Repeated screening colonoscopy reduces prevalence of advanced adenoma

March 2023 Prevention James Collins
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The risk of developing colorectal cancer is lower in those who have undergone screening colonoscopy owing to the ability to detect and remove lesions before they become cancerous. 1 Presently, screening colonoscopy is advised to be carried out in 10-year intervals to detect early colorectal cancer. However, this screening frequency is accompanied by high capacity demands, and thus there is a call for research to investigate whether this 10-year interval could be extended to lighten the burden on the healthcare system, while still providing a standard of care to patients.


In a registry-based cross-sectional study carried out by Heisser and colleagues, recently published in JAMA Intern Med., data on screening colonoscopies offered to the German population aged 55 years or older since 2002 reported to the German colonoscopy registry between January 2013 to December 2019 were included. 2 Further inclusion criteria yielded 120,298 repeat screening colonoscopy cases aged 65 years or older who had undergone screening colonoscopy with negative findings at least 10 years prior (target population). These cases were then compared with all screening colonoscopies carried out in patients at least 65 years old during the same period. The prevalence of colorectal cancers and advanced adenomas and cancers served as main outcomes.

Differences in prevalence

A sex-specific difference in the prevalence of advanced adenomas and cancers was noted in the target population whereby reported values were 3.6% (women) and 5.2% (men), 10 years after a negative screening result. This prevalence increased over time to 4.9% in women, and 6.6% in men for negative screening result reported at least 14 years prior. This same sex-specific difference in prevalence of advanced adenomas was also noted in the all colonoscopies group (7.1% for women, 11.6% in men). Of note, the prevalence of advanced adenomas was lower in the repeat screening group versus all colonoscopy group.
Furthermore, the prevalence of advanced adenomas was lower at younger versus older age, and prevalence values were lower in the repeat screening groups versus the all colonoscopies group (men; 10 years since negative screening (aged 65-69; 4.4%, aged at least 80; 6.7%); greater than 10 year interval (aged 65-69; 5.6%, aged at least 80; 6.5%); all colonoscopies group (aged 65-69; 11.2%, aged at least 80; 13.1%); women; 10 years since negative screening (aged 65-69; 3.2%, aged at least 80; 4.7%; greater than 10 year interval (aged 65-69; 3.9%, aged at least 80; 6%); all colonoscopies group (aged 65-69; 6.3%, aged at least 80; 9.8%)).

Interval extension

The findings of this study support the extension of the screening colonoscopy interval given the low prevalence of advanced adenoma at least 10 years after a negative screening result. This extension may be warranted more so in the female population, and in younger people without gastrointestinal complaints.


  1. Bretthauer M, Løberget M, Wieszczy P., et al. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. NEJM. 2022 387:1547-1556.
    • Heisser T, Kretschmann J, Hagen B., et al. Prevalence of Colorectal Neoplasia 10 or More Years after a Negative Screening Colonoscopy in 120 000 Repeated Screening Colonoscopies. JAMA Intern Med. 2023 Mar 1;183(3):183-190.