Colonoscopy and polypectomy: beside age, size of polyps main factor for long-term risk of colorectal cancer in a screening population

Kathrin Halfter,Gabriele Schubert-Fritschle,Dieter Hölzel,Anne Schlesinger-Raab,Jutta Engel,Lea Bauerfeind,Michael Schmidt

doi:10.1007/s00432-021-03532-7

Abstract

PurposeDespite national and international guideline recommendations, few studies have been conducted to estimate the impact of colonoscopy screening on long-term colorectal cancer incidence. Aim of this study was to determine the long-term impact of a full colonoscopy with polypectomy on colorectal cancer incidence in a large screening population.MethodsIn this prospective observational cohort study, a total of 10,947 colonoscopy screening participants from within the scope of the Munich Cancer Registry were consecutively recruited from participating gastroenterology practices and their subsequent colorectal cancer incidence assessed. Predictive factors associated with colorectal cancer were also evaluated in univariate and multivariate analyses.ResultsAfter a median follow-up of 14.24 years (95% CI [14.21–14.25]), 93 colorectal cancer cases were observed. This is equivalent to a truncated age-standardized rate of 69.0 (95% CI [43.3–94.7]) for male and 43.4 (95% CI [29.4–57.5]) for female participants (≥ 50 years at colonoscopy). The ratio of this observed to the expected rate from cancer registry data showed a 67% decrease in colorectal cancer incidence in the male and 65% in the female participants (p < 0.0001). In multivariate analysis of screening patients, age at screening (p < 0.0001) was the main predictive factor for colorectal cancer. In the subgroup with positive polyp findings, age (p < 0.0001) and the polyp size (p = 0.0002) were associated with colorectal cancer.ConclusionThese results underline the significance of a full colonoscopy screening combined with polypectomy in reducing the total disease burden of colorectal cancer.

Highlights

Colorectal cancer (CRC) rates have declined in the last decade, it remains among the most frequently diagnosed cancers
Screening programs with high patient participation rates are essential in decreasing the overall disease burden and mortality from colorectal cancer (CRC) through early detection of neoplasms or removal of precursor lesions
Studies detailing the impact of colonoscopy on cancer incidence or mortality have mainly been designed as observational cohort or case–control studies because of the already proven efficacy of sigmoidoscopy in reducing cancer incidence

Summary

Introduction

Colorectal cancer (CRC) rates have declined in the last decade, it remains among the most frequently diagnosed cancers. Screening programs with high patient participation rates are essential in decreasing the overall disease burden and mortality from CRC through early detection of neoplasms or removal of precursor lesions. A large number of countries have recently adopted colonoscopy for the general population as the primary screening instrument for CRC. Two large RCTs by Atkin et al and the PLCO by Schoen et al using sigmoidoscopy, limited to an examination of the distal colon, reported a CRC incidence reduction of 21% and 23% compared to a control group not screened (Atkin et al 2010; Schoen et al 2012). Comparisons to non-invasive screening tests such as the fecal immunochemical test showed an increase in patient participation, while the detection rate of precursor lesions was lower (Quintero et al 2012)

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