Optimizing the quality of colorectal cancer screening worldwide
Abstract
Screening, followed by colonoscopic polypectomy (or surgery for malignant lesions), prevents incident colorectal cancer and mortality. However, there are variations in effective application of nearly every aspect of the screening process. Screening is a multistep process, and failure in any single step could result in unnecessary morbidity and mortality. Awareness of variations in operator- and system-dependent performance has led to detailed, comprehensive recommendations in the United States and Europe on how colonoscopy screening should be performed and measured. Likewise, guidance has been provided on quality assurance for nonprimary colonoscopy-based screening programs, including strategies to maximize adherence. Quality improvement is now a validated science, and there is clear evidence that higher quality prevents incident cancer and cancer death. Quality must be addressed at the levels of the system, provider, and individuals, to maximize the benefits of screening for any population. We review the important aspects of measuring and improving the quality of colorectal cancer screening.
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Certain causes of diagnostic errors are directly linked to the behavior of the MD during the procedure.
“Nonetheless, certain causes are directly linked to the behavior of the MD during the procedure [7 , 8] .”
From Enhancing human-AI collaboration: The case of colonoscopy (2024) · cites this paper as [7]
Colonoscopy remains susceptible to errors, prompting significant efforts to reduce them.
“However, the procedure remains susceptible to errors, prompting significant efforts to reduce them [7 , 8] .”
From Enhancing human-AI collaboration: The case of colonoscopy (2024) · cites this paper as [7]
Over-alternation bias may contribute to observed increase in misses following detecting the first polyp during a colonoscopy.
“This tendency may contribute to the observed increase in misses following detecting the first polyp during a colonoscopy [7 , 27-29] .”
From Enhancing human-AI collaboration: The case of colonoscopy (2024) · cites this paper as [7]
The ‘How to optimize lesion detection?’ section discusses adenoma detection rates, and the Journal Pre-proof passages discuss factors associated with missed adenomas. Searches for over-alternation bias, the first polyp, and misses after an initial detection found no passage addressing that proposed connection. (LLM, conf=0.72)
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Cites
Adenoma detection rate and risk of colorectal cancer and death
Corley, D. A., Jensen, C. D., Marks, A. R., Zhao, W. K., Lee, J. K., Doubeni, C. A., Zauber, A. G., de Boer, J., Fireman, B. H., Schottinger, J. E., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1309086 · Cited by 2,270 · see citing works
Zorzi, M., Fedeli, U., Schievano, E., Bovo, E., Guzzinati, S., Baracco, S., Fedato, C., Saugo, M., & Dei Tos, A. P. (2015) · Gut · doi:10.1136/gutjnl-2014-307508 · Cited by 302 · see citing works
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Research works printed but not linked: 15
- [1]1. von Karsa L, Patnick J, Segnan N, et al. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013;45:51-9.
- [2]2. Rex DK, Bond JH, Winawer S, et al. Quality in the technical performance of colonoscopy and the continuous quality improvement process for colonoscopy: recommendations of the U.S. Multi-Society Task Force on Colorectal Cancer. Am J Gastroenterol 2002;97:1296-308.
- [3]3. Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Am J Gastroenterol 2006;101:873-85.
- [4]4. Rex DK, Schoenfeld PS, Cohen J, et al. Quality indicators for colonoscopy. Gastrointest Endosc 2015;81:31-53.
- [5]5. Kaminski MF, Thomas-Gibson S, Bugajski M, et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 2017;5:309-334.
- [6]6. Robertson DJ, Lee JK, Boland CR, et al. Recommendations on Fecal Immunochemical Testing to Screen for Colorectal Neoplasia: A Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017;152:1217-1237.e3.
- [7]7. Libby G, Brewster DH, McClements PL, et al. The impact of population-based faecal occult blood test screening on colorectal cancer mortality: a matched cohort study. Br J Cancer 2012;107:255-9.
- [9]9. Fedeli U, Zorzi M, Urso ED, et al. Impact of fecal immunochemical test-based screening programs on proximal and distal colorectal cancer surgery rates: A natural multiple-baseline experiment. Cancer 2015;121:3982-9.
- [10]10. White A, Thompson TD, White MC, et al. Cancer Screening Test Use - United States, 2015. MMWR Morb Mortal Wkly Rep 2017;66:201-206.
- [11]11. May FP, Yano EM, Provenzale D, et al. The Association Between Primary Source of Healthcare Coverage and Colorectal Cancer Screening Among US Veterans. Dig Dis Sci 2017;62:1923-1932.
- [12]12. Gellad ZF, Provenzale D. Colorectal cancer: national and international perspective on the burden of disease and public health impact. Gastroenterology 2010;138:2177-90.
- [13]13. Doubeni CA, Fedewa SA, Levin TR, et al. Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death. Gastroenterology 2019;156:63-74.e6.
- [14]14. Breen N, Lewis DR, Gibson JT, et al. Assessing disparities in colorectal cancer mortality by socioeconomic status using new tools: health disparities calculator and socioeconomic quintiles. Cancer Causes Control 2017;28:117-125.
- [15]15. Meester RG, Doubeni CA, Zauber AG, et al. Public health impact of achieving 80% colorectal cancer screening rates in the United States by 2018. Cancer 2015;121:22815.
- [16]16. Honein-AbouHaidar GN, Kastner M, Vuong V, et al. Systematic Review and Metastudy Synthesis of Qualitative Studies Evaluating Facilitators and Barriers to Participation in Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2016;25:907-17.
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Liu, N.-N., Jiao, N., Tan, J.-C., Wang, Z., Wu, D., Wang, A.-J., Chen, J., Tao, L., Zhou, C., Fang, W., et al. (2022) · Nature Microbiology · doi:10.1038/s41564-021-01030-7 · Cited by 306 · see citing works
Xin, Y., Chu, T., Wang, J., & Xu, A. (2022) · BMC Anesthesiology · doi:10.1186/s12871-022-01805-3 · Cited by 45 · see citing works
Colorectal Cancer Screening in a Changing World
Bresalier, R. S. (2022) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2022.05.002 · Cited by 29 · see citing works
Enhancing human-AI collaboration: The case of colonoscopy
Introzzi, L., Zonca, J., Cabitza, F., Cherubini, P., & Reverberi, C. (2024) · Digestive and Liver Disease · doi:10.1016/j.dld.2023.10.018 · Cited by 28 · see citing works
- Authors
- Kaminski, M. F., Robertson, D. J., Senore, C., & Rex, D. K.
- Affiliations
- University of Oslo (NO)
- Dartmouth College (US)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- Indiana University Hospital (US)
- Corresponding author
- Rex, Douglas K.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 158
- Issue
- 2
- Pages
- 404-417
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2991422847
- Cited by
- 171
- References
- 2
- Citations by year
- 2026: 8 · 2025: 21 · 2024: 34 · 2023: 32 · 2022: 40 · 2021: 26 · 2020: 9
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- Boston Scientific Corporation
- Olympus
- Braintree Laboratories
- Aerie Pharmaceuticals
- Medtronic
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Keywords
- colorectal cancer screening, colonoscopy, quality improvement, quality assurance, colonoscopic polypectomy, screening adherence, cancer prevention, quality measurement
- MeSH terms
- Global Burden of Disease, Colonoscopy, Humans, Mass Screening, Quality of Health Care, Global Health, Colorectal Neoplasms, Incidence, Practice Guidelines as Topic, Early Detection of Cancer
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