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Interval cancers after negative colonoscopy: population-based case-control study
  1. Hermann Brenner1,
  2. Jenny Chang-Claude2,
  3. Christoph M Seiler3,
  4. Michael Hoffmeister1
  1. 1Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center, Heidelberg, Germany
  2. 2Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
  3. 3Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
  1. Correspondence to Professor Hermann Brenner, Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center, INF 280, D-69120 Heidelberg, Germany; h.brenner{at}


Objective The risk of colorectal cancer after a previous negative colonoscopy is very low. Nevertheless, interval cancers occur. We aimed to assess the characteristics and predictors of interval cancers after negative colonoscopy.

Methods A population-based case-control study was conducted in Southern Germany in 2003–7. Sociodemographic and tumour characteristics were compared among 78 patients with interval cancers occurring 1–10 years after a negative colonoscopy and 433 colorectal cancers detected at screening. In addition, the indication for the preceding negative colonoscopy and its completeness were compared between patients with interval cancers and 515 controls with a preceding negative colonoscopy.

Results 56.4% of interval cancers occurred among women compared with 33.7% of cases detected by screening (p=0.0001). After adjustment for covariates, female sex (OR 2.28, 95% CI 1.35 to 3.83) and location in the caecum or ascending colon (OR 1.98, 95% CI 1.17 to 3.35) were independently associated with occurrence of interval cancers. The preceding negative colonoscopy was more commonly conducted because of a positive faecal occult blood test (26.0% vs 12.9%, p=0.009) and was more often incomplete (caecum not reached: 18.1% vs 6.7%, p=0.001) among interval cancer cases than among controls. Characteristics of the preceding negative colonoscopy strongly and independently associated with occurrence of interval cancers were follow-up of a positive faecal occult blood test among men (OR 5.49, 95% CI 2.10 to 14.35) and incompleteness among women (OR 4.38, 95% CI 1.69 to 11.30).

Conclusions The observed patterns suggest that a substantial proportion of interval cancers are due to neoplasms missed at colonoscopy and are potentially preventable by enhanced performance of colonoscopy.

  • Colonoscopy
  • colorectal cancer
  • interval cancers
  • epidemiology
  • Helicobacter pylori—epidemiology, colorectal cancer screening
  • Helicobacter pylori—in children
  • gastrointestinal cancer

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  • Funding This study was supported by grants from the German Research Council (Deutsche Forschungsgemeinschaft, grant numbers BR 1704/6-1, BR 1704/6-3, BR 1704/6-4, CH 117/1-1) and the German Federal Ministry of Education and Research (grant numbers 01KH0404, 01ER0814). The sponsors had no role in the study design and in the collection, analysis and interpretation of data.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was obtained from the Ethics Committees, Medical Faculty, University of Heidelberg, and Medical Chambers of Baden-Württemberg and Rhineland-Palatinate.

  • Provenance and peer review Not commissioned; externally peer reviewed.