OBJECTIVES: Assess the frequency and appropriateness of early repeated colonoscopy  METHODS: Patients undergoing a colonoscopy in 2005 were identified using paid claims data from a nationwide privately insured population.  Patients were screened to be between the ages of 50 and 64 years with at least one year continuous enrollment.  Colonoscopies with evidence of positive results [e.g., paid claims for biopsy, fulguration, snare, etc.], or with evidence suggesting clinical indications three months prior to the screening were defined as non-screen tests. The cumulative probability of repeated screening colonoscopy was then documented and the related risk factors for appropriate and inappropriate repeat screening tests were assessed using survival analysis and Cox proportional hazard regression models. RESULTS: A total of 51,400 colonoscopies were identified from the paid claims in 2005 for patients age 50-64.  The majority of these procedures were found to have either positive results [25,029 (48.7%)] or evidence of clinical indications for the procedure [17,842 (34.7%)]. Among 8,529 apparent screening colonoscopies with negative results, 8% had a repeated colonoscopy within six years, the majority of which were associated with evidence that the repeated test could be justified (78.7% with indications and 21.3% without indications). The initial regression analysis identified risk factors of repeated colonoscopy with indications including age over 55 (HR: 1.2; 95%CI: 1.0 – 1.5) and having at least one comorbidity (HR: 1.2; 95%CI: 1.0-1.5). The risk factors of repeated colonoscopy without indications include male (HR: 1.53; 95%CI: 1.07-2.20) and having at least one comorbidity (HR: 1.57; 95%CI: 1.04-2.31). CONCLUSIONS: The majority of all colonoscopies in 2005 were found not to be routine screening exams. The risk of a repeated screening colonoscopy within 6 years is low [8%]. Among these repeat procedures, the majority was done because of the existence of clinical indications.