From the Guidelines
For patients with small adenomas and a positive family history of colorectal cancer after a successful colonoscopy, the recommended follow-up interval is typically 5 years, as indicated by the most recent and highest quality study 1. This recommendation is based on the guidelines for screening and surveillance for the early detection of colorectal cancer and adenomatous polyps. The presence of adenomas, even small ones, indicates a predisposition to polyp formation, while a family history of colorectal cancer independently increases risk. The exact timing within this range should be individualized based on additional factors such as:
- The number of adenomas found
- Their size
- Histology (particularly if any showed high-grade dysplasia)
- Completeness of removal
- The strength of the family history (number of affected relatives and their age at diagnosis) Some key points to consider include:
- Patients with 1 or 2 small tubular adenomas with low-grade dysplasia should have their next follow-up colonoscopy in 5 to 10 years, as stated in 1 and 1
- The guidelines from 1 and 1 also support the idea of individualizing the follow-up interval based on clinical factors
- Patients should maintain regular follow-up with their gastroenterologist who may adjust this interval based on findings at each subsequent colonoscopy Between colonoscopies, patients should report any new symptoms such as rectal bleeding, change in bowel habits, or unexplained weight loss promptly rather than waiting for their scheduled surveillance. It's also important to note that the guidelines from 1 suggest that the risk for colon cancer in patients with only 1 or 2 small adenomas is similar to the average-risk population, but this does not necessarily apply to patients with a positive family history of colorectal cancer. Overall, the recommended follow-up interval for this patient is 5 years, based on the most recent and highest quality study 1.
From the Research
Follow-up Interval for Colonoscopy
The patient in question has a positive family history of colorectal cancer, with her mother developing the disease at age 57. She underwent a colonoscopy that revealed 2 conventional adenomas measuring 2 and 7 mm in size, which were removed with cold snare and demonstrated tubular adenomas with low-grade dysplasia.
Risk Factors for Adenoma Recurrence
Several studies have investigated the risk factors for adenoma recurrence at surveillance colonoscopy. A systematic literature review and pooled analyses of risk factors for finding adenomas at surveillance colonoscopy found that the presence of advanced adenomas, ≥3 adenomas, size ≥10 mm, and age ≥60 years were significant risk factors for adenoma findings 2.
Recommended Follow-up Interval
Given the patient's small adenomas (2 and 7 mm) and low-grade dysplasia, the risk of advanced neoplasia is relatively low. A study on the association of colonoscopy adenoma findings with long-term colorectal cancer incidence found that participants with nonadvanced adenoma (less than 1 cm without advanced histology) were not at significantly increased risk of developing colorectal cancer compared to those with no adenoma 3.
Surveillance Recommendations
Based on the patient's profile, the recommended follow-up interval for colonoscopy can be considered as follows:
- The patient has a family history of colorectal cancer, but the adenomas found were small and had low-grade dysplasia.
- Studies suggest that the risk of adenoma recurrence is higher in patients with advanced adenomas, multiple adenomas, or larger adenomas 2.
- Given the patient's adenomas were small and not advanced, a follow-up interval of 5 years may be reasonable, considering the low risk of advanced neoplasia 4, 5.
Key Points
- The patient's small adenomas and low-grade dysplasia suggest a lower risk of advanced neoplasia.
- Family history of colorectal cancer is a significant risk factor, but the patient's adenoma characteristics are not high-risk.
- A 5-year follow-up interval may be appropriate, but this should be individualized based on the patient's overall risk profile and clinical judgment.