Top Line: Helping ensure appropriate routine cancer surveillance is in the purview of any practicing oncologist.
The Study: The phase 3 EPoS II trial randomized 10,799 patients with completely resected high-risk adenomas (read: at least one adenoma with villous histologic features, high-grade dysplasia, or measuring at least 1 cm or 3–10 adenomas of any kind) to next surveillance colonoscopy at either 3 or 5 years. Note patients with hereditary cancer syndromes or inflammatory bowel disease were excluded. At interim analysis just over 5 years out, colorectal cancer incidence was similar between groups: 0.82% with 3-year versus 0.77% with 5-year surveillance, meeting the prespecified noninferiority criterion. While the more-intensive strategy detected more advanced adenomas, this did not (yet) translate into a meaningful reduction in colorectal cancer incidence. The 5-year strategy required nearly 50% fewer surveillance colonoscopies.
TBL: “Findings from the EPoS II trial suggest that the absolute risk of colorectal cancer after a high-quality baseline colonoscopy with complete excision is lower than
the term “high risk” conveys.” | Jover, N Engl J Med 2026
The Study: The phase 3 EPoS II trial randomized 10,799 patients with completely resected high-risk adenomas (read: at least one adenoma with villous histologic features, high-grade dysplasia, or measuring at least 1 cm or 3–10 adenomas of any kind) to next surveillance colonoscopy at either 3 or 5 years. Note patients with hereditary cancer syndromes or inflammatory bowel disease were excluded. At interim analysis just over 5 years out, colorectal cancer incidence was similar between groups: 0.82% with 3-year versus 0.77% with 5-year surveillance, meeting the prespecified noninferiority criterion. While the more-intensive strategy detected more advanced adenomas, this did not (yet) translate into a meaningful reduction in colorectal cancer incidence. The 5-year strategy required nearly 50% fewer surveillance colonoscopies.
TBL: “Findings from the EPoS II trial suggest that the absolute risk of colorectal cancer after a high-quality baseline colonoscopy with complete excision is lower than
the term “high risk” conveys.” | Jover, N Engl J Med 2026