Risks of Not Undergoing Screening Colonoscopy

Mortality Risk

• For individuals with a 4% baseline risk of colorectal cancer over 15 years, no screening results in 13 deaths per 1,000 people, compared to only 5 deaths per 1,000 with colonoscopy screening 1

Cancer Incidence and Stage at Diagnosis

• Delays in colonoscopy beyond 6 months after a positive fecal immunochemical test result in significantly higher risks: adjusted OR 1.31 for any colorectal cancer and 2.09 for advanced stage disease 2, 3
• Delays beyond 12 months further increase risk: adjusted OR 2.17 for any colorectal cancer and 2.84 for advanced stage disease 2, 3
• Patients with localized colorectal cancer have 90% 5-year survival, compared to only 14% for distant disease 4

Long-Term Protective Effect

• A negative colonoscopy provides protection for at least 10 years, with very low risk of advanced neoplasia within 5 years (1.3%-2.4%) 5
• Case-control studies demonstrate risk reduction lasting 10 years or more after colonoscopy 5

Missed Opportunity for Prevention

• Colonoscopy can prevent cancer by detecting and removing adenomatous polyps before they progress to malignancy 4

Common Pitfalls

• The evidence shows that adherence to any screening method is more important than which specific test is chosen 2, 3
• System barriers frequently contribute to non-compliance, including failure to arrange colonoscopy, failure to inform patients of positive results, and inadequate patient contact 2, 3