When should a 72-year-old man with a strong family history of colon cancer in his 70s and a single small tubular adenoma removed from the ascending colon have a repeat colonoscopy?

Recommended Surveillance Interval: 7-10 Years

This 72-year-old man with a single small tubular adenoma should have his next colonoscopy in 7-10 years, assuming the baseline examination was high-quality with complete polyp removal. 1

Risk Stratification

This patient falls into the low-risk adenoma category based on his colonoscopy findings:

• Single tubular adenoma (not multiple adenomas) 2
• Small size (<10 mm, as no size ≥10 mm was documented) 2
• No high-grade dysplasia (only tubular adenoma mentioned) 1
• No villous features (tubular histology only) 2

The 2012 US Multi-Society Task Force guidelines specifically recommend a 5-10 year interval for patients with 1-2 tubular adenomas <10 mm, with moderate quality evidence that has strengthened since 2006. 2 The most recent high-quality guidance from the American Gastroenterological Association narrows this to 7-10 years for this exact clinical scenario (strong recommendation, moderate quality evidence). 1

Family History Does Not Modify This Interval

The strong family history of colon cancer in his 70s does not shorten the post-polypectomy surveillance interval once an adenoma has been found and removed:

• Family history recommendations apply to screening intervals in asymptomatic individuals 2
• Once adenomas are detected, the adenoma characteristics dictate surveillance timing, not family history 1
• His family members developed cancer in their 70s (≥60 years), which represents lower familial risk than if they had been diagnosed <60 years 2

If this patient had a normal colonoscopy (no adenomas), then his family history would mandate a 5-year interval rather than 10 years. 2 However, the presence of the adenoma supersedes family history considerations for surveillance timing. 1

Critical Quality Requirements

The 7-10 year interval is only appropriate if the baseline colonoscopy met high-quality standards: 1

• Complete examination to cecum with photo documentation 1
• Adequate bowel preparation (minimal fecal residue) 1
• Minimum 6-minute withdrawal time from cecum 1
• Complete polyp removal with high confidence 1

If any of these quality metrics were not met, repeat colonoscopy should be performed sooner before establishing a long-term surveillance program. 1

Subsequent Surveillance Strategy

At the 7-10 year follow-up colonoscopy: 1

• If findings are normal or show only 1-2 small (<10 mm) tubular adenomas with low-grade dysplasia, the next interval can be extended to another 5 years 1
• If high-risk features appear (≥3 adenomas, any adenoma ≥10 mm, high-grade dysplasia, or villous features), the interval should be shortened to 3 years 1

Common Pitfalls to Avoid

Do not recommend 3-year surveillance for this patient—that interval is reserved for high-risk findings including: 1

• Any adenoma ≥10 mm 1
• 3-4 or more adenomas (even if small) 1
• Tubulovillous/villous histology 1
• High-grade dysplasia 1

Do not extend to 10 years unless the colonoscopy was completely normal with no adenomas. 2 The presence of even one small tubular adenoma requires surveillance shorter than the standard 10-year screening interval. 1

Verify complete polyp removal was documented. Incomplete removal of adenomas is associated with increased risk of interval colorectal cancer. 1 If piecemeal resection was performed (unlikely for a small polyp but possible), a 6-month follow-up would have been indicated to verify complete removal. 1

Do not rely on FIT testing as a substitute for colonoscopic surveillance in this patient with documented adenoma history. 3