A systematic review of 11 studies including 5,912 patients found that advanced neoplasia risk at a second surveillance colonoscopy depends on both baseline and first-surveillance findings, with rates ranging from about 4–5% in consistently low-risk groups to over 26% in those with persistently high-risk findings. For example, patients with baseline advanced neoplasia followed by advanced findings at first surveillance had a 26.1% prevalence at second surveillance, while those with no adenomas at both prior exams had only 4%. These results generally support 2020 USMSTF recommendations but suggest certain groups—such as those with baseline non-advanced followed by non-advanced adenomas (9.1%) or baseline advanced followed by non-advanced adenomas (12.8%)—may merit reconsideration of current surveillance intervals. Overall, incorporating results from both prior time points allows more refined risk stratification, supporting longer intervals for consistently low-risk patients and closer follow-up for those with persistently high-risk findings.