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Should We Shorten or Lengthen Postpolypectomy Surveillance Intervals?
- Adeyinka O. Laiyemo, MD, MPH;
- Elaine Lanza, PhD; and
- Arthur Schatzkin, MD, DrPH
IN RESPONSE:
We agree with Drs. Rex and Winawer that a single study is unlikely to be definitive, especially when, as they suggest, variability in clinician judgment influences the identified predictors of higher risk for advanced adenoma.
We did not, however, recommend shortening the interval of surveillance colonoscopy for the low-risk category. In our study, the advanced adenoma recurrence rate at 4 years was 9% among the high-risk category and 5% among the low-risk category. The c-statistics from multivariate models incorporating demographic and lifestyle factors with adenoma characteristics indicated little discrimination between the 2 risk groups. Although these finding may be interpreted to mean that we should screen both groups at 3 years, they could just as well suggest extending the surveillance interval for both groups to 5 years.
Given the cost and risk associated with colonoscopic surveillance, the challenge becomes developing surveillance interval recommendations based on risk categorization schemes with greater predictive capacity. Combining the data from completed and ongoing adenoma trials and observational studies may help achieve this goal, especially if we conduct multivariate analyses incorporating demographic and lifestyle information along with adenoma characteristics. Whether additional colonoscopy–adenoma studies are needed to achieve the desired predictability for risk assignment remains to be seen.
Adeyinka O. Laiyemo, MD, MPH
Elaine Lanza, PhD
Arthur Schatzkin, MD, DrPH
National Cancer Institute
Bethesda, MD 20892
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
