title: The big picture: does colonoscopy work?
abstract: Colonoscopy for average-risk colorectal cancer screening has transformed the practice of gastrointestinal medicine in the United States. However, although the dominant screening strategy, its use is not supported by randomized controlled trials. Observational data do support a protective effect of colonoscopy and polypectomy on colorectal cancer incidence and mortality, but the level of protection in the proximal colon is variable and operator-dependent. Colonoscopy by high-level detectors remains highly effective, and ongoing quality improvement initiatives should consider regulatory factors that motivate changes in physician behavior.
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia; Department of Gastroenterology, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD 4108, Australia. Electronic address: d.hewett@uq.edu.au.
authors.forename: David G
authors.initials: DG
authors.lastname: Hewett
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, 550 North University Boulevard, Indiana University Hospital #4100, Indianapolis, IN 46202, USA.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Rex
mesh_terms: D003106:Colon / Q000473:pathology*; D003113:Colonoscopy / Q000379:methods* / Q000639:trends; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods* / Q000639:trends; D006801:Humans
keywords: Adenoma detection; Colonoscopy; Colorectal cancer; Colorectal cancer screening; Interval cancer