Race, family history may influence endoscopistsâ?? surveillance recommendations

Last Updated: 2017-03-03

By Reuters Staff

NEW YORK (Reuters Health) - Endoscopists may recommend more frequent surveillance for some patients with low-risk adenomas based on factors including their family history or race, but this does not improve outcomes, new research shows.

“Our findings of similar rates of advanced adenomas detected after 3- or 5-year intervals in persons who had low-risk adenomas on their previous exam may help dissuade endoscopists from recommending shorter surveillance intervals to their patients,” Dr. Joseph Anderson of the VA Medical Center in White River Junction, Vermont and colleagues write in Gastroenterology, online February 20.

Guidelines recommend surveillance every 5 to 10 years for patients with low-risk adenomas, defined as one or two small tubular adenomas of less than 1 cm. But many endoscopists perform surveillance more often in low-risk individuals, Dr. Anderson and his team note.

An increasing number of low-risk adenomas are being detected with high-definition colonoscopes, they add, with detection rates as high as 40% to 60%. “Thus, decisions about the timing of follow-up surveillance colonoscopy for individuals with these findings are made with increasing frequency and can significantly affect the cost-effectiveness of colorectal cancer screening,” they write.

To better understand why endoscopists recommend shorter screening intervals, the researchers looked at data from a prospective chemoprevention trial in 1,560 people men and women 45 to 75 years old. All had at least one adenoma at baseline. Endoscopists chose to recommend follow-up screening at three- or five-year intervals.

Three-year surveillance intervals were recommended for 38.1% of the study participants. African American patients were significantly more likely to receive three- rather than five-year surveillance (relative risk to whites, 1.41), as were people of Asian/Pacific Islander ethnicity (RR, 1.7).

Patients who had two adenomas at baseline had an RR of 1.47 for three-year intervals compared to those with one. Patients with more than three serrated polyps had an RR of 2.16 for three-year surveillance, and poor to fair bowel prep was also associated with shorter surveillance (RR, 2.16).

Finally, having a family history of colorectal cancer (CRC) or having one or two serrated polyps at the initial exam was also associated with three-year surveillance intervals.

But there were no difference in outcomes for the three- to five-year surveillance group, with similar percentages of patients having one or more adenomas, advanced adenomas, or clinically significant polyps at follow-up.

“These findings support current guideline recommendations of performing follow-up examinations of individuals with low-risk adenomas at least five years after the index colonoscopy,” Dr. Anderson and colleagues conclude.

Dr. Anderson was not available for an interview by press time.

SOURCE: http://bit.ly/2mT3IeF

Gastroenterol 2017.