While nearly half of patients at increased risk for colorectal cancer prefer more frequent surveillance colonoscopies, the vast majority are willing to follow specialist recommendations, a study finds.1 With guideline updates extending intervals for lower-risk patients, clear communication from specialists plays a key role in patient acceptance.
Most patients prefer more frequent colonoscopies, but specialist recommendations drive acceptance of extended intervals. | Image credit: Ahmet Aglamaz – stock.adobe.com
The retrospective case analysis is published in Digestive Diseases and Sciences.
“As we found that most patients were comfortable with following specialist-endorsed surveillance strategies, communicating potential benefits with specialist involvement could improve acceptance,” wrote the researchers of the study. “Furthermore, since preferences for more frequent surveillance were more prevalent among those with a higher fear of [colorectal cancer], targeted interventions to decrease cancer-related fear may also improve the acceptability of extended colonoscopy intervals.”
Guidelines from the US Multi-Society Task Force on Colorectal Cancer recommend repeat colonoscopy intervals based on polyp type, size, and number, according to the American Gastroenterological Association.2 Patients with normal, high-quality colonoscopy results should undergo screening every 10 years, while those with 1 to 2 small tubular adenomas can extend follow-up to 7 to 10 years. More frequent surveillance (3-5 years) is advised for patients with 3 to 10 adenomas, high-risk features, or large sessile serrated polyps. Those with more than 10 adenomas require annual follow-up, and individuals undergoing piecemeal resection of large polyps should return in 6 months.
In the current study, the researchers aimed to evaluate patient preferences for colonoscopy frequency and response to an extended colonoscopy interval.1
The study analyzed patient preferences and responses to extended colonoscopy intervals using survey data and retrospective case analysis. Participants were enrolled in a nurse-managed surveillance program in South Australia. A survey was distributed to 800 randomly selected individuals in December 2018 to assess preferred surveillance intervals, comfort with specialist recommendations, and perceptions of colorectal cancer risk.
Logistic regression analyses examined factors influencing preferences for more frequent colonoscopies and trust in specialist recommendations. Additionally, a retrospective case analysis reviewed responses to a guideline-driven interval extension from 3 to 5 years. Patients were notified via letter, and clinical records from 2019 to 2024 were audited to track inquiries and adherence to the updated surveillance schedule.
Of a total of 800 patients, the survey yielded a 51.1% response rate. Nearly half of respondents (46.6%) preferred more frequent colonoscopies than their current interval, particularly those with greater fear of colorectal cancer and higher satisfaction with prior procedures. Despite this preference, 80.4% expressed comfort with following specialist recommendations, with trust associated with lower perceived colorectal cancer risk.
A retrospective review of 380 patients who received a letter extending their surveillance interval from 3 to 5 years showed minimal resistance, with only 2.9% contacting the program. Of these, most accepted the change after discussion, while a small fraction proceeded with earlier colonoscopies due to symptoms or personal preference.
The researchers noted a key limitation was the potential for survey response bias, as individuals less accepting of colonoscopies or specialist recommendations may have been less likely to participate. Additionally, the study population consisted of individuals with extensive experience in surveillance colonoscopies, which may not represent broader patient populations. While prior colonoscopy experience is often linked to patient preferences, the analysis found no significant association between the number of prior colonoscopies and a preference for more frequent surveillance.
Despite these limitations, the researchers believe these findings highlight the role of specialist endorsement in increasing patient acceptance of extended surveillance intervals.
“In conclusion, despite a preference for more frequent surveillance, most patients were comfortable following specialists’ recommendations,” wrote the researchers. “Therefore, communications of surveillance changes, especially those that decrease colonoscopy frequency, should be supported with specialist endorsement and aim to reduce cancer-related fear.”
References
1. Dix M, Aftab S, Young GP, et al. Assessing patient preferences and response to extended colonoscopy intervals in a colorectal cancer surveillance program. Dig Dis Sci. 2025 Feb 21. doi: 10.1007/s10620-025-08925-z. Epub ahead of print. PMID: 39982621.
2. Follow-up after colonoscopy and polypectomy. American Gastroenterological Association. July 2, 2020. Accessed February 21, 2025. https://gastro.org/clinical-guidance/follow-up-after-colonoscopy-and-polypectomy-a-consensus-update-by-the-u-s-multi-society-task-force-on-colorectal-cancer/
