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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.
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.
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.
Colonoscopy screening works, but the effect a health system gets is the effect of the invitation, not of the procedure; uptake, not test performance, is the binding constraint, and this is the trial that made that argument unavoidable.
The clinical proof of Vogelstein's sequence: interrupting the adenoma-carcinoma pathway with a snare prevents the cancer, which is why colonoscopy is the only screening test that both detects and prevents.
Shares UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set, Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late and the tag colorectal-evidence.
Shares Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late and the tag colorectal-evidence.
Shares Effect of colonoscopy screening on risks of colorectal cancer and related death (NordICC), Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late and the tag colorectal-evidence.
Shares Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, 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 and the tag colorectal-evidence.
Shares Colonoscopy, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Fragmented care and guideline gaps, The hardest cancers are found late and the tag colorectal-evidence.
Shares Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, 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 and the tag colorectal-evidence.
Shares Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths (National Polyp Study), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, 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 and the tag colorectal-evidence.
Shares Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late, 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, Colorectal cancer and the tag colorectal-evidence.