Optimizing the Quality of Colorectal Cancer Screening Worldwide

Gastroenterology. 2020 Jan;158(2):404-417. doi: 10.1053/j.gastro.2019.11.026. Epub 2019 Nov 20.


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.

Keywords: Colonoscopy; Colorectal Cancer; Colorectal Polyp; Fecal Immunochemical Test.

Publication types

  • Review

MeSH terms

  • Colonoscopy / standards
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / epidemiology
  • Colorectal Neoplasms / prevention & control*
  • Early Detection of Cancer / standards*
  • Global Burden of Disease
  • Global Health / standards*
  • Humans
  • Incidence
  • Mass Screening / organization & administration
  • Mass Screening / standards*
  • Practice Guidelines as Topic
  • Quality of Health Care / standards*