Which statement about surveillance colonoscopy in ulcerative colitis is correct?

• A. Surveillance should begin after 8–10 years of disease and occur every 1–2 years, depending on risk.
• B. Surveillance is not necessary if symptoms are absent.
• C. Surveillance is needed only if there is a family history of colorectal cancer.
• D. Surveillance should start at diagnosis and be yearly.

Answer: (A)

In ulcerative colitis, the risk of colorectal cancer grows with how long and how extensively the colon has been inflamed. Because of that, surveillance colonoscopy is timed to catch dysplasia early, before cancer develops.

The best statement reflects starting surveillance after about 8–10 years of disease and then repeating every 1–2 years, with the interval adjusted based on individual risk factors (such as extent of disease, presence of PSC, prior dysplasia, or a strong family history). This approach balances catching early changes with avoiding unnecessary procedures.

Surveillance is not contingent on symptoms alone, since cancer risk can be present even when the patient feels fine. Starting at diagnosis and yearly surveillance would be unnecessarily aggressive for most patients, and surveillance solely because of a family history ignores the broader risk from chronic inflammation.