Effectiveness of Colonoscopy Screening for Colorectal Cancer
Effectiveness of Colonoscopy Screening for Colorectal Cancer
Screening for colorectal cancer has been proven to be effective in reducing colorectal cancer incidence and mortality. While the precise benefit of screening exclusively by colonoscopy is not yet known, unarguably, the exam is central to the success of any screening programme. The test affords the opportunity to detect and resect neoplasia across the entire large bowel and is the definitive examination when other screening tests are positive. However, colonoscopy is invasive and often requires sedation as well as extensive bowel preparation, all of which puts the patient at risk. Furthermore, the test can technically be demanding and, unarguably, there is variation in how it is performed. This variation in performance has now been definitively linked to important outcome measures. For example, interval cancers are more common in low adenoma detectors as compared with high adenoma detectors. This review outlines the most current thinking regarding the effectiveness of colonoscopy as a screening tool. It also outlines key concepts to optimise its performance through robust quality assurance programmes and high-quality training.
Colonoscopy is the gold standard examination tool for the colon and rectum. It is capable of both detection and removal of neoplasia during a single examination. It aims at examining the entire colon, as opposed to flexible sigmoidoscopy which only covers the distal part. However, colonoscopy is difficult to learn, it is invasive and resource-demanding, uncomfortable and requires extensive bowel preparation for patients. There is large interendoscopist variability in quality of performance, and there is uncertainty with regard to the magnitude of the effect of colonoscopy screening on colorectal cancer (CRC) incidence and mortality. This review outlines the state-of-the-art of effectiveness, training and quality assurance of colonoscopy screening for CRC and highlights ongoing research and future perspectives.
Abstract and Introduction
Abstract
Screening for colorectal cancer has been proven to be effective in reducing colorectal cancer incidence and mortality. While the precise benefit of screening exclusively by colonoscopy is not yet known, unarguably, the exam is central to the success of any screening programme. The test affords the opportunity to detect and resect neoplasia across the entire large bowel and is the definitive examination when other screening tests are positive. However, colonoscopy is invasive and often requires sedation as well as extensive bowel preparation, all of which puts the patient at risk. Furthermore, the test can technically be demanding and, unarguably, there is variation in how it is performed. This variation in performance has now been definitively linked to important outcome measures. For example, interval cancers are more common in low adenoma detectors as compared with high adenoma detectors. This review outlines the most current thinking regarding the effectiveness of colonoscopy as a screening tool. It also outlines key concepts to optimise its performance through robust quality assurance programmes and high-quality training.
Introduction
Colonoscopy is the gold standard examination tool for the colon and rectum. It is capable of both detection and removal of neoplasia during a single examination. It aims at examining the entire colon, as opposed to flexible sigmoidoscopy which only covers the distal part. However, colonoscopy is difficult to learn, it is invasive and resource-demanding, uncomfortable and requires extensive bowel preparation for patients. There is large interendoscopist variability in quality of performance, and there is uncertainty with regard to the magnitude of the effect of colonoscopy screening on colorectal cancer (CRC) incidence and mortality. This review outlines the state-of-the-art of effectiveness, training and quality assurance of colonoscopy screening for CRC and highlights ongoing research and future perspectives.
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