ImportanceThe current recommendation for a 10-year rescreening interval after a negative colonoscopy screening (NCS) result has been questioned, with some studies showing a persistently lower risk of colorectal cancer (CRC) after NCS results.ObjectiveTo examine long-term CRC incidence and mortality after NCS results (ie, no presence of CRC or polyps) and according to a risk score based on major demographic and lifestyle risk factors.Design, Setting, and ParticipantsIn this cohort study, 3 prospective US population–based cohorts from the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-up Study were followed up from 1988 and 1991 to 2020. Data from the National Health and Nutrition Examination Survey (NHANES) from the January 1, 2017, to December 31, 2018, cycle were used to compare the risk profile distribution with that of the general US population. Data analysis was performed from October 2023 to August 2024.ExposuresTime-varying status of NCS results and risk score.Main Outcomes and MeasuresCox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% CIs for incidence and mortality of CRC.ResultsA total of 195 453 participants (median [IQR] age, 44 [37-56] years at baseline; 81% female) were followed up for a median (IQR) of 12 (6-20) years. Among 81 151 individuals with NCS results and 114 302 without endoscopy, 394 and 2229 CRC cases and 167 and 637 CRC deaths, respectively, were documented. Negative colonoscopy screening results were consistently associated with lower CRC incidence (HR, 0.51; 95% CI, 0.44-0.58) and mortality (HR, 0.56; 95% CI, 0.46-0.70) for 20 years. Among individuals with NCS results, those with an intermediate risk (scores, 6-7) and low risk (scores, 0-5) did not reach the 10-year cumulative incidence of CRC (0.78%) of the high-risk individuals (scores, 8-12) until 16 and 25 years after initial screening, respectively.Conclusion and RelevanceThese findings provide evidence for shared decision-making between patients and physicians to consider extending the rescreening intervals after an NCS result beyond the currently recommended 10 years, particularly for individuals with a low-risk profile. These results showed, as a proof of concepts, the importance of considering known CRC risk factors when making decisions for colonoscopy rescreening.

中文翻译：

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结肠镜检查筛查结果阴性后的结直肠癌发病率和死亡率


重要性目前建议的结肠镜检查筛查 （NCS） 阴性后 10 年重新筛查间隔受到质疑，一些研究表明，在 NCS 结果后患结直肠癌 （CRC） 的风险持续较低。目的根据基于主要人口统计学和生活方式风险因素的风险评分，检查 NCS 结果 （即不存在 CRC 或息肉） 后的长期 CRC 发病率和死亡率。设计、设置和参与者在这项队列研究中，从 1988 年和 1991 年到 2020 年对来自护士健康研究、护士健康研究 II 和卫生专业人员随访研究的 3 个基于美国人群的前瞻性队列进行了随访。来自 2017 年 1 月 1 日至 2018 年 12 月 31 日周期的全国健康和营养检查调查 （NHANES） 的数据用于比较风险概况分布与美国一般人群的风险分布。数据分析于 2023 年 10 月至 2024 年 8 月进行。主要结局和指标 Cox 比例风险回归用于计算 CRC 发生率和死亡率的风险比 （HRs） 和 95% CIs。结果共有 195 453 名参与者 （中位 [IQR] 年龄，基线时为 44 [37-56] 岁;81% 为女性）接受了中位 （IQR） 12 （6-20） 年的随访。在 81 151 例有 NCS 结果的个体和 114 302 例未进行内窥镜检查的个体中，分别记录了 394 例和 2229 例 CRC 病例以及 167 例和 637 例 CRC 死亡。阴性结肠镜筛查结果始终与较低的 CRC 发生率 （HR， 0.51;95% CI， 0.44-0.58） 和死亡率 （HR， 0.56;95% CI， 0.46-0.70） 相关 20 年。 在有 NCS 结果的个体中，中等风险 （评分，6-7） 和低风险 （评分，0-5） 的个体直到初筛后 16 年和 25 年才达到高危个体 （评分，8-12） 的 10 年累积发病率 （0.78%）。结论和相关性这些发现为患者和医生之间的共同决策提供了证据，以考虑将 NCS 结果后的重新筛查间隔延长到目前推荐的 10 年之后，特别是对于低风险的个体。这些结果表明，作为概念证明，在做出结肠镜检查复筛决策时考虑已知 CRC 危险因素的重要性。