High-intensity surveillance cuts CRC risk after polyp removal

  • Meester RGS & al.
  • Ann Intern Med
  • 24 Sep 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • High-intensity surveillance colonoscopy provides a modest advantage at acceptable cost after removal of precancerous adenomas.

Why this matters

  • Findings support current US guidelines recommending 3 years of surveillance for colorectal cancer (CRC) after removal of high-risk adenomas (HRAs), and suggest that 5-year surveillance is reasonable after removing low-risk adenomas (LRAs).

Study design

  • Microsimulation model of average-risk patients aged 50, 60, and 70 years with HRAs or LRAs removed during colonoscopy screening or after fecal immunochemical testing.
  • High- and low-intensity surveillance strategies were modeled at 5- vs 10-year intervals after LRA removal and 3- vs 5-year intervals after HRA removal.
  • Funding: National Cancer Institute.

Key results

  • In the absence of surveillance or screening, lifetime CRC incidence was estimated to be 10.9% after LRA removal and 17.2% after HRA removal.
  • CRC risk reduction by strategy:
    • Return to any screening: 39% (reference).
    • Low-intensity surveillance: 46%.
    • High-intensity surveillance: 55%.
  • High- vs low-intensity surveillance had a cost of
  • Good value is commonly defined as less than $50,000 per QALY gained.

Limitations

  • Limited data on surveillance outcomes.