American Board of Internal Medicine (ABIM) Certification Practice Exam

When should patients with long-standing colitis associated with inflammatory bowel disease begin surveillance colonoscopy for colon cancer?

1. After 5-7 years of disease

2. After 8-10 years of disease

3. After 10-12 years of disease

4. Immediately upon diagnosis

The correct answer is: After 8-10 years of disease

Patients with long-standing colitis associated with inflammatory bowel disease, such as ulcerative colitis or Crohn's disease, are at an increased risk for developing colon cancer over time. The recommended timeline for initiating surveillance colonoscopy is typically set at 8 to 10 years after the onset of the inflammatory bowel disease. The rationale behind this recommendation stems from studies that have demonstrated a gradual increase in the risk of colorectal cancer beginning approximately 8 years after the diagnosis. Regular surveillance colonoscopy plays a critical role because it allows for the early detection of dysplasia (precancerous changes) and colorectal cancer, which can improve outcomes significantly through early intervention. Surveillance colonoscopy may begin sooner in specific cases, such as with pancolitis (involvement of the entire colon) or if there are additional risk factors for colon cancer. However, in the absence of those additional risk factors, the 8 to 10-year benchmark is a widely accepted guideline in clinical practice. Patients are advised to continue regular surveillance colonoscopies every 1 to 2 years thereafter, depending on their findings and any dysplastic lesions observed. This proactive approach ultimately aims to detect potential malignancies early and provide appropriate management options.