# Quality indicators for colonoscopy and the risk of interval cancer

Source: https://onco.cc/key-papers/paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010/  
OnCo record `paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Patients examined by endoscopists who find adenomas in fewer than one in five people are around ten times more likely to develop a cancer before their next scheduled test. Who does the colonoscopy matters as much as whether it is done.

## Summary

Kaminski, Regula, Kraszewska and colleagues used a multivariate Cox model to test whether colonoscopy quality indicators predict interval cancer, using data from 186 endoscopists in a colonoscopy-based screening programme covering 45,026 people. Interval cancer was defined as a colorectal adenocarcinoma diagnosed between the screening colonoscopy and the scheduled surveillance colonoscopy; quality indicators came from the programme database and interval cancers from cancer registries.

Forty-two interval colorectal cancers were identified over 188,788 person-years. The adenoma detection rate predicted them; the caecal intubation rate did not.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: colorectal-evidence
- Journal: New England Journal of Medicine
- Year: 2010
- DOI: 10.1056/NEJMoa0907667
- Authors: Kaminski MF, Regula J, Kraszewska E, et al.
- Findings: 42 interval colorectal cancers over 188,788 person-years across 186 endoscopists.; Adenoma detection rate was significantly associated with interval cancer risk (p=0.008); caecal intubation rate was not (p=0.50).; Against a detection rate of 20 percent or higher, hazard ratios were 10.94 (95 percent CI 1.37 to 87.01) for rates under 11 percent, 10.75 (1.36 to 85.06) for 11 to 14.9 percent and 12.50 (1.51 to 103.43) for 15 to 19.9 percent.
- What it means: The paper that made the adenoma detection rate the central quality measure of every screening endoscopy service, and the reason endoscopist-level auditing is a condition of accreditation.
- Caveats: 42 events give very wide confidence intervals; the size of the effect is uncertain even though its direction is not.; Observational: endoscopists with low detection rates may differ in other ways.; Detection rates have risen since 2010, so the modern gradient is shallower.

## Sources

- N Engl J Med 2010: https://doi.org/10.1056/NEJMoa0907667
- PubMed: https://pubmed.ncbi.nlm.nih.gov/20463339/

## Connected records

- key papers: [Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths (National Polyp Study)](https://onco.cc/key-papers/paper-zauber-national-polyp-study-colonoscopic-polypectomy-nejm-2012/), [Effect of colonoscopy screening on risks of colorectal cancer and related death (NordICC)](https://onco.cc/key-papers/paper-bretthauer-nordicc-colonoscopy-screening-nejm-2022/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- terms: [Colonoscopy](https://onco.cc/terms/colonoscopy/), [Endoscopy (EGD, EUS, ERCP)](https://onco.cc/terms/endoscopy/)
- technologies: [AI polyp detection in colonoscopy](https://onco.cc/technologies/ai-endoscopy-detection/), [Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)](https://onco.cc/technologies/colorectal-screening/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Not enough oncologists, nurses, pathologists, physicists](https://onco.cc/bottlenecks/b-workforce/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/)
- ideas: [Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model](https://onco.cc/ideas/idea-crc-screening-uptake-and-age-extension/), [UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set](https://onco.cc/ideas/idea-crc-uk-colonoscopy-capacity-and-fit-threshold/)

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