More frequent colonoscopy surveillance not needed for early-onset colorectal cancer

Early-onset colorectal cancer (CRC) does not appear to carry an increased risk of advanced neoplasia compared with average-onset CRC and, hence, does not require more frequent colonoscopy surveillance, according to a study.

Researchers reviewed the medical records of 612 patients with early-onset CRC and 647 patients with average-onset CRC, all of whom had no evidence of disease on first surveillance colonoscopy. Surveillance intervals (three serial surveillance colonoscopies) and time to development of advanced neoplasia (CRC and advanced polyps [adenoma/sessile serrated]) were evaluated. Log-ranked Kaplan-Meier method and Cox proportional hazards were used in the analyses.

Overall surveillance findings were significantly different between the two groups, with patients with early-onset CRC having less advanced neoplasia than those with average-onset CRC (12.4 percent vs 16.0 percent; p=0.003).

The risk of developing advanced neoplasia from time of initial surgery to first surveillance colonoscopy was 29-percent lower in the early-onset group than in the average-onset group (hazard ratio [HR], 0.71, 95 percent confidence interval [CI], 0.52 1.0). Average follow-up time from surgical resection to first surveillance colonoscopy was 12.6 months for both cohorts.

Finding from subsequent colonoscopies indicated that while the early-onset group returned for follow-up surveillance colonoscopy earlier than the average-onset group, the incidence of advanced neoplasia or nonadvanced adenomas was not increased in the early-onset group.