Prevention of interval colorectal cancers: what every clinician needs to know

Colonoscopic screening and surveillance have been very effective tools in the fight against colorectal cancer (CRC). Colonoscopy is more than a cancer screening test; it also can prevent CRC by detecting and removing precancerous lesions. Despite this potential, there has been increasing concern about CRCs that occur after a previous colonoscopy and before the next screening/surveillance examination (interval CRCs). The etiology of interval CRC is thought to be caused mostly by missed or incompletely resected lesions on index colonoscopy with some contribution of rapidly progressive new lesions. If this is true, many interval cancers should be preventable by improving colonoscopy technique. There are a variety of strategies to decrease interval CRC rates including use of a split-dosed bowel preparation, optimizing withdrawal technique, ensuring complete polypectomy, and careful pathologic examination of the tissue removed. Furthermore, there should be an increased emphasis on how endoscopists are trained to cultivate high-quality technique throughout their careers. It is important to inform patients that even high-quality colonoscopy is not perfectly sensitive for the detection of advanced neoplasia. Improving colonoscopy quality can decrease interval CRC rates and further decrease CRC incidence and mortality.