Who benefits from continued colonoscopy surveillance after age of 75? Risk factors for post-colonoscopy advanced colorectal neoplasia. — The Association Specialists
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Who benefits from continued colonoscopy surveillance after age of 75? Risk factors for post-colonoscopy advanced colorectal neoplasia. (23728)

Molla M Wassie 1 , Melkalem M Azanaw 1 , Jean M Winter 1 , Norma Bulamu 1 , Liz Buckley 1 , Joshua Trigg 1 , Charles Cock 1 2 , Erin L Symonds 1 2
  1. Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
  2. Department of Gastroenterology and Hepatology, Flinders Medical Centre , Bedford Park, SA, Australia

Background

People at increased risk of Colorectal Cancer (CRC) are generally recommended to undergo colonoscopy surveillance until age 75y, with this being the stopping age due to procedural risks [1]. However, with improved survival, it is not clear whether this is an appropriate guideline.

Objective

To identify risk factors for post-colonoscopy advanced colorectal neoplasia among individuals aged ≥75y who have previously undergone at least one surveillance colonoscopy before age 75.

Methods

A retrospective cohort study was conducted among individuals aged ≥75y enrolled in a large southern Australian CRC surveillance cohort [2]. Of 5,160 individuals, 2,325 were eligible having had at least one colonoscopy before age 75. Data on colonoscopy outcomes, biomarkers (such as faecal immunochemical test (FIT) with positivity defined at ≥20 μg Hb/g), clinical, demographic, and socioeconomic factors, were extracted from clinical records. Post-colonoscopy CRC was identified through linkage to the South Australian Cancer Registry. Predictors of advanced neoplasia (advanced lesions or CRC) were identified using competing-risks regression with the Fine and Grey approach. Results were reported using the sub-distribution-hazard ratio [SHR] with 95% confidence interval (CI).

Results

The incidence of advanced neoplasia was 14.6% (340/2325), with a median follow-up of 5.0 years from the prior colonoscopy (IQR, 3.5-5.8y). Older age (SHR: 0.47; CI: 0.37-0.60 for ages 80-85y; and SHR: 0.36; CI: 0.23-0.58 for age ≥85y), and undertaking ≥3 FIT (SHR: 0.22; CI: 0.13-0.39) were associated with a reduced advanced neoplasia risk. In contrast, a prior history of advanced adenoma (SHR: 3.13; CI, 2.38-4.13), undergoing ≥3 prior colonoscopies (SHR:5.83; CI, 4.46-7.62), and having at least one prior positive FIT test (SHR:1.83; CI, 1.09-3.09) were associated with an increased risk.

Conclusion

Adults aged ≥75y with prior surveillance colonoscopies and advanced colorectal adenoma could benefit from continuing a personalised colonoscopy-based or non-invasive FIT-based surveillance to reduce future advanced neoplasia risk.  

  1. Cancer Council Australia Surveillance Colonoscopy Guidelines Working Party. Clinical Practice Guidelines for Surveillance Colonoscopy, Australia, 2019.
  2. Symonds EL, Simpson K, Coats M, Chaplin A, Saxty K, Sandford J, et al. A nurse-led model at public academic hospitals maintains high adherence to colorectal cancer surveillance guidelines. Med J Aust. 2018;208(11):492-6.