A large Dutch study of over 239,000 individuals in a colorectal cancer (CRC) screening program found that endoscopist performance—measured by adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSPDR)—is more predictive of post-colonoscopy CRC (PCCRC) risk than the presence of high-risk polyps.
High-risk polyps (≥10 mm, high-grade dysplasia, or multiple adenomas) did not correlate with higher short-term cancer risk. Instead, each 1% increase in ADR reduced PCCRC risk by 6%, and each 1% increase in PSPDR by 8%. Patients with low-risk polyps but examined by low-performing endoscopists had twice the cancer risk compared to those with high-risk polyps examined by high-performing endoscopists.