A Longer Wait Before the Next Colonoscopy Held Its Own Against the Usual Schedule

CATEGORY: GUT & DIGESTIVE HEALTH

The earlier repeat colonoscopy didn’t buy extra protection. Among 10,799 adults who’d had higher-risk colon polyps removed, those scheduled for their first follow-up exam at five years developed colorectal cancer at almost exactly the same rate as those rechecked at three: 0.77% versus 0.82% over five and a half years, meeting the trial’s bar for the longer wait being no worse.¹ The five-year schedule needed 4,434 colonoscopies where the three-year schedule needed 8,614, close to half as many.

Why the Calendar Matters After Polyps

Most colorectal cancers grow from polyps, small growths on the bowel wall, over many years. When a colonoscopy finds and removes the riskier kind, a large one, one with worrisome cells, or three or more at once, guidelines in the US and Europe have generally called people back within about three years. That interval was set decades ago. Scopes and removal tools have improved since. Each extra exam carries a day of prep, sedation, a small risk of complications, and real cost, multiplied across millions of people with polyp findings every year.

Eight Countries, a Coin-Flip Schedule, Cancer as the Yardstick

Adults aged 40 to 74 in eight European countries were randomly scheduled for a first surveillance exam at either three or five years after their polyps came out; the three-year group was scoped again at five. Cancer registries and the five-year exams then settled the outcome. More than 99% in both groups stayed cancer-free. Deaths from colorectal cancer were vanishingly rare in each, three in one group, two in the other. The shorter schedule did find more new polyps. Whether finding them earlier helps anyone is exactly what the trial’s authors say remains to be seen.

An Answer at Five Years, a Fuller One at Ten

This is a planned interim look. The trial’s primary endpoint is cancer incidence at ten years, so the final word arrives later, and about a third of participants hadn’t completed their five-year exam on schedule, which blurs the comparison somewhat. Still, the investigators note the result may encourage guideline committees to reconsider the three-year reflex, and an accompanying editorial weighs the same question. For a procedure this common, halving its frequency without measurable harm is a result with wide reach.

Key Takeaways

• Colorectal cancer rates after higher-risk polyp removal were essentially the same whether the first follow-up colonoscopy came at three years or five: 0.82% versus 0.77%.
• The longer interval meant roughly half as many colonoscopies, with no detected cost in cancers or cancer deaths so far.
• This is an interim result from a trial that reads out fully at ten years, and current guidelines still recommend the shorter interval.

References

1. Jover R, et al. Colonoscopy Intervals and Colorectal Cancer Incidence after Adenoma Removal. The New England Journal of Medicine. 2026; DOI 10.1056/NEJMoa2603816. link