Reassessing colonoscopy surveillance: Early- vs average-onset colorectal cancer

Editor's Note

Early-onset colorectal cancer (EO-CRC), diagnosed before age 50, is increasing in incidence worldwide. Despite existing postoperative colonoscopy surveillance strategies, the optimal intervals for EO-CRC patients are unclear due to limited long-term data. This study, titled “Early-onset Colorectal Cancer Patients Do Not Require Shorter Intervals for Post-surgical Surveillance Colonoscopy” and published on May 8 by Clinical Gastroenterology and Hepatology, aimed to compare surveillance colonoscopy findings between EO-CRC and average-onset colorectal cancer (AO-CRC) patients to better define appropriate surveillance intervals.

The researchers conducted a single-institution retrospective chart review of EO-CRC and AO-CRC patients with colonoscopy and no evidence of disease. The study included 1,259 CRC patients, with 612 in the EO-CRC group and 647 in the AO-CRC group. They examined surveillance intervals and the time to development of advanced neoplasia (CRC and advanced polyps, including adenomas and sessile serrated lesions). Each group underwent evaluation over three serial surveillance colonoscopies. Statistical analyses were performed using the log-rank Kaplan-Meier method and Cox proportional hazards model.

Key findings include:

• Risk of advanced neoplasia: EO-CRC patients had a 29% lower risk of developing advanced neoplasia from the time of initial surgery to the first surveillance colonoscopy compared to AO-CRC patients (hazard ratio, 0.71; 95% confidence interval, 0.52–1.0).
• Follow-up time: Both groups had an average follow-up time of 12.6 months from surgical resection to the first surveillance colonoscopy.
• Surveillance findings: EO-CRC patients had less advanced neoplasia at their first surveillance colonoscopy compared to AO-CRC patients (12.4% vs. 16.0%, respectively; P = .003).
• Subsequent colonoscopies: EO-CRC patients returned for follow-up surveillance earlier than AO-CRC patients. However, the EO-CRC cohort did not show higher rates of advanced neoplasia or non-advanced adenomas on subsequent colonoscopies.

The study concludes that patients with EO-CRC do not have a higher risk of advanced neoplasia compared to AO-CRC patients. Therefore, EO-CRC patients do not need more frequent colonoscopy surveillance than current guidelines recommend. This finding can help refine surveillance strategies and ensure appropriate, evidence-based follow-up care for EO-CRC patients.