Trial suggests less frequent colonoscopies may safely follow removal of high-risk polyps
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Every year, around 1.9 million people worldwide are diagnosed with bowel cancer. To prevent the disease, many countries have introduced screening programs that enable more polyps to be detected and removed before cancer develops.
However, some patients are assessed as being at increased risk of developing new polyps or cancer and are therefore recommended to undergo regular follow-up colonoscopies. These examinations are resource-intensive for the health care system and can be perceived as burdensome for patients.
The first results from the European Polyp Surveillance (EPoS) study, a large randomized research project on follow-up after polyp removal, have been published in the New England Journal of Medicine.
In the EPoS II study, 10,799 patients across eight European countries who had previously had high-risk adenomas—a type of polyp—removed were followed up. Participants were randomized to undergo their first follow-up colonoscopy after either three or five years.
Low risk in both groups
After five years of follow-up, the risk of colorectal cancer was very low in both groups. Among those who waited five years for their first checkup, 0.77% developed cancer, compared with 0.82% among those examined after three years. Nor did the researchers observe any clear differences in how far the cancer had progressed when it was detected.
At the same time, the longer follow-up interval meant that the number of colonoscopies fell sharply. During the follow-up period, nearly 4,200 fewer examinations were carried out in the group that waited five years for their first follow-up.
"More than 99% of patients did not develop colorectal cancer within five years of the polyps being removed. The results suggest that we need to reassess when these patients should be called in for their next colonoscopy," says Hans-Olov Adami, professor emeritus at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet, who coordinated the Swedish part of the research project.
At the same time, the researchers are presenting results from the parallel EPoS III study, which involved 1,861 patients with so-called serrated polyps, another type of polyp that can also be a precursor to cancer. In that group, too, the risk of cancer was low. After five years, around 1% of the participants had developed colorectal cancer, and none had died from the disease.
"The low risk of cancer was observed in both patients with high-risk adenomas and those with serrated polyps. This also underlines the importance of the first colonoscopy, as the studies are based on the polyps having been detected and completely removed," says Adami.
Publication details
Rodrigo Jover et al, Colonoscopy Intervals and Colorectal Cancer Incidence after Adenoma Removal, New England Journal of Medicine (2026). DOI: 10.1056/nejmoa2603816
Journal information: New England Journal of Medicine
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GastroenterologyCommon illnesses & PreventionPreventive medicine Provided by Karolinska Institutet Who's behind this story?
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