Longer Interval Between First Colonoscopy With Negative Findings for Colorectal Cancer and Repeat Colonoscopy

IF 22.5 1区 医学 Q1 ONCOLOGY JAMA Oncology Pub Date : 2024-05-02 DOI:10.1001/jamaoncol.2024.0827
Qunfeng Liang, Trasias Mukama, Kristina Sundquist, Jan Sundquist, Hermann Brenner, Elham Kharazmi, Mahdi Fallah
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Abstract

ImportanceFor individuals without a family history of colorectal cancer (CRC), colonoscopy screening every 10 years is recommended to reduce CRC incidence and mortality. However, debate exists about whether and for how long this 10-year interval could be safely expanded.ObjectiveTo assess how many years after a first colonoscopy with findings negative for CRC a second colonoscopy can be performed.Design, Setting, and ParticipantsThis cohort study leveraged Swedish nationwide register-based data to examine CRC diagnoses and CRC-specific mortality among individuals without a family history of CRC. The exposed group included individuals who had a first colonoscopy with findings negative for CRC at age 45 to 69 years between 1990 and 2016. The control group included individuals matched by sex, birth year, and baseline age (ie, the age of their matched exposed individual when the exposed individual’s first colonoscopy with findings negative for CRC was performed). Individuals in the control group either did not have a colonoscopy during the follow-up or underwent colonoscopy that resulted in a CRC diagnosis. Up to 18 controls were matched with each exposed individual. Individuals were followed up from 1990 to 2018, and data were analyzed from November 2022 to November 2023.ExposureA first colonoscopy with findings negative for CRC, defined as a first colonoscopy without a diagnosis of colorectal polyp, adenoma, carcinoma in situ, or CRC before or within 6 months after screening.Main Outcomes and MeasuresThe primary outcomes were CRC diagnosis and CRC-specific death. The 10-year standardized incidence ratio and standardized mortality ratio were calculated to compare risks of CRC and CRC-specific death in the exposed and control groups based on different follow-up screening intervals.ResultsThe sample included 110 074 individuals (65 147 females [59.2%]) in the exposed group and 1 981 332 (1 172 646 females [59.2%]) in the control group. The median (IQR) age for individuals in both groups was 59 (52-64) years. During up to 29 years of follow-up of individuals with a first colonoscopy with findings negative for CRC, 484 incident CRCs and 112 CRC-specific deaths occurred. After a first colonoscopy with findings negative for CRC, the risks of CRC and CRC-specific death in the exposed group were significantly lower than those in their matched controls for 15 years. At 15 years after a first colonoscopy with findings negative for CRC, the 10-year standardized incidence ratio was 0.72 (95% CI, 0.54-0.94) and the 10-year standardized mortality ratio was 0.55 (95% CI, 0.29-0.94). In other words, the 10-year cumulative risk of CRC in year 15 in the exposed group was 72% that of the 10-year cumulative risk of CRC in the control group. Extending the colonoscopy screening interval from 10 to 15 years in individuals with a first colonoscopy with findings negative for CRC could miss the early detection of only 2 CRC cases and the prevention of 1 CRC-specific death per 1000 individuals, while potentially avoiding 1000 colonoscopies.Conclusions and RelevanceThis cohort study found that for the population without a family history of CRC, the 10-year interval between colonoscopy screenings for individuals with a first colonoscopy with findings negative for CRC could potentially be extended to 15 years. A longer interval between colonoscopy screenings could be beneficial in avoiding unnecessary invasive examinations.
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首次结肠镜检查结果为阴性的结肠直肠癌与再次结肠镜检查之间的间隔时间更长
重要性对于没有结直肠癌(CRC)家族史的人,建议每 10 年进行一次结肠镜筛查,以降低 CRC 发病率和死亡率。这项队列研究利用瑞典全国范围内的登记数据,对无家族史的人群中的 CRC 诊断和 CRC 特异性死亡率进行了检查。暴露组包括 1990 年至 2016 年间 45 岁至 69 岁首次接受结肠镜检查结果为阴性的 CRC 患者。对照组包括按性别、出生年份和基线年龄(即与暴露者相匹配的暴露者首次结肠镜检查结果为阴性的年龄)匹配的个体。对照组中的个体要么在随访期间没有接受过结肠镜检查,要么接受结肠镜检查后确诊为 CRC。每个暴露个体最多可匹配 18 个对照组。暴露是指在筛查前或筛查后 6 个月内首次接受结肠镜检查,结果显示 CRC 阴性,但未诊断出结直肠息肉、腺瘤、原位癌或 CRC。主要结果和测量指标主要结果是 CRC 诊断和 CRC 特异性死亡。根据不同的随访筛查时间间隔,计算暴露组和对照组的 10 年标准化发病率比和标准化死亡率比,以比较暴露组和对照组的 CRC 和 CRC 特异性死亡风险。两组人员的年龄中位数(IQR)均为 59(52-64)岁。在对首次结肠镜检查结果为阴性的患者进行长达 29 年的随访期间,共发生了 484 例结肠癌病例和 112 例结肠癌死亡病例。在首次结肠镜检查结果为阴性后的15年中,暴露组患乳腺癌和乳腺癌特异性死亡的风险明显低于匹配对照组。在首次结肠镜检查结果为阴性的 15 年后,10 年标准化发病率比为 0.72(95% CI,0.54-0.94),10 年标准化死亡率比为 0.55(95% CI,0.29-0.94)。换句话说,暴露组在第 15 年患上 CRC 的 10 年累积风险是对照组的 72%。将首次结肠镜检查结果为阴性的人群的结肠镜筛查间隔时间从 10 年延长至 15 年,每 1000 人中仅有 2 例 CRC 病例被早期发现,1 例 CRC 死亡得以避免,同时可能避免 1000 次结肠镜检查。延长结肠镜筛查间隔时间有利于避免不必要的侵入性检查。
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来源期刊
JAMA Oncology
JAMA Oncology Medicine-Oncology
自引率
1.80%
发文量
423
期刊介绍: JAMA Oncology is an international peer-reviewed journal that serves as the leading publication for scientists, clinicians, and trainees working in the field of oncology. It is part of the JAMA Network, a collection of peer-reviewed medical and specialty publications.
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