Despite being largely preventable, colorectal cancer (CRC) remains the second leading cause of cancer death in the United States, highlighting gaps between screening recommendations and real-world implementation.
In a commentary on Medscape, Alicia H. Muratore emphasizes that while colonoscopy remains a cornerstone of prevention, reducing CRC mortality requires greater focus on screening participation, quality metrics, and broader risk reduction strategies.
Screening Works — But Participation Matters
Long-term studies show that colonoscopy with high-quality polypectomy can reduce CRC mortality by 60–70%. However, the effectiveness of screening programs depends heavily on patient participation and follow-through, as highlighted by results from the NordICC Trial.
In response to rising early-onset CRC, the United States Preventive Services Task Force lowered the recommended starting age for screening from 50 to 45 years in 2021. But guideline changes alone are not enough—successful prevention requires consistent implementation.
Quality Measures Matter
Gastroenterologists play a critical role in prevention through quality improvement in colonoscopy practices.
One key metric is the adenoma detection rate (ADR). Evidence shows that every 1% increase in ADR is associated with roughly a 3% reduction in colorectal cancer risk, making quality improvement in endoscopy directly tied to patient outcomes.