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Gastroenterology. 2019 Jul 31. pii: S0016-5085(19)41149-9. doi: 10.1053/j.gastro.2019.07.052. [Epub ahead of print]

Baseline Colonoscopy Findings Associated with 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance.

Author information

1
VA Portland Health Care System, Portland, Oregon, USA; Oregon Health & Science University, Portland, Oregon, USA.
2
Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, USA; Duke University, Durham, North Carolina, USA.
3
Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, USA.
4
Perry Point Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, Maryland, USA.
5
San Diego VA Medical Center, San Diego, California, USA; University of California San Diego, San Diego, California, USA.
6
White River Junction VA Medical Center, White River Junction, Vermont, USA; Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.
7
Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, USA; Duke University, Durham, North Carolina, USA. Electronic address: dawn.provenzale@va.gov.

Abstract

BACKGROUND & AIMS:

Few studies have evaluated long-term outcomes of ongoing colonoscopic screening and surveillance in a screening population. We aimed to determine the 10-year risk for advanced neoplasia (defined as adenomas ≥10mm, adenomas with villous histology or high-grade dysplasia, or colorectal cancer [CRC]) and assessed whether baseline colonoscopy findings were associated with long-term outcomes.

METHODS:

We collected data from the Department of Veterans Affairs Cooperative Studies Program Study on 3121 veterans asymptomatic veterans (50-75 years old) who underwent a screening colonoscopy from 1994 through 1997 at 13 medical centers and were then followed for 10 years or until death. We included 1915 subjects with at least 1 surveillance colonoscopy and estimated cumulative incidence of advanced neoplasia Kaplan-Meier curves. We then fit a longitudinal joint model to estimate risk of advanced neoplasia at each subsequent examination, adjusting for multiple colonoscopies within individuals.

RESULTS:

Through 10 years of follow up, there were 146 individuals among all baseline colonoscopy groups found to have at least 1 incident advanced neoplasia. The cumulative 10-year incidence of advanced neoplasia was highest among those with baseline CRC (43.7%; 95% CI, 13.0%-74.4%), followed by those with baseline AA (21.9%; 95% CI, 15.7, 28.1). The cumulative 10-year incidence of advanced neoplasia was 6.3% (95% CI, 4.1%-8.5%) and 4.1% (95% CI, 2.7%-5.4%) for baseline 1-2 adenomas and no neoplasia, respectively (log-rank P=.10). After adjusting for prior surveillance, the risk of advanced neoplasia at each surveillance examination was not significantly increased in veterans with 1 or 2 small adenomas at baseline (odds ratio, 0.96; 95% CI, 0.67-1.41) compared to veterans with no baseline neoplasia.

CONCLUSIONS:

Baseline screening colonoscopy findings associate with advanced neoplasia within 10 years. Individuals with only 1 or 2 small adenomas at baseline have a low risk of advanced neoplasia over 10 years. Alternative surveillance strategies, such as the use of non-invasive CRC screening modalities, could be considered for these individuals.

KEYWORDS:

cancer prevention; colon cancer; prognostic factors; tumor

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