevent colorectal cancer. But it’s also considered an invasive procedure, and it does carry some risks, Fallah said.
“There’s also a small chance of complications like infection or bleeding or perforation (a tear in the large bowel),” he said. “Waiting longer for a repeat colonoscopy in individuals with a low likelihood of colorectal cancer can potentially reduce these unnecessary risks.”
This move could even make colonoscopies more appealing to some people, since they’d have to do them less frequently, added Rohan Jeyarajah, MD, chair of surgery at the Burnett School of Medicine at Texas Christian University. It could also ease some logistical issues.
“[Longer intervals] would really have an impact on resources that are available for colonoscopies,” he told Health. “At this point, we are struggling to get people in for the 10-year colonoscopy mark based on physician availability. This is especially true in rural communities where there is a lack of gastroenterologists or surgeons who are able to perform screenings for colonoscopies.”
Many Experts Still Think the 10-Year Timeframe Is Best
Despite the study’s results, other colorectal cancer experts are more skeptical about extending the time between certain people’s first and second colonoscopies.
Colorectal cancer is usually a slow-growing cancer, but delaying screening could lead to negative consequences, Misagh Karimi, MD, medical oncologist at City of Hope Orange County Lennar Foundation Cancer Center, told Health.
“It’s estimated that it generally takes a polyp around 10 years to develop into cancer,” Karimi explained.
Additionally, colorectal cancer isn’t hereditary and has few symptoms, said Christina Seo, MD, a colon and rectal surgeon at Holy Name Medical Center in New Jersey. This means “there is not a good way to know who would benefit from a longer interval in colonoscopies,” she told Health.
Though this 15-year gap between colonoscopies would largely be affecting people over 50, experts also noted that rates of cancer, including colorectal cancer, in young people are on the rise. In his clinic, Karimi said he’s seeing some young people who developed colorectal cancer despite having no known risk factors or noticeable symptoms.
“We have actually lowered the starting screening age from 50 to 45 because of the uptick in cancers seen in younger patients,” Seo said.
The current focus seems to be on more screening for colorectal cancer, not less.
A final caveat to the new JAMA Oncology study is that the data came out of Sweden, not the U.S., Jeyarajah said.
“You have to take into consideration that this paper was published in another part of the world,” he explained. “We do know from incidences of gastric cancer in the Far East and colorectal cancer in the U.S. that there are nutritional and environmental factors that affect the outcome.”
The Importance of Screening for Colorectal Cancer
At this point, it’s unlikely that the U.S. will see any concrete guidelines changes due to this research. There would probably need to be long-term data and new regulations adopted in Europe before the U.S. would adopt a longer interval between colonoscopies, said Seo.
“This research offers valuable insights but doesn’t necessarily mean immediate changes to screening guidelines,” Fallah said. “It paves the way for further discussion and potentially revised recommendations in the future.”
Logistics aside, the most important thing is simply that people are getting screened for colorectal cancer in general, experts stressed.
“While colorectal cancer is one of the most curable cancers, research shows that tens of millions of people are skipping out on these lifesaving screenings due to fear of the preparation, test, and results,” Karimi said.
Since the prognosis is good for colorectal cancer when it’s caught early, screenings are of the utmost importance, he added.
Screening should start at age 45 for people who are at average risk—there are a number of different screening tests in addition to colonoscopy, so it’s best to have a conversation with your healthcare provider about the best colorectal cancer screening schedule for you.
People with a higher risk—including people with a family history of the disease or inflammatory bowel disease—may need to start colorectal cancer screening earlier or have tests done more frequently.
“The best way to stop cancer is to prevent it in the first place,” said Karimi. “Preventive screenings assist with early detection, and the earlier cancer is detected, the better the outcome.”
This story originally appeared on: Health News - Author:Sherri Gordon
