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Effectiveness, training and quality assurance of colonoscopy screening for colorectal cancer
  1. Douglas J Robertson1,2,
  2. Michal F Kaminski3,4,5,
  3. Michael Bretthauer5,6
  1. 1VA Medical Center, White River Junction, Vermont, USA
  2. 2Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
  3. 3Department of Gastroenterology and Hepatology, Medical Center for Postgraduate Education, Warsaw, Poland
  4. 4Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
  5. 5Institute of Health and Society, University of Oslo, Oslo, Norway
  6. 6Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Douglas J Robertson, Department of Gastroenterology, VA Medical Center, 215 M Main Street/Gastroenterology (111E), White River Junction, Vermont 05009, USA; douglas.robertson{at}


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.


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