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Showing content from https://pubmed.ncbi.nlm.nih.gov/31376388/ below:

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

. 2020 Mar;158(4):862-874.e8. doi: 10.1053/j.gastro.2019.07.052. Epub 2019 Jul 31. Baseline Colonoscopy Findings Associated With 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance Brian A Sullivan², Elizabeth R Hauser², Xuejun Qin², Laura W Musselwhite², Meghan C O'Leary³, Thomas S Redding 4th³, Ashton N Madison³, A Jasmine Bullard³, Reana Thomas³, Kellie J Sims³, Christina D Williams², Terry Hyslop², David Weiss⁴, Samir Gupta⁵, Ziad F Gellad², Douglas J Robertson⁶, Dawn Provenzale⁷

Affiliations

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

PMID: 31376388
DOI: 10.1053/j.gastro.2019.07.052

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

David Lieberman et al. Gastroenterology. 2020 Mar.

. 2020 Mar;158(4):862-874.e8. doi: 10.1053/j.gastro.2019.07.052. Epub 2019 Jul 31. Authors David Lieberman¹, Brian A Sullivan², Elizabeth R Hauser², Xuejun Qin², Laura W Musselwhite², Meghan C O'Leary³, Thomas S Redding 4th³, Ashton N Madison³, A Jasmine Bullard³, Reana Thomas³, Kellie J Sims³, Christina D Williams², Terry Hyslop², David Weiss⁴, Samir Gupta⁵, Ziad F Gellad², Douglas J Robertson⁶, Dawn Provenzale⁷ Affiliations

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

PMID: 31376388
DOI: 10.1053/j.gastro.2019.07.052

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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 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.

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 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.

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, could be considered for these individuals.

Keywords: Cancer Prevention; Colon Cancer; Prognostic Factors; Tumor.

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Comment in

Surveillance Colonoscopy: Time to Dial it Back?
Rabeneck L. Rabeneck L. Gastroenterology. 2020 Mar;158(4):816-817. doi: 10.1053/j.gastro.2020.01.010. Epub 2020 Jan 10. Gastroenterology. 2020. PMID: 31930987 No abstract available.