Researchers at the National Center for Tumor Diseases (NCT) Heidelberg and the German Cancer Research Center (DKFZ) have determined which interval between two consecutive colonoscopies provides the best early detection of colorectal cancer. According to the results, the interval can potentially be extended beyond the previously recommended 10 years to 15 years if the first examination is normal. A more precise recommendation can now also be made for people with colorectal cancer in a close relative, with an interval of eight years. These findings hold promise for a more personalized approach to colorectal cancer screening.
The NCT Heidelberg is a joint institution of the German Cancer Research Center (DKFZ) and Heidelberg University Hospital (UKHD).
Colonoscopy is the most important screening tool for the early detection and treatment of large bowel cancer. People with statutory health insurance in Germany are entitled to a colonoscopy - women from the age of 55, men from the age of 50. An interval of 10 years until the next examination is recommended, provided there are no symptoms.
Researchers at the NCT Heidelberg and the DKFZ, together with Swedish colleagues, have investigated ways to create more precise recommendations for a safe waiting time between two consecutive colonoscopies. In two studies, they focused on two groups of people.
In their first study, the epidemiologists investigated the extent to which the ten-year interval should be increased for people without a family history in the event of a first negative examination. To do this, they used the nationwide Swedish colonoscopy data, the world's largest collection of data on familial cancers, which covers more than twelve million people over several decades.
Mahdi Fallah, Leader of Risk Adapted Cancer Prevention Group, Division of Preventive Oncology, NCT Heidelberg and DKFZ, says: "Our research suggests we might be able to wait longer than the current 10-year recommendation between colonoscopies for certain people. This study shows that people with no family history of colorectal cancer and normal first colonoscopies could potentially wait 15 years before their next one." Such a longer interval between colonoscopies for people with normal first exams may only miss a small number of colorectal cancer cases (1.4 per 1,000 people) but it could prevent about one unnecessary colonoscopy per person, while still detecting most cancers early and saving lives.
The second study focused on the correct timing of the second colonoscopy in people who have been diagnosed with colorectal cancer in a first-degree relative aged 60 years or older. This applies to the majority of people with a family history of the disease. They have a relatively high risk of developing the disease - at the same time, there are no standardized screening recommendations for them.
"We were able to examine data from almost 15,000 people with a family history of colorectal cancer who had a previous colonoscopy with no signs of tumors. The research suggests that people with only one close relative diagnosed with colorectal cancer at age 60 or older might be able to wait eight years for their next colonoscopy after a clean initial exam,” says Mahdi Fallah. “These findings hold promise for a more personalized approach to colorectal cancer screening.”
The eight-year recommendation is based on two observations: First, individuals with a first negative colonoscopy over an eight-year period had a significantly lower risk of colorectal cancer than control subjects with familial risk but without a colonoscopy. Second, people with a family history and a first negative colonoscopy over a period of eight years even had a lower risk of developing the disease than people without a family history who had not had a colonoscopy. In addition, the eight-year interval can save around two colonoscopies per lifetime compared to the five-year interval, with only a very small number of colorectal cancer cases (1.7 per 1,000 people) being missed.
"Basically, we want to find out which screening intervals are best adapted to personal risks. In doing so, we aim to miss as few findings as possible - while at the same time not burdening people with unnecessary examinations. With our new recommendations, we have come a good deal closer to this goal," says Mahdi Fallah.
Publications:
Qunfeng Liang, Trasias Mukama, Kristina Sundquist, Jan Sundquist, Hermann Brenner, Elham Kharazmi, Mahdi Fallah: Longer Interval Between First Colonoscopy With Negative Findings for Colorectal Cancer and Repeat Colonoscopy; JAMA Oncology (2024);
https://doi.org/10.1001/jamaoncol.2024.0827
Qunfeng Liang, Kristina Sundquist, Jan Sundquist, Hermann Brenner, Elham Kharazmi, Mahdi Fallah: Colonoscopy screening interval in relatives of patients with late-onset colorectal cancer: A nationwide matched cohort study; Science Bulletin 69 (2024) 732–736;
https://doi.org/10.1016/j.scib.2024.01.008
Press contact:
Dr. Martin Staiger
Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg
Kommunikation und Veranstaltungen
Im Neuenheimer Feld 460
69120 Heidelberg
Tel.: +49 6221 42-1755
E-Mail: martin.staiger@nct-heidelberg.de
www.nct-heidelberg.de
Dr. Sibylle Kohlstädt
Deutsches Krebsforschungszentrum (DKFZ)
Strategische Kommunikation und Öffentlichkeitsarbeit
Im Neuenheimer Feld 280
69120 Heidelberg
Tel.: +49 6221 42-2843
Fax: +49 6221 42-2968
E-Mail: s.kohlstaedt@dkfz.de
www.dkfz.de
Dr. Stefanie Seltmann
Universitätsklinikum Heidelberg und Medizinische Fakultät der Universität Heidelberg
Presse- und Öffentlichkeitsarbeit
Im Neuenheimer Feld 672
69120 Heidelberg
Tel.: +49 6221 56-5052
Fax: +49 6221 56-4544
E-Mail: stefanie.seltmann@med.uni-heidelberg.de
www.klinikum.uni-heidelberg.de
German Cancer Research Center (DKFZ)
With more than 3,000 employees, the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) is Germany’s largest biomedical research institute. DKFZ scientists identify cancer risk factors, investigate how cancer progresses and develop new cancer prevention strategies. They are also developing new methods to diagnose tumors more precisely and treat cancer patients more successfully. The DKFZ's Cancer Information Service (KID) provides patients, interested citizens and experts with individual answers to questions relating to cancer.
To transfer promising approaches from cancer research to the clinic and thus improve the prognosis of cancer patients, the DKFZ cooperates with excellent research institutions and university hospitals throughout Germany:
- National Center for Tumor Diseases (NCT, 6 sites)
- German Cancer Consortium (DKTK, 8 sites)
- Hopp Children's Cancer Center (KiTZ) Heidelberg
- Helmholtz Institute for Translational Oncology (HI-TRON Mainz) - A Helmholtz Institute of the DKFZ
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim
- National Cancer Prevention Center (jointly with German Cancer Aid)
The DKFZ is 90 percent financed by the Federal Ministry of Education and Research and 10 percent by the state of Baden-Württemberg. The DKFZ is a member of the Helmholtz Association of German Research Centers.
The National Center for Tumor Diseases (NCT) Heidelberg
The National Center for Tumor Diseases (NCT) Heidelberg is a joint institution of the German Cancer Research Center, Heidelberg University Hospital and German Cancer Aid. The NCT's goal is to link promising approaches from cancer research with patient care from diagnosis to treatment, aftercare and prevention. The interdisciplinary tumor outpatient clinic is the central element of the NCT. Here the patients benefit from an individual treatment plan prepared in a timely manner in interdisciplinary expert rounds, the so-called tumor boards. Participation in clinical studies provides access to innovative therapies. The NCT thereby acts as a pioneering platform that translates novel research results from the laboratory into clinical practice. The NCT cooperates with self-help groups and supports them in their work. The pediatric oncologists at the KiTZ work together in joint structures with the NCT Heidelberg.
Heidelberg University Hospital and Faculty of Medicine: Internationally Renowned Patient Care, Research and Teaching
Heidelberg University Hospital (Universitätsklinikum Heidelberg, UKHD) is one of the largest and most prestigious medical centers in Germany. The Medical Faculty of Heidelberg University (Medizinische Fakultät Heidelberg, MFHD) belongs to the internationally renowned biomedical research institutions in Europe. Both institutions have the common goal of developing new therapies and implementing them rapidly for patients. Heidelberg University Hospital and the Medical Faculty of Heidelberg University employs around 14.500 employees and is committed to providing trainings and qualifications. Every year, around 86,000 patients and more than 1.100.000 outpatient cases are treated in more than 50 clinical departments with almost 2.500 beds. Together with the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) and the German Cancer Aid, the UKHD established the first National Center for Tumor Diseases (NCT) in Heidelberg. The goal is to provide care at the highest level as an oncology center of excellence and to rapidly transfer promising approaches from cancer research to the hospital. In addition, the UKHD operates in partnership with the DKFZ and the University of Heidelberg the Hopp Children’s Cancer center Heidelberg (KiTZ), a unique and nationally known therapy and research center for oncological and hematological diseases in children and adolescents. The Heidelberg Curriculum Medicinale (HeiCuMed) is one of the top medical training programs in Germany. Currently, there are about 4.000 future physicians studying in Heidelberg.