Colorectal cancer prevention rates achieved by high quality colonoscopy screening

What is it about?

This paper presents the proportion of colorectal cancers that were prevented among screening eligible persons by a high-quality colonoscopy procedure. Not all colonoscopies are created equal. Some providers complete it too rapidly; as a result, pre-cancerous polyps are left behind to grow into cancer while the person has a false sense of assurance that they were screened and all is well. The adenoma detection rate is very important; on average, what percent of screened persons by a provider were found to have an adenomatous polyp? This varies widely from 10% to 30%, the higher range is when the doctor took the time and technique to go over all inner surfaces of the large intestine thoroughly to look for polyps. On average the higher it is, the better. Second the doctor should also complete a thorough removal of the new growth tissue, called a complete polypectomy. We studied over 15,000 persons who had a screening done at a colonoscopy center in South Carolina which had a 29.7% adenoma detection rate, a procedure protocol that enables thorough polyp removal. We found that in this group of persons, over 4.8 years of follow-up, their rate of colorectal cancer was only one sixth the rate of the general population, adjusted for age and sex. Their death rate from colorectal cancer was only a tenth of the general population. This confirms that we can truly prevent colorectal cancer almost fully by properly performed colonoscopies, once every 10 years, starting at 50 years of age.

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Why is it important?

Our study is unique because almost every study of colonoscopy groups has shown poor colorectal cancer prevention rates, ranging from 54% (the best) to 28% the poorest. The studies did not report the adenoma detection rates of the physicians who performed those procedures. Because of the mediocre colorectal cancer prevention achieved by sub-par colonoscopies, the medical profession and the population have lost confidence in the power of colonoscopy screening. Our study shows that if performed thoroughly, taking the time it needs and with additional supportive tech personnel, we can make almost 90% of colorectal cancer a thing of the past.

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