Can we improve adenoma detection rates? A systematic review of intervention studies

Abstract

Optimizing the effectiveness of colonoscopy has substantial potential for decreasing colorectal cancer mortality, regardless of the initial screening modality. Colorectal cancer is the third most common cancer diagnosed and the second leading cause of cancer deaths in the United States. 1 Jemal A. Siegel R. Ward E. et al. Cancer statistics, 2009. CA Cancer J Clin. 2009; 59: 225-249 Crossref PubMed Scopus (9825) Google Scholar Colorectal cancer screening can reduce mortality through the detection of early-stage adenocarcinomas and the removal of precursor adenomatous polyps. 2 Levin B. Lieberman D.A. McFarland B. et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008; 58: 130-160 Crossref PubMed Scopus (1361) Google Scholar Colonoscopy is either the primary screening method or a follow-up modality for all colorectal cancer screening programs (eg, abnormal fecal blood test results and sigmoidoscopic examinations). 3 Lin O.S. Kozarek R.A. Schembre D.B. et al. Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy. JAMA. 2006; 295: 2357-2365 Crossref PubMed Scopus (138) Google Scholar , 4 Regula J. Rupinski M. Kraszewska E. et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med. 2006; 355: 1863-1872 Crossref PubMed Scopus (691) Google Scholar , 5 Schoenfeld P. Cash B. Flood A. et al. Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med. 2005; 352: 2061-2068 Crossref PubMed Scopus (420) Google Scholar , 6 Strul H. Kariv R. Leshno M. et al. The prevalence rate and anatomic location of colorectal adenoma and cancer detected by colonoscopy in average-risk individuals aged 40-80 years. Am J Gastroenterol. 2006; 101: 255-262 Crossref PubMed Scopus (156) Google Scholar Its resultant widespread use makes it one of the most commonly performed medical procedures in the United States. 7 Seeff L.C. Richards T.B. Shapiro J.A. et al. How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. Gastroenterology. 2004; 127: 1670-1677 Abstract Full Text Full Text PDF PubMed Scopus (364) Google Scholar