S576 One-Year Outcomes in Older Adults Overdue for Low-Risk Colon Polyp Surveillance

Introduction: The value of ongoing colon polyp surveillance in older adults is uncertain due to shifting benefits and harms in the context of competing mortality. We examined outcomes of patients overdue for surveillance colonoscopy regarding colonoscopy receipt, health status, and intentions for surveillance. Methods: We performed a one year look-back of patients age 65-82 overdue for polyp surveillance at a single medical center. Patients were considered overdue if time since last colonoscopy exceeded recommended interval for next colonoscopy. We included patients with low-risk colon polyps (i.e., ≤2 small adenomas or serrated lesions without advanced features) without colorectal cancer (CRC), inflammatory bowel disease or genetic CRC syndrome. Patients were identified as part of a surveillance colonoscopy research study for whom no verbal contact was made after mailed invitation letter was sent. We collected demographics, colonoscopy history, whether they underwent surveillance colonoscopy and the findings, discussed colonoscopy with their primary care provider (PCP), or developed conditions making colonoscopy no longer appropriate. Results: In Spring 2025, we identified 240 patients previously overdue due for polyp surveillance (median elapsed time since last colonoscopy: 6.4 years). Median (range) age was 70.9 (65-82) years, 46.7% were female. During look back, 76 (31.7%) had completed surveillance, mostly with colonoscopy (N = 72). Among those who underwent colonoscopy with available reports (N = 57), 31 (54.4%) had no neoplasia, 13 (22.8%) 1-2 non-advanced adenomas, 8 (14.0%) multiple non-advanced adenomas, and 5 (8.8%) an advanced adenoma. There were no CRCs. Eight (3.3%) were not eligible for surveillance due to death, comorbidities or symptoms. Among the remaining 156, 60 were planning colonoscopy, 3 were planning stool-based test, 10 declined colonoscopy, 3 were told to stop surveillance and 80 did not discuss surveillance with their primary care physicians. Conclusion: Among older adults due for colon polyp surveillance, only a minority completed colonoscopy within the following year of whom most had no neoplasia or only non-advanced adenomas. Very few became too sick for surveillance within this short time-frame. Our work suggests there is an opportunity for providers to directly engage with patients on whether further surveillance offers any benefit and our findings (e.g., low chances of advanced neoplasia) could help inform those discussions.