Purpose: Colorectal Cancer (CRC) is the third most common cancer and the second leading cause of cancer related deaths among men and women in United States. Early detection and removal of adenomatous polyps is the key to prevention and improved survival as CRC can be diagnosed while still localized. Multisociety surveillance guidelines from 2003 recommended a 5 year interval for single, small (<1 cm) tubular adenomas, 3 to 5 years for two small adenomas, and a 3 year interval for larger or multiple polyps, or polyps with villous features. We propose that earlier follow up with low-risk adenoma is prevalent and compromises the ability to offer primary CRC screening. Methods: We searched the endoscopy database at an academic medical center for colonoscopies performed in 2002 and identified patients who had a repeat colonoscopy within three years from the original date. Particular reasons for repeat endoscopies were identified amongst these patients. We further categorized these reasons as pathology revealing high grade dysplasia or cancerous lesions vs. poor quality of preparation for the first colonoscopy vs. clinical symptoms vs. other reasons not specified. Incomplete removal of polyp on initial colonoscopy as the reason for earlier follow up was not rare and was categorized in the not specified reasons. Results: Data were quantified based on time interval in between the two colonoscopies and the various reasons for which they were repeated in that time interval. Please refer to data Table. The colonoscopies repeated in all four time intervals were mostly for unspecified reasons. For the colonoscopies repeated for unspecified reasons, 78.4% were performed by the same endoscopist on initial as well as repeat attempt.TableConclusion: Despite the established guidelines, colonoscopies were repeated sooner mostly for unspecified reasons. This could partially be due to an open access to endoscopy system with patients referred too soon by their PCP. This in turn limits our ability to screen individuals without previous or recent colonoscopy. Potential reasons for divergence from practice guidelines should be studied further.