Garrett Lawlor

Incident rates of colonic neoplasia in older patients: When should we stop screening?

Introduction:u2002 Current guidelines endorse colon cancer screening every 5–10u2003years in patients over 50u2003years of age. However, there is no consensus regarding what age is appropriate to stop screening. The aim of this study was to characterize neoplasia occurrence/recurrence in a large cohort of patients ≥70u2003years of age undergoing colonoscopy.

Incident rates of colonic neoplasia according to age and gender: implications for surveillance colonoscopy intervals.

Introduction: Current guidelines endorse surveillance colonoscopy at 3 to 5 years following initial detection of neoplasia. However, individual patients risks may vary according to age and gender. This study aimed to characterize neoplasia recurrence in a large patient cohort undergoing surveillance colonoscopy. Methods: All patients undergoing two colonoscopies at least 12 months apart between 1996 and 2000, with detection and removal of a polyp on the index colonoscopy, were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified according to age (<50, 50-64, 65-74, ≥75 years) and gender. Results: Overall, 1803 patients underwent two colonoscopies at least 12 months apart (median interval, 140 weeks) with removal of a polyp on initial examination. Polyps ≥5 mm were detected in 334 (19%) patients and polyps ≥10 mm in 105 (6%) on subsequent endoscopy. All age and gender groups were well matched with respect to size of polyp detected on initial colonoscopy (P = 0.2). Kaplan-Meier curves and a Cox proportional hazards model demonstrated similar rates of neoplasia recurrence for all patients irrespective of age and gender. Conclusions: Similar rates of neoplasia recurrence were observed among patients of different gender and age groups on surveillance colonoscopy. From a health resource utilization perspective, these findings support current recommendations for similar surveillance intervals for patients regardless of age and gender.

Does Risk of Neoplasia Persist Over Time? Implications for Surveillance Colonoscopy Intervals

Does Risk of Neoplasia Persist Over Time? Implications for Surveillance Colonoscopy Intervals Gavin Harewood, Garrett Lawlor Introduction: In patients with a prior history of neoplasia, current guidelines endorse colon cancer surveillance every 3-5 years. The optimal interval for subsequent surveillance could theoretically be tailored according to the patient’s risk to optimize resource utilization. This study aimed to characterize neoplasia occurrence/recurrence according to prior history of neoplasia in a large patient cohort undergoing colonoscopy. Methods: All patients undergoing 2 colonoscopies at least 12 months apart between 1996 and 2000, with removal of a polyp if detected on index examination, were identified using our endoscopic database to determine the incidence of colonic neoplasia. Patients were classified as a) normal non-surveillance index exam (screen), b) normal surveillance index exam, i.e. history of neoplasia prior to index exam (surv-norm), and c) neoplasia on index exam (surv-neo). Results: Overall, 3,844 patients underwent two colonoscopies at least 12 months apart (median interval, 149 weeks), 1,165 with normal nonsurveillance index exam, 876 with normal surveillance index exam, and 1,803 with neoplasia on index exam. Polyps R5mm were detected on subsequent colonoscopy in 57 (4.9%) patients (screen), 94 (10.7%) (surv-norm), and 334 (18.5%) (surv-neo), p!0.0001; polyps R10 mm in 23 (2.0%) patients (screen), 27 (3.1%) (surv-norm), and 105 (5.8%) (surv-neo), p!0.0001. Kaplan-Meier curve for neoplasia occurrence/recurrence is shown (figure) with higher rates for surv-neo and surv-norm vs screen, p!0.0001 (log rank test). Using a Cox proportional hazards model, adjusted (for age, gender) hazard ratios (95% C.I.) demonstrated increased neoplasia (polyps R5mm, R10mm) rates for surveillance patients despite a normal index exam (table). Conclusions: The risk for lesion recurrence among patients with previous neoplasia continues to be significantly higher than for de novo lesion occurrence despite a prior normal surveillance exam. Patients with a previous history of colonic neoplasia warrant continued close observation despite a subsequent normal surveillance examination.