Adenoma detection rate and colorectal cancer risk in fecal immunochemical test screening programs

The benefit of FIT screening programs depends on the identification of neoplasia at colonoscopy after a positive FIT. A retrospective population-based study in the Veneto region (Northeast Italy) investigated the association of adenoma detection rate (ADR) of endoscopists and risk of postcolonoscopy colorectal cancer (PCCRC). The study included 49,626 colonoscopies done by 113 endoscopists. Mean ADR was 48.3% (range 23-70). After 328,778 person-years follow-up, 277 PCCRC cases were diagnosed. Incidence rates of PCCRC in groups with endoscopist ADR 20%-39.9%, 40%-44.9%, 45%-49.9%, 50%-54.9%, and 55%-70% were 13.13, 10.61, 7.60, 6.01, and 5.78 per 10,000 person years. The adjusted HR for PCCRC associated with 1% increase in ADR was 0.96 (95% CI 0.95-0.98).