American Board of Internal Medicine (ABIM) Certification Practice Exam

Patients with 3-10 adenomas that are ≥10 mm should have a colonoscopy at what interval?

1. 1 year

2. 3 years

3. 5 years

4. 10 years

The correct answer is: 3 years

Patients with 3 to 10 adenomas that are 10 mm or larger are at an increased risk for colorectal cancer and therefore require closer surveillance. According to the guidelines for colorectal cancer screening and surveillance, individuals with this level of adenoma burden should undergo a surveillance colonoscopy every 3 years. This recommendation is based on the understanding that multiple adenomas, especially those that are large, significantly increase the likelihood of advanced neoplasia. Surveillance intervals are designed to ensure that any new or missed lesions can be detected and treated promptly to prevent progression to cancer. A 3-year interval strikes a balance between the necessity for close monitoring due to the higher risk of significant pathology and the practicality of not over-scheduling colonoscopies unnecessarily, which can lead to undue burden on patients and healthcare systems. This approach helps stratify patients into categories where evidence suggests a particular risk level, allowing for targeted surveillance that is both effective and efficient.