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

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 158; no. 4; pp. 862 - 874.e8
• Main Authors: Lieberman, David, Sullivan, Brian A., Hauser, Elizabeth R., Qin, Xuejun, Musselwhite, Laura W., O’Leary, Meghan C., Redding, Thomas S., Madison, Ashton N., Bullard, A. Jasmine, Thomas, Reana, Sims, Kellie J., Williams, Christina D., Hyslop, Terry, Weiss, David, Gupta, Samir, Gellad, Ziad F., Robertson, Douglas J., Provenzale, Dawn
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2020
• Subjects: Adenoma - diagnostic imaging; Adenoma - pathology; Adenoma - surgery; Aged; Cancer Prevention; Colon - diagnostic imaging; Colon - pathology; Colon - surgery; Colon Cancer; Colonic Polyps - diagnostic imaging; Colonic Polyps - pathology; Colonic Polyps - surgery; Colonoscopy - statistics & numerical data; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - pathology; Early Detection of Cancer - statistics & numerical data; Female; Follow-Up Studies; Humans; Incidence; Intestinal Mucosa - diagnostic imaging; Intestinal Mucosa - pathology; Intestinal Mucosa - surgery; Longitudinal Studies; Male; Mass Screening; Middle Aged; Neoplasm Staging; Prognostic Factors; Prospective Studies; Retrospective Studies; Risk Assessment; Risk Factors; Tumor; United States - epidemiology; United States Department of Veterans Affairs - statistics & numerical data; Veterans - statistics & numerical data; United States; CSP; OR; CRC; Colon Cancer; Prognostic Factors; CI; Tumor; Cancer Prevention; EMR; VA; AN; PLCO
• ISSN: 0016-5085; 1528-0012; 1528-0012
• DOI: 10.1053/j.gastro.2019.07.052

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. We collected data from the Department of Veterans Affairs Cooperative Studies Program Study on 3121 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 by Kaplan-Meier curves. We then fit a longitudinal joint model to estimate risk of advanced neoplasia at each subsequent examination after baseline, adjusting for multiple colonoscopies within individuals. 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 advanced adenoma (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 to 2 small adenomas (<1cm, and without villous histology or high-grade dysplasia) and no neoplasia, respectively (log-rank P = .10). After adjusting for prior surveillance, the risk of advanced neoplasia at each subsequent 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 with veterans with no baseline neoplasia. 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, could be considered for these individuals.