Colorectal cancer screening by colonoscopy: putting it into perspective

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Nationwide colorectal cancer (CRC) screening programs aim to reduce disease burden.
• Colonoscopy is a primary CRC screening method, with observational studies supporting its effectiveness in reducing CRC incidence and mortality.
• Despite screening and surveillance, interval CRCs, often right-sided, still occur, potentially due to operator-dependent factors.

Purpose of the Study:

• To evaluate the effectiveness of colonoscopy in CRC screening and surveillance.
• To explore strategies for improving colonoscopy quality and polyp detection rates.
• To address the occurrence of interval CRCs and the 'high-detection paradox'.

Main Methods:

• Review of observational studies on colonoscopy effectiveness for CRC screening.
• Discussion of quality indicators and advanced colonoscopy techniques.
• Analysis of factors contributing to interval CRC and the implications of high polyp detection rates.

Main Results:

• Colonoscopy is suggested to effectively reduce CRC incidence and mortality, with ongoing randomized trials.
• Quality indicators and advanced techniques aim to improve colonoscopy performance and reduce interval CRCs.
• High polyp detection rates lead to increased surveillance, termed the 'high-detection paradox'.

Conclusions:

• High-quality colonoscopy is vital for effective CRC screening and surveillance.
• Further research is needed on the cost-effectiveness of high-quality colonoscopy and risk-stratified surveillance intervals.
• Optimizing colonoscopy techniques and quality indicators may help minimize interval CRCs.