• Nastazja Dagny Pilonis, Marek Bugajski, Paulina Wieszczy, Robert Franczyk, Joanna Didkowska, Urszula Wojciechowska, Malgorzata Pisera, Maciej Rupinski, Jaroslaw Regula, and Michal Filip Kaminski.
• The Maria Sklodowska-Curie National Research Institute of Oncology and Medical Center for Postgraduate Education, Warsaw, Poland (N.D.P., M.B., P.W., M.R., J.R.).
• Ann. Intern. Med. 2020 Jul 21; 173 (2): 81-91.

BackgroundCurrent guidelines recommend a 10-year interval between screening colonoscopies, but evidence is limited.ObjectiveTo assess the long-term risk for colorectal cancer (CRC) and death from CRC after a high- and low-quality single negative screening colonoscopy.DesignObservational study.SettingPolish Colonoscopy Screening Program.ParticipantsAverage-risk individuals aged 50 to 66 years who had a single negative colonoscopy (no neoplastic findings).MeasurementsStandardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) of CRC after high- and low-quality single negative screening colonoscopy. High-quality colonoscopy included a complete examination, with adequate bowel preparation, performed by endoscopists with an adenoma detection rate of 20% or greater.ResultsAmong 165 887 individuals followed for up to 17.4 years, CRC incidence (0.28 [95% CI, 0.25 to 0.30]) and mortality (0.19 [CI, 0.16 to 0.21]) were 72% and 81% lower, respectively, than in the general population. High-quality examination resulted in 2-fold lower CRC incidence (SIR, 0.16 [CI, 0.13 to 0.20]) and mortality (SMR, 0.10 [CI, 0.06 to 0.14]) than low-quality examination (SIR, 0.32 [CI, 0.29 to 0.35]; SMR, 0.22 [CI, 0.18 to 0.25]). In multivariable analysis, the hazard ratios for CRC incidence after high-quality versus low-quality colonoscopy were 0.55 (CI, 0.35 to 0.86) for 0 to 5 years, 0.54 (CI, 0.38 to 0.77) for 5.1 to 10 years, and 0.46 (CI, 0.25 to 0.86) for 10 to 17.4 years. Only after high-quality colonoscopy did the SIR and SMR for 10.1 to 17.4 years of follow-up not differ compared with earlier observation periods.LimitationThe general population was used as the comparison group.ConclusionA single negative screening colonoscopy was associated with reduced CRC incidence and mortality for up to 17.4 years. Only high-quality colonoscopy yielded profound and stable reductions in CRC incidence and mortality throughout the entire follow-up.Primary Funding SourcePolish Ministry of Health.

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